What are the zones for albuterol (salbutamol) instructions in asthma management?

Albuterol Zones for Asthma Management

Albuterol administration in asthma management follows a zone-based approach determined by peak expiratory flow (PEF) measurements and clinical symptoms, with treatment intensity increasing as severity worsens from mild to life-threatening. 1

Zone Classification

Green Zone (Mild/Normal)

• PEF >75% of predicted or personal best 2
• Normal speech, pulse <110 beats/min, respiratory rate <25 breaths/min 2
• Management: Standard albuterol dosing as needed, no immediate intervention required beyond usual treatment 2

Yellow Zone (Moderate)

• PEF 50-75% of predicted or personal best 2
• Can complete sentences but with difficulty 2
• Management:
  • Increase albuterol use - nebulized salbutamol 5 mg or terbutaline 10 mg 2
  • Add prednisolone 30-60 mg 2
  • Monitor response 15-30 minutes after treatment 2
  • Step up usual treatment and implement self-management plan 2

Red Zone (Severe)

• PEF <50% of predicted or personal best 2
• Cannot complete sentences in one breath, respiratory rate >25 breaths/min, pulse >110 beats/min 2
• Management:
  • Immediate nebulized salbutamol 5 mg or terbutaline 10 mg with oxygen as driving gas 2
  • Prednisolone 30-60 mg or IV hydrocortisone 200 mg 2
  • Consider hospital admission if multiple features present 2
  • Repeat nebulized treatment every 15-30 minutes if not improving 2

Critical Zone (Life-threatening)

• PEF <33% of predicted or personal best 2
• Silent chest, cyanosis, feeble respiratory effort, bradycardia, hypotension, exhaustion, confusion, or coma 2
• Management:
  • Immediate oxygen 40-60% 2
  • Nebulized salbutamol 10 mg or terbutaline 5 mg 2
  • Prednisolone 30-60 mg or IV hydrocortisone 200 mg 2
  • Consider adding ipratropium 0.5 mg to nebulizer 2
  • Hospital admission with potential ICU transfer 2

Administration Methods

Nebulizer Administration

• For severe or life-threatening asthma exacerbations 1
• Dosing: 2.5 mg/3 mL solution (equivalent to 3 mg albuterol sulfate) 3
• Administration time: 5-15 minutes until no more mist forms in nebulizer chamber 3
• Particularly effective for patients unable to coordinate breathing with MDI use 4

Metered-Dose Inhaler (MDI) Administration

• Equally effective as nebulizer when used correctly with spacer device 5
• Typically 1/4 of nebulizer dosing for equivalent effect 6
• Can provide faster treatment times and shorter ED stays (163.6 vs 175 min) 5
• Lower total albuterol dose required (1,125 μg vs 6,700 μg) 5

Monitoring and Follow-up

During Acute Treatment

• Measure PEF 15-30 minutes after starting treatment 2
• Maintain oxygen saturation >92% 2
• Chart PEF before and after bronchodilator administration 2

Discharge Criteria

• PEF >75% of predicted or personal best with diurnal variability <25% 2
• On discharge medication for 24 hours with inhaler technique checked 2
• Provided with written self-management plan 2
• Follow-up with primary care within 1 week 2
• Follow-up in respiratory clinic within 4 weeks 2

Common Pitfalls to Avoid

• Underestimating severity - always use objective measurements like PEF 1
• Delaying corticosteroid administration in moderate to severe exacerbations 1
• Using sedatives during asthma exacerbations - strictly contraindicated 1
• Failing to provide patients with a written action plan based on peak flow zones 2
• Not checking inhaler technique before discharge, leading to ineffective home treatment 2