Recommended Salbutamol Dose for Pediatric Patients
For acute asthma exacerbations in children, administer nebulized salbutamol at 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, or use a simplified weight-based approach: 2.5 mg for children <20 kg and 5 mg for children ≥20 kg. 1
Acute Asthma Management - Nebulized Therapy
Initial Treatment Dosing
- Weight-based dosing: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for the first 3 doses 1
- Simplified weight-based approach (equally effective):
- Very young children: Consider half doses (e.g., 2.5 mg reduced appropriately) 3
Maintenance Dosing After Initial Treatment
- Continue at 0.15-0.3 mg/kg every 1-4 hours as needed based on clinical response 1
- Standard maintenance: 4-6 hourly nebulizations 3
- If not improving after 15-30 minutes: increase frequency to every 15-30 minutes 3
Administration Technique
- Dilute salbutamol in 2-3 mL normal saline for adequate nebulization 1
- Use oxygen as the preferred gas source for nebulization (6-8 L/min flow rate) 1
- For young children (e.g., 2-year-olds) who won't tolerate a mouthpiece, use a face mask 1
- Maintain oxygen saturation >92% during treatment 3, 1
Metered-Dose Inhaler (MDI) Alternative
MDI with spacer is equally effective as nebulization when used with proper technique 1, 4
MDI Dosing Protocol
- Acute treatment: 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses 1
- Maintenance: Every 1-4 hours as needed 1
- Always use with a spacer/holding chamber for proper delivery 1
- Requires appropriate technique and coaching 1
Severe/Life-Threatening Asthma
Enhanced Treatment Protocol
- Add ipratropium bromide 100-250 mcg to nebulizer, repeat every 6 hours until improvement 3, 1
- Continuous nebulization for refractory cases: 0.5 mg/kg/hour up to 10-15 mg/hour 1
- Consider intravenous salbutamol if nebulized therapy fails (loading dose 1 mcg/kg/min over 10 minutes, then 0.2 mcg/kg/min, titrate up to 4 mcg/kg/min) 5
Monitoring Requirements
- Assess clinical response after each nebulization 1
- Monitor heart rate, respiratory rate, oxygen saturation continuously 1
- Repeat peak expiratory flow measurements 15-30 minutes after treatment 3
- Watch for tachycardia, tremor, and hypokalemia with frequent dosing 1
Levalbuterol (Alternative)
If using levalbuterol instead of racemic albuterol, administer at half the dose 2, 6:
- 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses 6
- Maintenance: 0.075-0.15 mg/kg every 1-4 hours 6
Special Populations
Perioperative Use
- For children <6 years with upper respiratory infections requiring anesthesia: administer nebulized salbutamol (2.5 mg for <20 kg, 5 mg for >20 kg) 30 minutes before induction to reduce respiratory complications by approximately 50% 2, 1
Important Caveats
- Fixed-dose approach (2.5 mg for all children with mild-moderate asthma) can be as effective as weight-based dosing 1
- Children should use salbutamol under adult supervision 7
- Maximum daily nebulized dose should not exceed 40 mg 3
- Regular use exceeding twice weekly indicates poor asthma control and need for controller medication adjustment 2