Salbutamol Administration Guidelines
For acute asthma exacerbations, salbutamol should be administered every 20 minutes for 3 doses initially, then every 1-4 hours as needed based on clinical response. 1, 2
Initial Treatment for Acute Exacerbations
Mild to Moderate Exacerbations
- For nebulizer administration: 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 MDI with spacer: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- MDI with spacer is as effective as nebulized therapy with proper technique and coaching 1
Severe Exacerbations
- Nebulized salbutamol plus ipratropium, hourly or continuous 1
- For continuous nebulization in severe cases: 0.5 mg/kg/hour is recommended 2
- For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min 1, 2
Maintenance Dosing After Initial Treatment
- After the first hour of treatment, adjust frequency based on severity and response 1
- For moderate exacerbations: administer every 60 minutes 1
- For severe exacerbations: administer hourly or continuously 1
- Continue treatment for 1-3 hours, provided there is improvement; make admission decision in < 4 hours 1
Special Considerations
- Early response to treatment (within 30 minutes) is the most important predictor of outcome 3
- Approximately 70% of patients show good response pattern to salbutamol, while 30% show poor response pattern despite high doses 3
- As-required (PRN) administration from 24 hours after hospital admission may be associated with reduced total drug delivery, fewer side effects, and possibly shorter hospital stays compared to regular scheduled administration 4
- No significant difference has been observed between continuous and intermittent nebulization methods in terms of clinical outcomes for acute severe asthma 5
Discharge Recommendations
- Continue treatment with inhaled SABA as needed 1
- Continue course of oral systemic corticosteroid if prescribed 1
- Consider initiation of an inhaled corticosteroid (ICS) 1
- Patient education should include medication review, inhaler technique, action plan review, and scheduling follow-up appointment with primary care provider within 1-4 weeks 1
Common Pitfalls and Caveats
- Failure to recognize poor responders early (within 30 minutes) may delay appropriate escalation of care 3
- Overuse of salbutamol without addressing underlying inflammation can mask worsening asthma control 6
- Regular monitoring of heart rate, tremor, and other side effects is essential, especially with frequent or high-dose administration 2, 4
- For children, always use the minimum dose of 2.5 mg even if weight-based calculation results in a lower dose 2