What is the recommended dose of Salbutamol (albuterol) for viral bronchitis?

Salbutamol Dosing in Viral Bronchitis

Salbutamol (albuterol) is generally not recommended for routine use in viral bronchitis, particularly in infants with bronchiolitis, as evidence shows limited benefit and potential harm. 1

Evidence Against Routine Use in Bronchiolitis

• The American Academy of Pediatrics strongly recommends against administering albuterol (salbutamol) to infants and children with a diagnosis of bronchiolitis due to lack of consistent benefit in clinical outcomes 1
• A Cochrane systematic review of 30 randomized controlled trials involving 1992 infants found no significant benefit in the clinical course of infants with bronchiolitis who received bronchodilators 1
• The potential adverse effects (tachycardia and tremors) and cost of these agents outweigh any potential benefits 1
• Studies have shown that bronchodilators may improve clinical symptom scores temporarily but do not affect disease resolution, need for hospitalization, or length of stay 1

When a Trial of Salbutamol Might Be Considered

Despite the general recommendation against routine use, some guidelines suggest a trial of bronchodilator may be reasonable in select cases:

• For office or clinic settings, if a trial is attempted, albuterol/salbutamol is more appropriate than epinephrine 1
• Parameters to measure effectiveness should include improvements in wheezing, respiratory rate, respiratory effort, and oxygen saturation 1
• If there is documented clinical improvement, there may be justification for continuing the nebulized bronchodilator treatments 1
• In the absence of a clinical response, the treatment should not be continued 1

Dosage Recommendations When Used

If a trial of salbutamol is deemed necessary:

• For nebulized salbutamol in children: 5 mg or 0.15 mg/kg 1
• For MDI with spacer in children: 100 μg per actuation, with up to 20 actuations as needed 1
• For adults with acute bronchitis with wheezing: Consider 2-4 puffs (200-400 μg) via handheld inhaler four hourly for mild episodes 1
• For moderately severe episodes in adults: 400 μg (4 puffs) via handheld inhaler four hourly 1

Special Considerations for Viral Bronchitis in Adults

• In adults with acute bronchitis, β2-agonist bronchodilators should not be routinely used to alleviate cough 1
• However, in select adult patients with acute bronchitis and wheezing accompanying the cough, treatment with β2-agonist bronchodilators may be useful 1
• A subgroup of patients with airflow obstruction at baseline and wheezing at the onset of illness may show some benefit 1

Monitoring and Discontinuation

• Document pre-therapy and post-therapy changes using an objective means of evaluation 1
• If no improvement is observed after a trial dose, treatment should be discontinued 1
• Be aware of potential side effects including tremor, nervousness, and shakiness which are more common in treatment groups 1
• For patients with chronic bronchitis, 3 mg of nebulized salbutamol may be an optimal dose, producing satisfactory bronchodilation with fewer side effects related to systemic absorption 2

Cautions and Contraindications

• Potential adverse effects include tachycardia and tremors 1
• In elderly patients, β-agonists may rarely precipitate angina; a first treatment should be supervised 1
• Monitoring for side effects is particularly important in young children and infants 1

In conclusion, while salbutamol is commonly prescribed for viral bronchitis, particularly in children, the evidence does not support its routine use. If a trial is attempted, objective assessment of response should guide continuation or discontinuation of therapy.