Albuterol Solution Dosing for Pediatric Patients
For pediatric patients, the recommended dose of albuterol nebulizer solution is 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, or 0.5 mg/kg/hour by continuous nebulization. 1
Weight-Based Dosing Algorithm
For Intermittent Nebulization:
- Children <15 kg: Use albuterol inhalation solution 0.5% instead of 0.083% 2
- Children ≥15 kg: 2.5 mg (one 3 mL vial of 0.083% solution) administered 3-4 times daily 2
- All children: Initial treatment for acute exacerbations: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1, 3
- Maintenance dosing: 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed 1
For Continuous Nebulization:
- All children: 0.5 mg/kg/hour continuous nebulization 1
- No optimal weight-based dose has been definitively established, with studies using doses ranging from 0.07-3.2 mg/kg/hour 4
Administration Methods
Nebulizer Solution:
- For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min 1
- Use large volume nebulizers for continuous administration 1
- May mix with ipratropium bromide nebulizer solution for severe exacerbations 1, 3
Metered-Dose Inhaler (MDI):
- Children: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 3
- Always use with valved holding chamber/spacer for children 1, 3
- Allow 6-8 breaths per actuation when using a spacer 3
Special Considerations
Levalbuterol Alternative:
- Levalbuterol (R-albuterol) can be administered at half the mg dose of albuterol with comparable efficacy and safety 1, 5
- Recommended dose: 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 1
- For children with mild to moderate persistent asthma, 0.31 mg is an effective starting dose 5
Monitoring and Safety
Side Effects to Monitor:
- Tachycardia (dose-related) 3, 6
- Tremors (dose-related) 3, 6
- Hypokalemia (serum potassium <3.0 mEq/L) - relatively uncommon at standard doses 3, 6
- Cardiac arrhythmias - rare but possible 3, 6
Important Caveats:
- Higher doses of albuterol (beyond standard recommendations) have not been shown to improve outcomes in terms of hospital length of stay or admission rates 4, 7
- Lower doses of albuterol via MDI (6-12 puffs) are as effective as higher doses (9-18 puffs) for acute asthma exacerbations 7
- If a previously effective dosage regimen fails to provide usual relief, this often indicates worsening asthma requiring reassessment of therapy 2
- For very young infants with bronchopulmonary dysplasia, even lower doses (1.25 mg) may be appropriate with careful heart monitoring 8
Treatment Duration
- Continue albuterol as medically indicated to control recurring bouts of bronchospasm 2
- For acute exacerbations, treatment is typically continued until symptoms improve, with follow-up in 2-6 weeks to assess response 3
Remember that the goal of albuterol treatment is to minimize symptoms to ≤2 days/week with minimal or no exacerbations, no activity limitations, and maintenance of near-normal pulmonary function 3.