Maximum Daily Dosage of Levosalbutamol MDI for Acute Asthma Exacerbation
For acute asthma exacerbation, the maximum daily dosage of levosalbutamol MDI is equivalent to albuterol MDI dosing, which is 4-8 puffs every 20 minutes for 3 doses initially, then as needed. 1, 2
Initial Treatment Protocol
- For children: 4-8 puffs every 20 minutes for up to 3 doses, then as needed 1
- For adults: 8 puffs every 20 minutes for up to 3 doses, then as needed 1, 2
- Levosalbutamol is administered at one-half the mg dose of albuterol for comparable efficacy and safety 1
- A valved holding chamber (spacer) should be used to improve medication delivery, especially for patients with difficulty coordinating inhalation 2
Maintenance Dosing After Initial Treatment
- After the first hour of treatment, adjust frequency based on severity and response 3
- For moderate exacerbations: administration every 60 minutes 3
- For severe exacerbations: administration hourly or consider continuous nebulization if available 3
- Continue treatment for 1-3 hours, provided there is improvement 3
Safety Considerations
- Regular monitoring of heart rate, tremor, and other side effects is essential, especially with frequent or high-dose administration 3
- Higher doses of salbutamol (600 mcg at 10-minute intervals) may produce slightly better therapeutic response but with greater side effects compared to lower doses (400 mcg at 10-minute intervals) 4
- Levosalbutamol may have a superior risk/benefit ratio compared to racemic salbutamol 5
- Be aware that higher mean daily salbutamol use is associated with future severe exacerbations and poor asthma control 6
Special Considerations
- For severe exacerbations, consider adding ipratropium bromide to enhance bronchodilation 1, 3
- When using ipratropium with levosalbutamol MDI, administer 4-8 puffs every 20 minutes as needed for children and 8 puffs every 20 minutes as needed for adults, for up to 3 hours 1
- Levosalbutamol 100 mcg via MDI produces similar bronchodilator response as 200 mcg of racemic salbutamol in stable asthma patients 7
Common Pitfalls and Caveats
- Failure to use a spacer device can reduce medication delivery and effectiveness 2
- Overreliance on rescue medication without addressing underlying inflammation may lead to poor outcomes 6
- Monitoring serum potassium is important during intensive treatment, as beta-agonists can cause hypokalemia 8
- The addition of ipratropium has not been shown to provide further benefit once the patient is hospitalized 1