Albuterol PRN Dosing
For adults and children ≥12 years with stable asthma, use albuterol MDI 2 puffs (180 mcg) as needed for symptom relief, or nebulizer 2.5 mg three to four times daily as needed. 1
Standard PRN Dosing for Stable Asthma
Adults and Children ≥12 Years
- MDI: 2 puffs (90 mcg per puff = 180 mcg total) as needed for symptom relief 2
- Nebulizer: 2.5 mg (one 3 mL vial of 0.083% solution) three to four times daily as needed 1
- More frequent administration or higher doses are not recommended for routine maintenance 1
Children 2-11 Years
- Weight ≥15 kg: 2.5 mg nebulized three to four times daily as needed 1
- Weight <15 kg: Use 0.5% concentration solution (not 0.083%) to allow for doses less than 2.5 mg 1
- MDI with spacer: 2 puffs as needed (use with valved holding chamber and face mask for children <4 years) 3
Acute Exacerbation Dosing (Emergency/Urgent Care)
Initial Treatment Phase
- Adults nebulizer: 2.5-5 mg every 20 minutes for 3 doses 2
- Adults MDI: 4-8 puffs every 20 minutes for 3 doses 3, 2
- Children nebulizer: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 2, 4
- Children MDI: 4-8 puffs every 20 minutes for 3 doses 3
Maintenance Phase After Initial Treatment
- Every 1-4 hours as needed based on clinical response 2
- For patients with poor initial response (<15% improvement in FEV1 at 15 minutes), continue treatments every 30 minutes 5
- For patients with good initial response (≥15% improvement in FEV1), treatments can be spaced to every 60 minutes 5
Severe Exacerbations
- Continuous nebulization: 10-15 mg/hour for adults or 0.5 mg/kg/hour for children 2, 4
- Add ipratropium bromide 0.25 mg to albuterol for moderate-to-severe exacerbations (may be used for up to 3 hours) 3, 2
Administration Technique
Nebulizer
- Dilute to minimum of 3 mL with normal saline for optimal delivery 2, 4
- Use gas flow of 6-8 L/min 2, 4
- Delivery time should be approximately 5-15 minutes 1
MDI
- Always use with valved holding chamber (spacer) for optimal delivery 2, 6
- For mild-to-moderate exacerbations, MDI with proper technique is as effective as nebulized therapy 2, 4
- For severe exacerbations, nebulized therapy is preferred 2
Important Clinical Caveats
- Seek medical attention immediately if a previously effective dosage regimen fails to provide usual relief, as this indicates seriously worsening asthma requiring reassessment 1
- Monitor for adverse effects including tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 2, 4
- Response to treatment is a better predictor of hospitalization need than initial exacerbation severity 2
- Consider adding systemic corticosteroids early for moderate-to-severe exacerbations 2
Emerging Evidence on Combination Therapy
Recent high-quality evidence demonstrates that as-needed albuterol-budesonide combination (180 mcg albuterol + 160 mcg budesonide) reduces severe exacerbation risk by 26-47% compared to albuterol alone in patients with uncontrolled asthma 7, 8. This represents a paradigm shift from traditional SABA-only rescue therapy, though this combination is not yet standard practice and requires specific FDA-approved combination inhalers 7, 8.