What is the recommended prescription for an albuterol (salbutamol) inhaler for a 9-year-old child?

Albuterol Inhaler Prescription for a 9-Year-Old Child

For a 9-year-old child with asthma, the recommended albuterol inhaler prescription is 2 puffs (90 mcg/puff) every 4-6 hours as needed for symptoms, administered via metered-dose inhaler (MDI) with a valved holding chamber/spacer. 1

Dosing Recommendations

Quick-Relief (Rescue) Medication

• MDI formulation: Albuterol HFA 90 mcg/puff
• Standard dosing: 2 puffs every 4-6 hours as needed 1
• Pre-exercise dosing: 2 puffs 15-30 minutes before exercise to prevent exercise-induced bronchospasm
• During exacerbations: May increase to 4-8 puffs every 20 minutes for up to 3 doses, then every 1-4 hours as needed 1, 2

Nebulizer Alternative (if needed)

• Solution strength: 0.083% (0.63 mg/3 mL or 1.25 mg/3 mL)
• Dosing: 1.25-5 mg in 3 mL of saline every 4-6 hours as needed 1
• Acute exacerbation dosing: 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed 2

Administration Instructions

MDI Technique

1. Always use a spacer/valved holding chamber with pediatric patients 2
2. Shake the inhaler well before each use
3. Insert MDI into spacer device
4. Create a proper seal between face mask/mouthpiece and child's face
5. Press down on the inhaler to release medication
6. Have child take 6-8 slow, deep breaths for each puff 2
7. Wait approximately 30-60 seconds between puffs

Important Monitoring Points

• Monitor for potential side effects:
  • Tachycardia
  • Tremors
  • Hyperactivity
  • Hypokalemia with repeated dosing 2
• An increasing need for albuterol (>2 days/week for symptom control) indicates poor asthma control and should prompt reassessment of controller therapy 1

Clinical Pearls and Cautions

• Common pitfall: Prescribing albuterol without a spacer device. Children may not be able to coordinate proper inhalation technique without a spacer, significantly reducing medication delivery.

• Caution: Regular use exceeding 2 days/week for symptom control (not including pre-exercise use) indicates inadequate asthma control and should prompt evaluation for additional controller medication 1

• Device selection: For children who cannot effectively use an MDI with spacer, a nebulizer may be considered as an alternative delivery method, using 0.15 mg/kg (minimum dose 2.5 mg) per treatment 1, 3

• Prescription details: Ensure the prescription includes both the medication (Albuterol HFA 90 mcg/puff) and appropriate spacer device, with clear instructions on proper administration technique

By following these evidence-based recommendations, you can optimize the delivery of albuterol to effectively manage asthma symptoms while minimizing potential side effects in a 9-year-old child.