Albuterol Nebulizer Solution Dosage for Pediatric Patients
For pediatric patients, the recommended dosage of albuterol nebulizer solution is 0.15 mg/kg (minimum dose 2.5 mg) administered every 20 minutes for 3 doses, then every 1-4 hours as needed. 1
Standard Dosing Guidelines
- For children weighing at least 15 kg: 2.5 mg (one unit-dose vial of 0.083% solution) administered three to four times daily by nebulization 2
- For children weighing less than 15 kg who require less than 2.5 mg/dose: Use albuterol inhalation solution 0.5% instead of the 0.083% solution 2
- For acute asthma exacerbations: 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then every 1-4 hours as needed 3, 1
Administration Based on Severity
Mild-to-Moderate Exacerbations
- Initial treatment: 2.5 mg every 20 minutes for 3 doses 3
- Maintenance: 2.5 mg every 1-4 hours as needed 3
- MDI with spacer (4-8 puffs) can be as effective as nebulized therapy when proper technique is used 3, 4
Severe Exacerbations
- Consider adding ipratropium bromide (0.25-0.5 mg) to albuterol for the first three doses 3, 5
- For patients with severe asthma, adding ipratropium significantly reduces hospitalization rates (37.5% vs 52.6%) 5
- For continuous nebulization in severe cases: 0.5 mg/kg/hour 1, 6
Practical Administration Tips
- Dilute albuterol solution to a minimum of 3 mL with normal saline for optimal delivery 1
- Use oxygen as the driving gas whenever possible for nebulization 3
- Flow rate of 6-8 L/min is recommended for effective nebulization 1
- Treatment duration should be approximately 5-15 minutes per nebulization 2
Important Considerations and Cautions
- Only use preservative-free albuterol products for continuous nebulization, as benzalkonium chloride (BAC) in multidose preparations can cause bronchospasm 7
- Monitor for side effects such as tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1, 6
- Levalbuterol (R-albuterol) may be considered at half the milligram dose of racemic albuterol with comparable efficacy and potentially fewer side effects 3, 8
- If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this may indicate worsening asthma requiring reassessment 2