What is the recommended dosage and use of Salbutamol (albuterol) nebulization for relief of acute bronchospasm in conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD)?

Salbutamol Nebulization Uses and Dosage

For acute bronchospasm in asthma and COPD, the recommended dosage of salbutamol nebulization is 5 mg repeated every 4-6 hours for adults and 5 mg (or 0.15 mg/kg) every 1-4 hours for children. 1

Dosage Recommendations by Condition

Acute Asthma

• Adults:

  • 5 mg salbutamol nebulization every 4-6 hours 1
  • For severe asthma: oxygen plus nebulized salbutamol 5 mg every 4-6 hours
  • Add ipratropium bromide 500 μg if not improving 1

• Children:

  • 5 mg (or 0.15 mg/kg) salbutamol nebulization every 1-4 hours 1
  • For severe asthma: add ipratropium bromide 250 μg if not improving after 30 minutes 1

COPD Exacerbations

• Adults:
  • 2.5-5 mg salbutamol nebulization every 4-6 hours for 24-48 hours or until clinical improvement 1
  • Consider combined treatment with 2.5-10 mg salbutamol plus 250-500 μg ipratropium bromide for severe COPD with poor response to salbutamol alone 1

Clinical Assessment and Treatment Algorithm

1. Assess severity of bronchospasm:

   • For asthma: ability to complete sentences, respiratory rate, heart rate, PEF
   • For COPD: respiratory rate, heart rate, oxygen saturation

2. Initiate treatment based on severity:

   • Mild-moderate: standard dosing as above
   • Severe asthma (cannot talk/feed, respiratory rate >50/min, heart rate >140/min, PEF <50% predicted): more frequent dosing (every 1-4 hours) 1

3. Monitor response:

   • If inadequate response after 30 minutes, add ipratropium bromide
   • For adults: 500 μg
   • For children: 250 μg 1

4. Continue or adjust treatment:

   • Continue nebulization every 4-6 hours until clinical improvement
   • If previously effective dose fails to provide usual response, consider destabilization of underlying condition and need for anti-inflammatory treatment 2

Important Considerations and Precautions

• Safety monitoring:

  • Watch for tachycardia, tremor, and hypokalemia, especially with higher or more frequent dosing 1
  • Measure arterial blood gas tensions in severely ill patients requiring hospitalization 1
  • β-agonists may rarely precipitate angina 1

• Equipment and administration:

  • Disposable components should be changed every 3-4 months 1
  • Compressors need annual servicing 1
  • First treatment should always be done under supervision 1
  • For patients with glaucoma using ipratropium, use a mouthpiece rather than a mask 1

• Maintenance therapy:

  • Nebulizer therapy can be used in conjunction with regular inhalers 1
  • Regular preventative treatment should not be discontinued even when using a nebulizer for acute symptoms 1
  • Avoid back-to-back nebulizations due to increased risk of side effects and potential for paradoxical bronchospasm 1

Special Considerations

• Combined treatment with salbutamol and ipratropium bromide has shown superior results in acute asthma compared to salbutamol alone, particularly in patients with PEF below 140 L/min 3

• For MDI vs nebulizer comparison: When doses are calculated based on the percentage of drug reaching the lower airway, MDI with spacer can be as effective as nebulization, though nebulization may produce more side effects due to higher systemic absorption 4

• Continuous and intermittent nebulization of salbutamol show similar efficacy in acute severe asthma, so the choice between methods should be based on logistical considerations 5