Recommended Albuterol Dosing for Acute Asthma Exacerbations
For acute asthma exacerbations, adults should receive 2.5 mg of albuterol administered via nebulizer three to four times daily, while children should receive weight-based dosing of 0.15 mg/kg per dose (minimum 2.5 mg). 1, 2
Adult Dosing
Nebulizer Administration
- Standard dose: 2.5 mg (one vial of 0.083% solution) administered 3-4 times daily 2
- For severe exacerbations: Can be administered every 20 minutes for 3 doses in the first hour, then every 40 minutes for additional doses as needed 3
- Continuous nebulization option: 2.5 mg/hour for standard dosing has shown good efficacy with fewer side effects than higher doses 4
Metered-Dose Inhaler (MDI) Administration
- MDI with spacer is as effective as nebulization when used properly 5
- Approximately 1/6 of the nebulizer dose is needed with MDI (about 0.4 mg or 4 puffs of 100 mcg/puff) 5
Pediatric Dosing
By Age/Weight
- Children weighing <10 kg: 2 puffs (200 mcg) via MDI with spacer and face mask every 4-6 hours 1
- Children under 5 years: 1-2 puffs (100-200 mcg) every 4-6 hours as needed 1
- Children weighing <15 kg: Should use 0.5% solution instead of 0.083% solution 2
- Weight-based dosing: 0.15 mg/kg per dose (minimum 2.5 mg) 1
Acute Exacerbation Protocol
- MDI with spacer: 2-6 puffs (100 mcg/puff) depending on weight, repeated every 20 minutes for up to 3 doses 1
- Nebulizer: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed 1
- Continuous nebulization for severe cases: 0.5 mg/kg/hour up to 10-15 mg/hour 1
Administration Guidelines
- Always use a spacer/holding chamber with MDI for all pediatric patients 1
- For nebulization, dilute albuterol in 2-3 mL of saline solution (minimum) 1
- For continuous nebulization, dilute in 25-30 mL of saline for 1 hour of treatment 1
- Oxygen is the preferred gas source for nebulization 1
Monitoring and Adverse Effects
- Monitor for tachycardia, tremor, and hypokalemia, especially with repeated dosing 1
- Track respiratory rate, work of breathing, and oxygen saturation 1
- Continuous monitoring is essential for patients receiving high doses or continuous nebulization 1
- Potassium levels may drop with high-dose therapy; monitor accordingly 4
Treatment Failure Considerations
- If no significant improvement after 3 doses (7.5 mg total), consider adding ipratropium bromide 6, 7
- Ipratropium dosing: 0.5 mg via nebulizer or 4-8 puffs via MDI every 20 minutes for 3 doses 1
- Approximately 34% of patients may not respond adequately to albuterol alone and may require hospitalization 7
- Consider systemic corticosteroids (1-2 mg/kg/day, maximum 60 mg/day) for severe exacerbations 1
Clinical Pearls
- Response to albuterol typically follows a dose-response curve, with most patients (65-75%) achieving maximal bronchodilation after two doses 5
- MDI with spacer can be as effective as nebulization when used correctly, requiring about 1/6 of the nebulized dose 5
- Patients with more severe obstruction (FEV1 <30% predicted) and symptoms lasting >24 hours before presentation may benefit most from combination therapy with ipratropium 6
- If a previously effective dosage regimen fails to provide relief, seek immediate medical advice as this often indicates worsening asthma requiring therapy reassessment 2