Ventolin (Albuterol) Dosing for Bronchospasm Treatment
For treating bronchospasm, albuterol (Ventolin) is recommended at 2.5 mg via nebulizer three to four times daily for adults and children weighing at least 15 kg, while children under 15 kg should receive 0.15 mg/kg (minimum 1.25 mg) via nebulizer or 4-8 puffs via MDI with spacer. 1, 2, 3
Age-Specific Dosing Guidelines
Adults:
- Nebulizer solution: 2.5 mg in 3 mL saline, 3-4 times daily 2, 1
- MDI: 2 puffs every 4-6 hours as needed 2
- During acute exacerbations: May double dose 2
Children 5-11 years (or ≥15 kg):
- Nebulizer solution: 1.25-5 mg in 3 mL saline, 3-4 times daily 2, 1
- MDI: 2 puffs every 4-6 hours as needed 2
Children <5 years (or <15 kg):
- Nebulizer solution: 0.15 mg/kg (minimum 1.25 mg) 3, 1
- MDI: 4-8 puffs with spacer/valved holding chamber 3
Acute Exacerbation Dosing
Adults and Children ≥15 kg:
- Nebulizer: 2.5 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 3
- MDI: 4-8 puffs via spacer every 20 minutes for 3 doses, then every 1-4 hours as needed 3
Children <15 kg:
- Nebulizer: 0.15 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed 3
- MDI: 4-8 puffs with valved holding chamber every 20 minutes for 3 doses, then as needed 3
Administration Techniques
For MDI:
- Always use a spacer/valved holding chamber for children 3
- For adults, proper technique includes:
- Shake inhaler well before use
- Exhale completely
- Place mouthpiece in mouth with good seal
- Inhale slowly and deeply while activating the inhaler
- Hold breath for 5-10 seconds
For Nebulizer:
- Standard nebulization time: 5-15 minutes 1
- May mix with cromolyn solution, budesonide inhalant suspension, or ipratropium solution 2
- For continuous nebulization in severe exacerbations: 7.5 mg/hr is as effective as higher doses 4
Important Considerations
Potential Adverse Effects:
- Common: Tachycardia, skeletal muscle tremor, hypokalemia, headache, hyperglycemia 2
- Monitoring: Heart rate, tremors, and response to treatment 3
Cautions:
- Increasing use or lack of expected effect indicates diminishing asthma control 2
- Regular use exceeding twice weekly for symptom control (not prevention of exercise-induced bronchospasm) indicates need for controller medication 2
- Paradoxical bronchospasm can occur rarely, particularly with preservatives like benzalkonium chloride in multi-dose solutions 5, 6
Special Situations:
- Mechanically ventilated patients: MDI with spacer effective at doses up to 15 puffs 7
- Severe exacerbations: Consider adding ipratropium bromide for potentially shorter ED length of stay 8
When to Seek Medical Advice
If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this often indicates worsening asthma requiring reassessment of therapy 1.