What is the recommended dose of salbutamol (Metered-Dose Inhaler (MDI)) for pediatric patients with acute asthma symptoms?

Pediatric Salbutamol MDI Dosing for Acute Asthma

For pediatric patients with acute asthma symptoms, the recommended dose of salbutamol via MDI is 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed. 1

Dosing Guidelines by Age

• Children 4 years and older: 4-8 puffs via MDI with valved holding chamber (spacer) every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2
• Adults: Same dosing as children 4 years and older

Administration Technique

• Always use a valved holding chamber (spacer) with MDI for pediatric patients to improve drug delivery
• Prime the inhaler before first use and when not used for more than 2 weeks by releasing four "test sprays" into the air 2
• Ensure proper technique: shake inhaler well before each use, exhale fully, place mouthpiece in mouth with tight seal, actuate during slow deep inhalation, hold breath for 10 seconds

Severity-Based Treatment Algorithm

Mild-to-Moderate Exacerbation

1. Initial treatment: 4-8 puffs salbutamol MDI with spacer every 20 minutes for up to 3 doses 1
2. Monitor response: symptoms, work of breathing, oxygen saturation
3. If improving: Continue treatment every 1-4 hours as needed
4. If not improving: Escalate to severe exacerbation protocol

Severe Exacerbation

1. Consider nebulized therapy (0.15 mg/kg, minimum 2.5 mg) every 20 minutes for 3 doses 1
2. Add ipratropium bromide via MDI or nebulizer
3. Add oral systemic corticosteroids
4. Consider hospital admission if no improvement

Efficacy Considerations

Multiple studies have demonstrated that salbutamol delivered via MDI with spacer is as effective as nebulized therapy for mild to moderate asthma exacerbations in children 3, 4, 5. This delivery method offers several advantages:

• Equivalent bronchodilation when used correctly
• Faster administration time
• Lower risk of contamination
• More cost-effective
• Easier to use at home

Important Monitoring Parameters

• Clinical response (respiratory rate, work of breathing, oxygen saturation)
• Heart rate (monitor for tachycardia as side effect)
• Tremor and palpitations (common side effects reported in 5.5-11.1% of patients) 3

Cautions and Pitfalls

• Proper spacer technique is crucial: Efficacy depends on correct administration technique
• Clean spacer regularly: Medication buildup can block delivery 2
• Watch for tachycardia: Beta-agonists can cause significant increase in heart rate
• Failure to respond: If previously effective dose regimen fails to provide usual response, this may indicate worsening asthma requiring reassessment and possible addition of anti-inflammatory treatment 2
• Avoid overuse: More frequent administration or larger number of inhalations than recommended is not advised 2

Prevention of Exercise-Induced Bronchospasm

For prevention of exercise-induced bronchospasm, administer 2 puffs via MDI 15-30 minutes before exercise 2