What is the recommended treatment and dosage for Albuterol (Salbutamol) in managing bronchospasm associated with asthma or Chronic Obstructive Pulmonary Disease (COPD)?

Albuterol Dosing for Bronchospasm in Asthma and COPD

For bronchospasm management in asthma and COPD, albuterol should be administered at 2.5-5 mg via nebulizer every 20 minutes for three doses in acute exacerbations, then 2.5-10 mg every 1-4 hours as needed, or 4-8 puffs via MDI every 20 minutes for three doses, then every 1-4 hours as needed. 1

Dosage by Administration Method

Nebulizer Solution

• Adults: 2.5-5 mg every 20 minutes for 3 doses in acute exacerbations, then 2.5-10 mg every 1-4 hours as needed 1
• Children 5-11 years: 1.25-5 mg in 3 mL of saline 1
• Children <5 years: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed 1, 2
• Maintenance therapy: 2.5 mg administered three to four times daily by nebulization for adults and children weighing at least 15 kg 3

Metered-Dose Inhaler (MDI)

• Adults and Children: 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• For mild exacerbations of COPD: 200-400 μg salbutamol via hand-held inhaler 1

Treatment Algorithms

Acute Asthma Exacerbation Management

1. Assess severity:

   • Mild-to-moderate: FEV1 or PEF 40-69% predicted 1
   • Severe: FEV1 or PEF <40% predicted 1

2. Initial treatment:

   • Begin with inhaled albuterol via nebulizer (2.5-5 mg) or MDI with valved holding chamber (4-8 puffs) every 20 minutes for 3 doses 1
   • For severe exacerbations, consider continuous nebulization 1

3. Adjunctive therapy:

   • Add ipratropium bromide (500 μg) for severe exacerbations 1
   • Add systemic corticosteroids for moderate-to-severe exacerbations 1

4. Maintenance:

   • Continue albuterol treatments every 1-4 hours based on response 1
   • Transition to MDI before discharge when clinically improved 1

COPD Exacerbation Management

1. Mild exacerbation:

   • Albuterol 200-400 μg via hand-held inhaler 1

2. Moderate-to-severe exacerbation:

   • Nebulized albuterol 2.5-5 mg every 4-6 hours for 24-48 hours 1
   • Consider combined treatment with ipratropium bromide (250-500 μg) for more severe cases 1

3. Important caution:

   • For patients with carbon dioxide retention and acidosis, the nebulizer should be driven by air, not oxygen 1

Special Considerations

Optimal Delivery Techniques

• Dilute nebulizer solutions to a minimum of 3 mL at gas flow of 6-8 L/min for optimal delivery 1
• For MDI use in mild-to-moderate exacerbations, proper technique with valved holding chamber is as effective as nebulized therapy 1

Potential Adverse Effects

• Tachycardia, tremor, and hypokalemia may occur, especially with frequent administration 2
• Rare paradoxical bronchospasm has been reported with both MDI and nebulized albuterol 4
• Monitor heart rate and oxygen saturation during treatment 5

Dosing Considerations

• Higher than customary doses may be needed during acute exacerbations 5
• For continuous nebulization in severe cases, higher doses may be required 1
• If a previously effective dosage regimen fails to provide relief, seek medical advice immediately as this may indicate worsening asthma requiring reassessment 3

Alternative Approaches

• For mild persistent asthma, combination therapy of beclomethasone and albuterol in a single inhaler used as needed may be effective 6
• Levalbuterol (R-albuterol) administered in half the milligram dose of albuterol provides comparable efficacy and safety 1

Monitoring Response

• Assess symptoms, physical examination, PEF, and oxygen saturation after each treatment 1
• Continue treatment until FEV1 or PEF >75% predicted normal or best 1
• Transition to hand-held inhaler 24 hours prior to discharge 1