Recommended Albuterol Rescue Inhaler Dosage
For adults, the recommended albuterol rescue inhaler dosage is 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed. 1
Dosing Guidelines by Delivery Method
Metered-Dose Inhaler (MDI)
- Adults: 4-8 puffs (90 mcg/puff) every 20 minutes for up to 4 hours during acute symptoms, then every 1-4 hours as needed 1
- Children (5-11 years): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- Children (<5 years): 1-2 puffs every 4-6 hours; may increase during acute symptoms 1
- Using a valved holding chamber (spacer) with MDI is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 1, 2
Nebulizer Solution
- Adults: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed 1
- Children: 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 1
- Continuous nebulization (severe exacerbations): 10-15 mg/hour for adults; 0.5 mg/kg/hour for children 1
Clinical Considerations
Efficacy Duration
- Bronchodilator effect begins within 5 minutes of administration 3
- Peak effect typically occurs at 1-2 hours after dosing 3
- Duration of action is approximately 4 hours in most patients 4
- For patients with persistent symptoms, repeat dosing may be required every 4 hours 4
Administration Technique
- For MDIs: Proper technique is essential for effective drug delivery 2
- Shake inhaler well before use
- Exhale completely before actuation
- Actuate during slow, deep inhalation
- Hold breath for 10 seconds after inhalation
- Wait 30-60 seconds between puffs
Special Considerations
- For nebulizer solutions, dilute aerosols to a minimum of 3 mL at gas flow of 6-8 L/min for optimal delivery 1
- Large volume nebulizers should be used for continuous administration 1
- Ipratropium bromide may be mixed with albuterol in the same nebulizer for severe exacerbations 1
Common Pitfalls to Avoid
- Overreliance on rescue inhaler: Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 1
- Inadequate technique: Poor MDI technique significantly reduces medication delivery; spacers/holding chambers should be used to improve delivery, especially in children 2
- Delay in seeking help: Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 1
- Inadequate monitoring: Patients should be monitored for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1
Remember that albuterol is intended for rescue therapy, and increasing reliance on it indicates worsening asthma control that may require adjustment of controller medications 1, 5.