Albuterol Nebulizer Dosing Guidelines
For adults, the standard dose of albuterol via nebulizer is 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed. 1
Adult Dosing
- Initial treatment: 2.5-5 mg every 20 minutes for 3 doses 2, 1
- Maintenance dosing: 2.5-10 mg every 1-4 hours as needed based on clinical response 1
- For severe exacerbations: Continuous nebulization at 10-15 mg/hour may be used 1
- For optimal delivery, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min 2, 3
Pediatric Dosing
- Children should receive 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses 2, 4
- Maintenance dosing: 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed 2
- For severe exacerbations: Continuous nebulization at 0.5 mg/kg/hour 1, 4
- FDA labeling states that for children weighing at least 15 kg, the usual dose is 2.5 mg administered three to four times daily 5
- Children weighing <15 kg who require <2.5 mg/dose should use albuterol inhalation solution 0.5% instead of 0.083% 5
Administration Techniques
- Use large volume nebulizers for continuous administration 2
- Ipratropium bromide may be mixed with albuterol in the same nebulizer for severe exacerbations 2, 1
- The flow rate should be regulated to deliver the solution over approximately 5-15 minutes 5
- Increasing the fill volume from 3 mL to 4 or 5 mL decreases the amount of medication trapped in the dead volume and increases the amount delivered to the patient 3
Important Considerations
- In mild-to-moderate exacerbations, a metered-dose inhaler (MDI) with valved holding chamber is as effective as nebulized therapy when used with proper technique 2, 6
- Monitor for side effects such as tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1
- If a previously effective dosage regimen fails to provide relief, this often indicates worsening asthma requiring reassessment of therapy 5
- Regular use of rescue medication exceeding twice weekly indicates poor asthma control and need for controller medication adjustment 1
Special Situations
- For severe exacerbations with life-threatening features, consider adding intravenous magnesium sulfate if the exacerbation remains severe after 1 hour of intensive conventional treatment 2
- When transitioning from acute to maintenance therapy, the FDA recommends 2.5 mg administered three to four times daily by nebulization 5