Is salbutamol (albuterol) effective for treating coughs?

Salbutamol for Cough Management

Salbutamol is not recommended for treating coughs unless the cough is related to underlying asthma, COPD, or in children with upper respiratory infections under specific circumstances. 1

Indications for Salbutamol in Cough Management

Asthma-Related Cough

• Salbutamol is effective for cough associated with asthma or cough-predominant asthma, where bronchospasm is the underlying mechanism 2
• For acute asthma exacerbations with cough, nebulized salbutamol at doses equivalent to 2.5-5 mg is recommended 2
• In children with asthma-related cough, salbutamol can be administered via nebulizer (5 mg or 0.15 mg/kg) or as an inhalational powder (400 μg) 2, 3

COPD-Related Cough

• For acute COPD exacerbations with cough, nebulized salbutamol at doses of 2.5-5 mg is recommended 2
• In chronic COPD management, salbutamol may be used up to 1 mg via hand-held inhalers before considering nebulized therapy 2
• The bronchodilator effect helps reduce cough by decreasing airway obstruction, but it is not a direct antitussive 4

Children with Upper Respiratory Infections

• In children under 6 years with upper respiratory infections (URI), inhaled salbutamol before general anesthesia is recommended to reduce perioperative cough and bronchospasm 2
• Children premedicated with salbutamol had approximately 50% less perioperative cough and bronchospasm in a prospective study of 400 children 2
• The recommended dose is 2.5 mg for children weighing less than 20 kg and 5 mg for children over 20 kg 2

When Salbutamol is NOT Indicated for Cough

• Salbutamol is not recommended for acute or chronic cough not related to asthma or COPD 1
• For post-infectious cough without evidence of bronchospasm, salbutamol has not shown benefit 1
• In chronic cough management algorithms, salbutamol is only considered when spirometry or bronchodilator testing suggests reversible airflow obstruction 2

Administration Routes and Comparative Efficacy

• Inhaled salbutamol provides superior bronchodilation compared to oral administration for respiratory conditions 5
• Nebulized salbutamol provides the greatest immediate bronchodilation effect but tablets may have longer duration 3
• For children with mild to moderate asthma, frequent low doses of salbutamol (0.075 mg/kg every 30 minutes) showed no advantage over standard hourly dosing (0.15 mg/kg every 60 minutes) and was associated with increased vomiting 6

Diagnostic Approach Before Considering Salbutamol

• Spirometry should be performed in all patients with chronic cough to identify if there is reversible airflow obstruction that might respond to salbutamol 2
• If an obstructive pattern is identified on spirometry, FEV1 should be measured before and after inhalation of salbutamol to determine bronchodilator responsiveness 2
• A chest radiograph should be obtained in all patients with chronic cough to rule out other causes before considering bronchodilator therapy 2

Alternative Treatments for Non-Asthmatic Cough

• For cough suppression in patients without asthma or COPD, inhaled ipratropium bromide is recommended as first-line treatment 1
• Central-acting antitussives (codeine, dextromethorphan) may be used for short-term symptomatic relief in chronic bronchitis 1
• Hypertonic saline solution can be used on a short-term basis to increase cough clearance in patients with bronchitis 1

Pitfalls and Caveats

• Using salbutamol for non-asthmatic cough may delay appropriate diagnosis and treatment of the underlying cause 1
• Single peak expiratory flow (PEF) measurements to assess bronchodilator response are not as accurate as FEV1 in diagnosing airflow obstruction as a cause of cough and should be avoided 2
• Overuse of salbutamol can lead to tachycardia, tremor, and potentially worsening of ventilation-perfusion mismatch in some patients 4, 7