Albuterol Administration for 2-Year-Old Children
Yes, albuterol can be safely administered to 2-year-old children as it is FDA-approved for patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. 1
Administration Methods and Dosing
- Albuterol can be administered to 2-year-olds via metered-dose inhaler (MDI) with a valved holding chamber (spacer) and face mask, or via nebulizer 2, 3
- For MDI administration in children under 5 years of age, 1-2 puffs every 4-6 hours is the recommended dosage 2
- For nebulizer administration, albuterol can be delivered through a face mask that should fit snugly over the nose and mouth 2
- Studies have shown that MDI with spacer delivery may be as effective as nebulizer delivery in children as young as 2 months 4
Efficacy and Safety
- A randomized controlled safety trial demonstrated that cumulative dosing with albuterol HFA 180 mcg or 360 mcg via MDI-spacer and face mask in children younger than 2 years did not result in any significant safety issues 3
- Clinical improvement was observed in young children receiving albuterol via both MDI with spacer and nebulizer, with equivalent efficacy demonstrated in several studies 5, 4
- Potential side effects include tachycardia, skeletal muscle tremor, hypokalemia, increased lactic acid, headache, and hyperglycemia 2
- Rare instances of ventricular ectopy have been reported but are generally not clinically significant in otherwise healthy children 3
Practical Considerations
- For children under 4 years, a face mask should be used with the spacer device to ensure proper medication delivery 2
- Parents often find administration of albuterol using a spacer device easier (94%) and better accepted by their children (62%) compared to nebulizers 5
- MDI with spacer administration takes less time than nebulization and may be more convenient for home use 2
- In ventilated premature infants, albuterol delivered by MDI has been shown to improve respiratory system compliance more than nebulizer-delivered albuterol 6
Special Considerations
- Albuterol should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, as the action of albuterol on the vascular system may be potentiated 1
- Beta-receptor blocking agents and albuterol inhibit the effect of each other 1
- Regular use exceeding twice weekly for symptom control (not prevention of exercise-induced bronchospasm) indicates diminished control of asthma and the need for reassessment 2
Clinical Pearls
- For acute wheezing episodes in 2-year-olds, high-dose albuterol (50 mcg/kg) via MDI with spacer has been shown to be equivalent to nebulized albuterol (150 mcg/kg) 5
- Albuterol has been demonstrated to provide protection against methacholine-induced bronchospasm in young wheezy children when administered via MDI with spacer 7
- Periodically clean the HFA actuator, as drug may plug the orifice over time 2