What is the recommended dose of Ventolin (albuterol) for acute bronchospasm?

Ventolin (Albuterol) Dosing for Acute Bronchospasm

For acute bronchospasm in adults, administer 2.5 mg albuterol in 3 mL saline via nebulizer every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed; for children 5-11 years use 1.25-5 mg every 20 minutes for 3 doses, then 0.15-0.3 mg/kg (up to 10 mg) every 1-4 hours; and for children under 5 years use 0.63 mg/3 mL. 1

Age-Specific Dosing Protocols

Adults

• Initial treatment: 2.5 mg in 3 mL saline via nebulizer every 20 minutes for 3 doses 1
• Maintenance: 2.5-10 mg every 1-4 hours as needed 1
• Severe exacerbations: Consider continuous nebulization at 7.5 mg/hour 1, 2
• MDI alternative: 2 puffs (200 mcg/puff) every 4-6 hours 3

Children 5-11 Years

• Initial treatment: 1.25-5 mg in 3 mL saline every 20 minutes for 3 doses 1
• Maintenance: 0.15-0.3 mg/kg (maximum 10 mg) every 1-4 hours 1
• MDI alternative: 2 puffs every 4-6 hours 3

Children Under 5 Years

• Recommended dose: 0.63 mg/3 mL via nebulizer 1
• MDI alternative: 1-2 puffs every 4-6 hours via face mask with proper seal 3

Administration Considerations

Nebulizer Technique

• Dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min for optimal delivery 1
• Use jet nebulizers only; ultrasonic nebulizers are ineffective for suspensions 3
• For children under 4 years, use a face mask that fits snugly over nose and mouth 3

Severe Exacerbations

• Continuous nebulization: 7.5 mg/hour is the recommended dose for acute severe exacerbations 1, 2
• Higher doses (15 mg/hour) offer no additional benefit in peak flow improvement or length of stay compared to 7.5 mg/hour 2
• May combine with ipratropium bromide 0.25-0.5 mg for severe cases 3, 1

Clinical Monitoring and Safety

Expected Response

• Onset of action: Improvement in pulmonary function typically occurs within 5 minutes 4
• Peak effect: Maximum improvement usually occurs at approximately 1 hour and remains close to peak for 2 hours 4
• Duration: Clinically significant improvement (≥15% increase in FEV1) continues for 3-4 hours in most patients, up to 6 hours in some 4

Common Side Effects

• Tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 3, 1
• These effects are generally minimal with inhaled route compared to systemic administration 3

Warning Signs of Poor Control

• Increasing use or lack of expected effect indicates diminished asthma control 3, 1
• Regular use exceeding 2 days per week for symptom control (not prevention of exercise-induced bronchospasm) suggests need for controller medication adjustment 3, 1

Important Clinical Pitfalls

Preservative-Related Bronchospasm

• Multi-dose albuterol solutions containing benzalkonium chloride (BAC) can cause paradoxical bronchospasm with repeated nebulization 5
• BAC effects are cumulative and prolonged, particularly in patients with severe asthma receiving frequent treatments 5
• If a patient fails to improve despite appropriate dosing, consider switching to preservative-free formulations 5

Levalbuterol Alternative

• Levalbuterol provides comparable efficacy at one-half the mg dose of racemic albuterol 1
• Adult dose: 0.63-1.25 mg; children 5-11 years: 0.31-1.25 mg; children under 5 years: 0.31 mg/3 mL 1
• Prime the inhaler by releasing actuations before first use 3