Albuterol and Fluticasone Dosing for a 25kg Child with Asthma
For a 25kg child with asthma, the recommended albuterol dose is 2.5-3.75mg via nebulizer or 4-8 puffs via MDI every 20 minutes for 3 doses during exacerbations, and fluticasone should be dosed at 88-264 mcg/day (low dose) divided twice daily as controller therapy. 1, 2
Albuterol Dosing
Nebulizer Administration
- Acute exacerbation dosing:
- 0.15 mg/kg (3.75mg for a 25kg child) every 20 minutes for 3 doses
- Then 0.15-0.3 mg/kg (3.75-7.5mg) every 1-4 hours as needed
- Minimum dose: 2.5mg 1
- Continuous nebulization (if needed):
- 0.5 mg/kg/hour (12.5mg/hour for a 25kg child) 2
- Dilute in 25-30mL saline for 1 hour of nebulization
Metered-Dose Inhaler (MDI) Administration
- With valved holding chamber:
- 4-8 puffs (90mcg/puff) every 20 minutes for 3 doses
- Then every 1-4 hours as needed 1
- For children >25kg: 12 puffs may be used during acute exacerbations 3
Fluticasone Dosing
Controller Therapy Dosing
- Low dose: 88-264 mcg/day divided twice daily 2
- Medium dose: 264-660 mcg/day divided twice daily 2
- High dose: >660 mcg/day divided twice daily 2
Administration
- Administer via MDI with valved holding chamber and face mask if child is under 4 years 4
- Twice daily dosing schedule 2
Important Clinical Considerations
Delivery Method Comparison
- MDI with spacer is as effective as nebulized therapy with proper technique and coaching 1
- For acute management, nebulizer may provide slightly better improvement in clinical scores and peak flow compared to MDI with spacer 3
- However, spacer devices are easier to use and more cost-effective 5
Combination Therapy
- For moderate-severe exacerbations, consider adding ipratropium bromide:
Monitoring
- Assess respiratory rate, work of breathing, and oxygen saturation before and after treatment 2
- Increasing use or lack of expected effect indicates diminished asthma control 2
- If symptoms persist despite appropriate albuterol dosing, consider adding systemic corticosteroids at 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 2
Safety Considerations
- Higher doses of albuterol (up to 18 puffs for children >25kg) have been shown to be safe but do not necessarily improve outcomes 6
- No significant differences in safety outcomes (heart rate, serum potassium, glucose levels, EKG) have been observed between standard and higher dosing regimens 6
- For fluticasone, doses of 88mcg twice daily have shown efficacy in reducing asthma exacerbations without clinically relevant systemic effects 4
Remember that proper delivery technique is crucial, especially for young children, with a face mask that fits snugly over both nose and mouth when using a spacer device 2.