What is the recommended dosage and treatment protocol for Salbutamol (albuterol) in managing acute bronchospasm?

Salbutamol (Albuterol) Dosage and Treatment Protocol for Acute Bronchospasm

For acute bronchospasm management, salbutamol should be administered via nebulizer at a dose of 2.5 mg in 3 cc of saline for adults, with doses of 1.25-5 mg for children 5-11 years and 0.63 mg for children under 5 years. 1

Adult Dosing

Nebulizer Administration

• For adults with acute bronchospasm: 2.5 mg in 3 cc of saline 1
• May double dose for severe exacerbations 1
• For continuous nebulization: 7.5 mg/hour is as effective as higher doses (15 mg/hour) 2
• Nebulized treatments typically given every 4-6 hours, but may be used more frequently if required 1

Metered-Dose Inhaler (MDI)

• Two inhalations (90 mcg per actuation) every 4-6 hours 3
• More frequent administration or larger number of inhalations is not recommended 3
• In some patients, one inhalation every 4 hours may be sufficient 3

Pediatric Dosing

Nebulizer Administration

• Children under 5 years: 0.63 mg/3 mL 1
• Children 5-11 years: 1.25-5 mg in 3 cc of saline 1
• For severe episodes in children: 0.15 mg/kg 1

Metered-Dose Inhaler

• Children 4 years and older: same as adults - two inhalations every 4-6 hours 3

Treatment Protocol for Acute Bronchospasm

Initial Assessment and Treatment

• Assess severity using airway, breathing, circulation (ABC) approach 1
• Administer oxygen if hypoxic 1
• For moderate exacerbations:
  • Administer salbutamol 2.5-5 mg via nebulizer 1
  • Alternative: ipratropium bromide 0.25-0.5 mg 1

Severe Exacerbations

• For severe exacerbations or poor response to initial treatment:
  • Combine salbutamol with ipratropium bromide 500 μg 1
  • May double salbutamol dose 1
  • Consider systemic corticosteroids (prednisolone 30 mg/day or hydrocortisone 100 mg if oral route not possible) 1

Continuous Nebulization

• For severe, persistent bronchospasm: consider continuous nebulization 1
• Effective dose: 7.5 mg/hour (higher doses of 15 mg/hour show no additional benefit) 2

Treatment Failure

• If inadequate response to nebulized bronchodilators:
  • Consider intravenous methylxanthines (aminophylline 0.5 mg/kg per hour) 1
  • Monitor theophylline blood levels daily if used 1
  • Consider magnesium sulfate 1

Special Considerations

Children with Upper Respiratory Infection

• For children under 6 years with URI undergoing anesthesia: administer inhaled salbutamol before general anesthesia 1
• Recommended dose: 2.5 mg for children <20 kg, 5 mg for children >20 kg 1

Exercise-Induced Bronchospasm Prevention

• Two inhalations 15-30 minutes before exercise 3

Monitoring and Follow-up

• Continue nebulized bronchodilators for 24-48 hours or until clinical improvement 1
• After improvement, transition to metered dose inhaler or dry powder inhaler 1
• If previously effective dose regimen fails to provide usual response, reevaluate treatment and consider anti-inflammatory therapy 3

Common Pitfalls and Caveats

• Nebulizers should be driven by compressed air (not oxygen) in COPD patients with elevated PaCO₂ or respiratory acidosis 1
• Oxygen can be continued via nasal prongs at 1-2 L/min during nebulization to prevent desaturation 1
• MDI with spacer may be as effective as nebulization for treating acute bronchospasm in some patients 4
• Side effects may include tremor and tachycardia, particularly at higher doses 5
• Proper cleaning and maintenance of inhalers is essential to prevent medication buildup and blockage 3