Pediatric Albuterol Inhaler Dosing with Spacer
For pediatric patients using an albuterol inhaler with a spacer, the recommended initial dosage is 1-2 puffs every 4-6 hours as needed for children under 5 years of age. 1
Age-Based Dosing Guidelines
Children Under 5 Years
- Initial dose: 1-2 puffs every 4-6 hours as needed for bronchospasm 1
- For acute symptoms: May increase to 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 2
- A spacer/holding chamber must always be used when administering MDI treatments to young children 2
Children 5-11 Years
- Initial dose: 2 puffs every 4-6 hours as needed 1
- For acute symptoms: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 3
Efficacy Considerations
- Metered-dose inhalers with spacers are equally effective as nebulizers for delivering albuterol to children with acute asthma when proper technique is used 4, 5
- Even low-dose regimens (2 puffs) of albuterol delivered by MDI with spacer have been shown to be as clinically beneficial as higher doses or nebulized treatment in children with mild acute asthma 6
- For preschool children with acute wheezing, high-dose albuterol (50 mcg/kg) via MDI with spacer has demonstrated equivalent efficacy to nebulized albuterol 7
Administration Techniques
- Puffs can be taken in 10-15 second intervals; longer intervals offer no benefits 1
- The actuator of the MDI should be periodically cleaned as medication may plug the orifice 2
- A valved holding chamber (spacer) must be used when administering MDI treatments to children 2
- For children under 4 years, use a spacer with a face mask 1
Monitoring and Safety
- Monitor for potential adverse effects including tachycardia, skeletal muscle tremor, hypokalemia, and hyperglycemia 2
- Increasing use or lack of expected effect indicates diminishing asthma control and need for controller medication adjustment 3
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for medical attention 3
Clinical Pearls
- MDIs with spacers require shorter treatment times compared to nebulizers (66 minutes vs 103 minutes) 5
- Fewer episodes of vomiting occur with spacer devices compared to nebulizers (9% vs 20%) 5
- Children using nebulizers show a significantly greater mean percent increase in heart rate from baseline compared to those using spacers with MDIs (15% vs 5%) 5
- Parents often find administration of albuterol using spacer devices easier (94%) and better accepted by their children (62%) 7