Albuterol Dosing by Weight
For children with asthma, the recommended albuterol dose is 0.15 mg/kg (minimum dose 2.5 mg) via nebulizer or 4-8 puffs via MDI every 20 minutes for 3 doses during exacerbations. 1
Pediatric Dosing
Intermittent Nebulizer Treatment
- Standard dosing: 0.15-0.30 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
- Dilution requirement: Dilute in minimum 2-3 mL of saline for adequate nebulization 2
- For children <15 kg: Use 0.5% solution instead of 0.083% solution when doses less than 2.5 mg are required 3
Continuous Nebulization
- Standard dosing: 0.5 mg/kg per hour up to 10-15 mg/hour 2, 1
- Dilution: Use larger volume of saline (typically 25-30 mL for 1 hour of nebulization) 2
Metered-Dose Inhaler (MDI)
- Acute exacerbation: 4-8 puffs (90 mcg/puff) every 15-20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
- Important: A spacer/holding chamber must be used when administering MDI treatments 2
Adult Dosing
Nebulizer Treatment
- Standard dosing: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed 1
- For severe exacerbations: Continuous nebulization at 10-15 mg/hour 1
Metered-Dose Inhaler (MDI)
- Acute exacerbation: 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
Administration Considerations
Nebulizer Administration
- Treatment should take 5-10 minutes and continue until "spluttering" occurs plus one additional minute 1
- Oxygen is the preferred gas source for nebulization, especially in severe exacerbations 2, 1
- For children under 4 years, use a face mask that fits snugly over both nose and mouth 1
Response Assessment
- Evaluate response after 3 doses (60-90 minutes after initiation) 1
- Monitor respiratory rate, work of breathing, and oxygen saturation 1
- If symptoms persist despite appropriate albuterol dosing, consider adding ipratropium bromide 1
Special Considerations
Levalbuterol Alternative
- Levalbuterol (R-albuterol) can be administered at half the mg dose of racemic albuterol 2, 1
- Studies show levalbuterol 0.31 mg is clinically comparable to 1.25 mg of racemic albuterol with a more favorable safety profile 4
Safety Considerations
- The threshold dose for toxicity in unintentional ingestion is approximately 1 mg/kg 5
- Signs of toxicity include tachycardia, widened pulse pressure, hyperglycemia, agitation, and hypokalemia 5
- Monitor for cardiac effects (tachycardia) and electrolyte disturbances (hypokalemia) with high doses 6
Dosing Efficacy
- Recent research suggests no significant difference in hospital length of stay or duration of continuous albuterol therapy among different weight-based doses ranging from 0.07-3.2 mg/kg/h 7
- High-dose continuous albuterol (up to 3.7 mg/kg/hr) has been used in status asthmaticus with low rates of mechanical ventilation and without significant toxicity 6
Common Pitfalls and Caveats
- Underdosing during acute exacerbations can lead to inadequate bronchodilation
- Failure to use a spacer with MDI significantly reduces drug delivery
- Inadequate dilution of nebulizer solution can result in poor aerosol generation
- Continuous monitoring is essential for patients receiving high doses or continuous nebulization
- For elderly patients, monitor for potential precipitation of angina with β-agonist use 1