Albuterol Dosing for Acute Asthma Exacerbations and COPD Management
For acute asthma exacerbations, albuterol should be administered via nebulizer at 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed; or via MDI at 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed. 1
Nebulizer Dosing
Adults:
- 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed 1
- For continuous nebulization in severe cases: 10-15 mg/hour 1
- Standard maintenance dosing: 2.5 mg administered three to four times daily 2
Children:
- Children ≥15 kg: 2.5 mg (one vial) administered three to four times daily 2
- Children <15 kg: Use 0.5% solution instead of 0.083% solution 2
- Children ≥12 years: Same as adult dosing 1
- Children <12 years: 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed 1
MDI Dosing
Adults and Children ≥12 years:
- 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed 1
- For optimal delivery, use a valved holding chamber (VHC) 1
Children <12 years:
- 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- Should use with VHC and face mask for children <4 years 1
Administration Techniques
- For nebulizer delivery: Dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min 1
- Use large volume nebulizers for continuous administration 1
- For MDI: In mild-to-moderate exacerbations, MDI plus VHC is as effective as nebulized therapy with appropriate administration technique 1
- Administer over approximately 5 to 15 minutes for nebulized solution 2
Special Considerations
For Severe Exacerbations:
- Consider adding ipratropium bromide to albuterol therapy 1
- For life-threatening exacerbations: Consider intravenous magnesium sulfate (2 g over 20 minutes in adults; 25-75 mg/kg up to 2 g in children) 1
- Evidence suggests that 2.5 mg of albuterol is as effective as higher doses (7.5 mg) for most patients with acute asthma 3
Levalbuterol Alternative:
- Levalbuterol can be administered in one-half the mg dose of albuterol for comparable efficacy and safety 1, 4
- For MDI: Follow same dosing pattern as albuterol MDI 4
- For nebulization: 1.25-2.5 mg every 20 minutes for 3 doses, then 1.25-5 mg every 1-4 hours as needed 1
Dosing Frequency Optimization
- For most patients, albuterol can be effectively administered at 60-minute intervals 5
- Patients with poor initial bronchodilator response may benefit from more frequent administration at 30-minute intervals 5
- Ad-lib (as-needed) administration may be as effective as scheduled administration for hospitalized patients, with significantly fewer total treatments required 6
Monitoring
- If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this may indicate worsening asthma requiring reassessment of therapy 2
- Monitor for side effects including tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 7