Salbutamol Dosing for Pediatric Patients
For pediatric patients requiring salbutamol (albuterol), the recommended dose is 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
Nebulized Salbutamol Dosing
- For acute asthma exacerbations requiring nebulized treatment, administer 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
- For children weighing less than 20 kg: 2.5 mg per dose 1
- For children weighing more than 20 kg: 5 mg per dose 1
- Dilute in 2-3 mL of saline solution for adequate nebulization 2
- For continuous/prolonged nebulization: 0.5 mg/kg per hour up to 10-15 mg/hour 2
Metered-Dose Inhaler (MDI) Dosing
- 4-8 puffs (90 mcg per puff) every 15-20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
- A spacer/holding chamber must be used when administering MDI treatments to ensure proper delivery 2
- MDI delivery is as effective as nebulized therapy with appropriate technique and coaching 1
Administration Considerations
- Oxygen is the preferred gas source for nebulization 2
- Supplemental oxygen may be needed when compressed air-driven nebulizers are used 2
- Levalbuterol may also be used; the dose is half of the racemic albuterol dose listed above 2
- Monitor heart rate, respiratory rate, oxygen saturation, and clinical response during administration 1
Special Considerations and Precautions
- For children with upper respiratory infections under age 6, preoperative nebulized salbutamol (2.5 mg for <20 kg, 5 mg for >20 kg) administered 30 minutes before general anesthesia can reduce perioperative respiratory adverse events 1
- Use with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension 3
- Repeated dosing with 0.15 mg/kg has been associated with an asymptomatic decline of 20-25% in serum potassium levels in initially normokalemic children aged 5-17 years 3
- Salbutamol should not be used more frequently than recommended as the action may last up to six hours 3
Clinical Efficacy
- Onset of bronchodilation is rapid with all forms of administration, but nebulized salbutamol provides the greatest relief in severe asthma 4
- Maximum average improvement in pulmonary function usually occurs at approximately 1 hour following inhalation and remains close to peak for 2 hours 3
- Clinically significant improvement in pulmonary function continues for 3-4 hours in most patients and up to 6 hours in some patients 3
Remember that proper technique in administration is crucial for effective treatment, and monitoring for side effects such as tachycardia, tremors, and hypokalemia is essential during therapy.