Albuterol Inhaler Dosing for a 22kg Child
For a 22kg child, the recommended albuterol inhaler dosing is 4-8 puffs via metered-dose inhaler (MDI) with a valved holding chamber every 20 minutes for 3 doses, then every 1-4 hours as needed. 1
Dosing Options Based on Administration Method
Metered-Dose Inhaler (MDI)
- For a 22kg child (≥15kg): 4-8 puffs with valved holding chamber every 20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
- For mild exacerbations: 4-8 puffs via MDI with valved holding chamber every 20-30 minutes for 3 doses 1
- For moderate to severe exacerbations: 3 treatments of 4-8 puffs via MDI with valved holding chamber administered every 20-30 minutes 1
Nebulizer Solution
- For a 22kg child (≥15kg): 2.5mg every 20 minutes for 3 doses, then every 4-6 hours as needed 1
- Alternative calculation: 0.15 mg/kg (minimum dose 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 2
- For continuous nebulization in severe cases: 0.5 mg/kg/hour 2
Treatment Assessment and Adjustment
- Initial treatment: Administer 3 treatments of albuterol every 20-30 minutes
- Reassessment after initial treatment (60-90 minutes after treatment initiation):
- Monitor subjective response, physical findings, lung function, and oxygen saturation
- For incomplete response: Continue albuterol and consider adding ipratropium bromide
- For poor response: Continue albuterol every 30 minutes, add ipratropium bromide, and consider continuous nebulization in severe cases 1
Monitoring and Side Effects
- Monitor respiratory rate, work of breathing, and oxygen saturation
- Watch for potential side effects:
- Cardiac effects (tachycardia)
- Electrolyte disturbances (hypokalemia)
- Tremor
- Hyperactivity
- Vomiting 1
Important Considerations
- A spacer with valve and face mask should always be used for children under 10 years old 1
- Approximately 60-70% of patients will respond sufficiently to initial 3 doses 1
- If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this often indicates worsening asthma requiring therapy reassessment 3
Treatment Goals
The treatment goal for asthma patients is to maintain control of asthma, defined as:
- Minimal or no chronic symptoms day or night
- Minimal or no exacerbations
- No limitations on activities
- Maintenance of (near) normal pulmonary function
- Minimal use of short-acting inhaled beta-2 agonists
- Minimal or no adverse effects from medications 2
Remember that proper asthma control with appropriate medication is safer than having uncontrolled asthma symptoms and exacerbations, which can lead to inadequate oxygenation 2.