What is the recommended dosage and usage of an albuterol (beta-2 adrenergic receptor agonist) inhaler for treating bronchospasm in asthma or chronic obstructive pulmonary disease (COPD)?

Albuterol Inhaler Dosage and Usage for Bronchospasm in Asthma and COPD

The recommended dosage for albuterol inhaler in adults is 2 inhalations (180-200 μg) every 4-6 hours as needed for bronchospasm in asthma or COPD, with more frequent administration (every 20 minutes for 1 hour) during acute exacerbations. 1, 2

Standard Dosing Recommendations

Adults and Adolescents (≥12 years)

• Mild symptoms: 2 inhalations (180-200 μg) of albuterol via hand-held inhaler every 4-6 hours as needed 1
• Moderate symptoms: 2-4 inhalations (180-400 μg) every 4 hours as needed 1
• Acute exacerbations: 4-8 inhalations every 20 minutes for up to 4 hours, then every 1-4 hours as needed 3, 1

Children (2-11 years)

• Standard dosing: 2 inhalations (180-200 μg) every 4-6 hours as needed 2
• Acute exacerbations: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 3

Nebulizer Dosing (When Inhaler Use Is Not Possible)

Adults and Children ≥15 kg

• 2.5 mg (one 3 mL vial of 0.083% solution) administered 3-4 times daily 2
• For acute severe asthma/COPD: 5 mg nebulized, repeated every 4-6 hours if improved 3

Children <15 kg

• Use 0.5% solution instead of 0.083% solution 2
• Dosage: 0.15 mg/kg per dose 3

Administration Technique

1. Proper MDI technique:

   • Shake inhaler well before use
   • Exhale completely
   • Place mouthpiece in mouth with lips sealed around it (or 1-2 inches from open mouth)
   • Begin slow, deep inhalation and activate inhaler
   • Continue inhaling slowly and deeply
   • Hold breath for 10 seconds
   • Wait 30-60 seconds between inhalations

2. With spacer/holding chamber (preferred method):

   • Attach inhaler to spacer
   • Shake well
   • Exhale completely
   • Place mouthpiece in mouth with lips sealed
   • Activate one puff into spacer
   • Inhale slowly and deeply
   • Hold breath for 10 seconds
   • Wait 30-60 seconds between inhalations

Treatment Algorithm for Acute Exacerbations

Mild-to-Moderate Exacerbation

1. Start with 4-8 puffs of albuterol via MDI with spacer every 20 minutes for up to 1 hour 1, 4
2. Assess response after 1 hour:
   • If good response (>15% improvement in FEV1): Continue albuterol every 60 minutes 4
   • If poor response (<15% improvement in FEV1): Continue albuterol every 30 minutes 4
3. Add oral corticosteroids if not improving after initial treatment

Severe Exacerbation

1. Administer oxygen to maintain saturation 88-92% in COPD or >94% in asthma 1
2. Give nebulized albuterol 5 mg (or 2.5 mg if using MDI with spacer) 3, 1
3. Consider adding ipratropium bromide 500 μg to albuterol if no improvement 3
4. Administer systemic corticosteroids
5. Consider hospitalization if no improvement after repeated treatments

Special Considerations

• Elderly patients: Monitor for cardiovascular side effects; albuterol may precipitate angina in susceptible patients 3
• Patients with glaucoma: Use mouthpiece rather than face mask with nebulized therapy to avoid eye exposure to medication 1
• Paradoxical bronchospasm: Though rare, discontinue albuterol and seek immediate medical attention if worsening shortness of breath occurs after administration 5
• Overuse warning: Increasing need for albuterol (using >2 canisters/month or >10-12 puffs/day) indicates poor asthma control and need for reassessment of maintenance therapy 3, 2

Monitoring Parameters

• Relief of symptoms
• Improvement in peak flow measurements
• Side effects: tremor, tachycardia, palpitations, headache
• Frequency of use (increasing use suggests need for controller medication adjustment)

Hand-held inhalers are preferred for most patients, with nebulizers reserved for those who cannot use inhalers properly or during severe exacerbations requiring higher medication doses 1.