Albuterol Nebulized Treatment Dose and Frequency for Acute Bronchospasm
For acute bronchospasm treatment, adults should receive 2.5-5 mg of albuterol via nebulizer every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, while children should receive 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed. 1, 2, 3
Adult Dosing
- For adults with acute bronchospasm, administer 2.5-5 mg albuterol via nebulizer every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed 1, 2
- For severe exacerbations, continuous nebulization at 7.5 mg/hour is recommended (higher doses of 15 mg/hour have not shown additional benefit) 2, 4
- When using metered-dose inhaler (MDI), administer 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 3
Pediatric Dosing
- For children, 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, 2
- For children using MDI, administer 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 3
- For children under 5 years, use 0.63 mg/3 mL solution 2
Administration Techniques
- For optimal delivery via nebulizer, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min 1, 3
- Use large volume nebulizers for continuous administration 1, 3
- MDI with valved holding chamber (spacer) is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 1, 3, 5
Combination Therapy
- For severe exacerbations, albuterol may be mixed with ipratropium bromide in the same nebulizer 1, 3
- While combination therapy shows a trend toward improved outcomes, the difference may not be statistically significant for all patients 6
Monitoring and Safety Considerations
- Monitor for common beta-agonist side effects including tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 2, 7
- Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 2, 3
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 2, 3
Important Cautions
- Use preservative-free albuterol solutions when possible, especially for continuous nebulization, as benzalkonium chloride (BAC) preservative can cause paradoxical bronchospasm 8, 9
- BAC effects are cumulative and more pronounced in patients with severe airway obstruction, potentially antagonizing albuterol's bronchodilator effects 9
- Levalbuterol (R-albuterol) may be used as an alternative at half the mg dose of racemic albuterol with comparable efficacy 1, 10