What is the starting dose of albuterol (beta-2 adrenergic receptor agonist) for a female patient with a weight of 141.5 kg (313 pounds)?

Albuterol Inhaler Dosing for a 313-pound Female Patient

The standard starting dose for albuterol metered-dose inhaler (MDI) in a 313-pound (141.5 kg) adult female is 2 puffs (90 mcg/puff) every 4-6 hours as needed, regardless of weight. 1

Dosing Guidelines for Albuterol MDI

Albuterol dosing via MDI is not weight-based for adults. The National Asthma Education and Prevention Program (NAEPP) guidelines recommend:

• Standard dosing: 2 puffs (180 mcg) every 4-6 hours as needed for symptom relief
• During exacerbations: 4-8 puffs every 20 minutes for up to 3 doses, then every 1-4 hours as needed 1
• Administration technique: Use with a spacer/holding chamber for optimal delivery

Important Considerations

Administration Technique

• Proper inhalation technique is critical for medication effectiveness
• Use a spacer device to improve drug delivery
• Wait 10-15 seconds between puffs (longer intervals offer no benefit) 1
• Observe patient technique regularly, as many patients have difficulty with proper inhalation 1

Monitoring

• Monitor for common dose-dependent side effects:
  • Tremor
  • Anxiety
  • Tachycardia
  • Heart pounding (without hypertension) 1

Formulation Considerations

• Albuterol MDI (90 mcg/puff) is as effective as nebulized therapy when used correctly with a spacer 1
• All current albuterol MDIs use hydrofluoroalkane propellants, which may feel different to patients than older formulations but have equal potency 1

Dosing in Acute Exacerbations

If treating an acute exacerbation:

1. Start with 4-8 puffs via MDI with spacer every 20 minutes for up to 3 doses
2. Then continue with 4-8 puffs every 1-4 hours as needed 1
3. Consider continuous monitoring if requiring frequent dosing

Common Pitfalls to Avoid

• Pitfall #1: Underdosing during acute exacerbations. Two puffs are not equivalent to a nebulizer treatment; 6-10 puffs may be needed to achieve comparable bronchodilation 1
• Pitfall #2: Poor inhaler technique leading to inadequate medication delivery. Always verify proper technique
• Pitfall #3: Overreliance on albuterol. Increasing use (more than twice weekly) indicates poor asthma control and need for controller medication 1
• Pitfall #4: Not using a spacer device, which significantly reduces drug delivery effectiveness

Remember that albuterol is for symptom relief only. If the patient requires albuterol more than twice weekly, this indicates inadequate asthma control and the need to initiate or adjust controller medications 1.