Pediatric Albuterol Inhaler Dosing
The recommended albuterol metered-dose inhaler (MDI) dose for pediatric patients is 4-8 puffs (90 mcg per puff) every 15-20 minutes for 3 doses, then every 1-4 hours as needed, with a spacer/holding chamber required for all administrations. 1
Age-Based Dosing Guidelines
Children 4-12 Years:
- MDI with spacer: 4-8 puffs every 15-20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
- Nebulizer: 2.5 mg (0.5 mL of 0.5% solution) every 20 minutes for 3 doses, then 0.15-0.30 mg/kg up to 10 mg every 1-4 hours as needed 2
Children Under 4 Years:
- MDI with spacer and mask: 4-8 puffs every 20 minutes for 3 doses 1
- Nebulizer: 2.5 mg for children ≥15 kg; for children <15 kg, use 0.5% solution at 0.15 mg/kg 3
Weight-Based Considerations:
- Children <15 kg: Use 0.5% solution (0.15 mg/kg) rather than fixed 2.5 mg dose 3
- Children 15-25 kg: 2.5 mg via nebulizer or 6 puffs via MDI 4
- Children >25 kg: 2.5 mg via nebulizer or 8-12 puffs via MDI 4
Administration Techniques
MDI Administration:
- Always use a spacer/holding chamber with MDI for all pediatric patients 2, 1
- For young children (<4 years), use a face mask that fits snugly over both nose and mouth 1
- Ensure the child is breathing normally during administration 1
- Allow 30-60 seconds between puffs for optimal lung deposition
Nebulizer Administration:
- Use oxygen as the preferred gas source for nebulization 2, 1
- Dilute albuterol in a minimum of 2-3 mL of saline solution for adequate nebulization 2
- Typical nebulization time is approximately 5-15 minutes 3
Safety Considerations
- Monitor for tachycardia, which is the most common dose-limiting side effect 1, 5
- Watch for tremors, hypokalemia, and hyperglycemia with high or frequent dosing 5
- Higher doses (up to 18 puffs based on weight) have been studied and shown to be safe but did not demonstrate additional clinical benefit over standard dosing 4
Continuous Nebulization for Severe Exacerbations
- For severe exacerbations: 0.5 mg/kg/hour up to 10-15 mg/hour via continuous nebulization 2
- Dilute in larger volume of saline (25-30 mL for 1 hour of nebulization) 2
- Continuous cardiac monitoring is recommended for patients receiving continuous nebulization 5
Alternative Formulations
- Levalbuterol (R-albuterol) can be used at half the dose of racemic albuterol with similar efficacy 2, 1
Treatment Response
- Most patients show improvement in pulmonary function within 5 minutes of administration 3
- Peak effect typically occurs at approximately 1 hour and may last 3-6 hours 3
- If a previously effective dosage regimen fails to provide relief, seek immediate medical attention as this may indicate worsening asthma requiring reassessment 3
Remember that proper delivery technique is crucial for effective treatment, particularly in young children. The spacer/holding chamber is not optional but required for all MDI administrations in pediatric patients.