Salbutamol MDI Dosage for Children Based on Weight
For children with acute asthma symptoms, salbutamol via MDI with spacer should be administered at 0.15 mg/kg per dose (minimum 2.5 mg), which typically translates to 2-6 puffs (100 mcg/puff) depending on the child's weight, repeated every 20 minutes for up to 3 doses in acute exacerbations. 1
Dosage Guidelines
The American Academy of Pediatrics recommends the following approach for salbutamol (albuterol) administration via MDI for children with acute asthma:
- Weight-based dosing: 0.15 mg/kg per dose (minimum 2.5 mg)
- Practical administration:
- For children <20 kg: 2-4 puffs via MDI with spacer
- For children >20 kg: 4-6 puffs via MDI with spacer
- Frequency during acute exacerbation: Every 20 minutes for 3 doses, then every 1-4 hours as needed 1
Administration Technique
- Always use a spacer/holding chamber with MDI for all pediatric patients to ensure optimal lung deposition 1
- For children under 5 years: Use a spacer with face mask
- For children over 5 years: Use a spacer with mouthpiece when possible
Monitoring and Safety
- Monitor for:
- Clinical response (respiratory rate, work of breathing, oxygen saturation)
- Potential side effects: tachycardia, tremor, and hypokalemia with high doses 1
- If symptoms persist despite appropriate salbutamol dosing, consider:
Efficacy Considerations
Multiple studies have demonstrated that MDI with spacer delivery is as effective as nebulized salbutamol for treating mild to moderate asthma exacerbations in children 2, 3, 4. This approach offers several advantages:
- Equal clinical efficacy to nebulization
- More cost-effective
- More portable and convenient
- Less time-consuming to administer
Common Pitfalls to Avoid
- Not using a spacer device: Always use a spacer with MDI in children to improve drug delivery to the lungs
- Inadequate technique: Ensure proper technique with slow, deep breaths and holding breath for 5-10 seconds when age-appropriate
- Underdosing: Don't hesitate to use the full recommended dose based on weight
- Failing to reassess: Monitor response after each dose and adjust treatment accordingly
- Not considering hospitalization: If no improvement after 3 doses, consider more intensive management
Remember that children with severe attacks may appear distressed and assessment in very young children may be difficult. The presence of life-threatening features (PEF <33% predicted, poor respiratory effort, cyanosis, silent chest, fatigue/exhaustion, or altered consciousness) should prompt immediate intensive management and consideration for transfer to higher level of care 5.