What is the recommended dosage of albuterol (salbutamol) respules for nebulizer for treating bronchospasm?

Albuterol Respules for Nebulizer Dosage

For adults with acute bronchospasm, use 2.5 mg albuterol in 3 mL of saline every 20 minutes for three doses, then every 4-6 hours as needed; for children ages 5-11 years, use 1.25-5 mg in 3 mL of saline; and for children under 5 years, use 0.63 mg/3 mL. 1

Age-Specific Dosing Recommendations

Adults

• Standard dose: 2.5 mg in 3 mL of saline every 4-6 hours for maintenance therapy 1
• Acute exacerbations: 2.5 mg every 20 minutes for three doses, then reassess 1
• Severe exacerbations: May double the dose to 5 mg for severe cases 1
• Maximum response: Most hospitalized asthmatics (72%) require cumulative doses of 7.5 mg to achieve maximum bronchodilation 2

Children (5-11 years)

• Dosing range: 1.25-5 mg in 3 mL of saline 1
• Acute severe asthma: 5 mg or 0.15 mg/kg, whichever is appropriate 1
• Frequency: Same as adults - every 20 minutes for three doses in acute settings, then every 4-6 hours 1

Children (<5 years)

• Standard dose: 0.63 mg/3 mL 1
• Alternative dosing: 0.15 mg/kg for acute severe asthma 1

Clinical Context and Timing

Onset and Duration

• Onset of action: Most patients show improvement within 5 minutes as measured by FEV1 3
• Peak effect: Maximum bronchodilation typically occurs at approximately 1 hour 3
• Duration: Clinically significant improvement (≥15% increase in FEV1) continues for 3-4 hours in most patients, and up to 6 hours in some 3

Acute Exacerbation Protocol

• Initial treatment: Administer 2.5 mg (or 5 mg for severe cases) every 20 minutes for up to three doses 1
• Continued therapy: If response is adequate, decrease frequency to every 4-6 hours 1
• Poor response: Consider continuous nebulization at 7.5 mg/hour for refractory cases 4

Important Clinical Considerations

Combination Therapy

• May be mixed with cromolyn solution, budesonide inhalant suspension, or ipratropium solution for nebulization 1
• For COPD exacerbations: Combine albuterol 2.5-5 mg with ipratropium 250-500 μg every 4-6 hours for superior bronchodilation 1, 5

Dosing Pitfalls to Avoid

• Do not routinely exceed 2.5 mg every 20 minutes unless dealing with severe obstruction, as studies show no advantage in most patients 6
• However, be prepared to escalate to 7.5 mg cumulative doses in hospitalized patients, as 50% require higher than standard 2.5 mg doses to achieve maximum bronchodilation 2
• Continuous nebulization (7.5 mg/hour) is as safe and effective as intermittent dosing for severe asthma, with continued improvement beyond 2 hours 4

Safety Monitoring

• Cardiovascular effects: Monitor pulse rate, blood pressure, and consider ECG in high-risk patients, though side effects are minimal even at doses up to 10 mg 3, 2
• Oxygen saturation: Generally not significantly affected by nebulized albuterol up to 10 mg 2
• In children: Doses above 3 mg may cause heart rate increases >10% 3

Special Populations

• COPD with CO2 retention: Drive nebulizer with air, not oxygen, to prevent worsening hypercapnia 1, 7
• Brittle asthma: May require higher doses (5 mg salbutamol) for sudden severe attacks 1

Transition Strategy

• Switch to MDI: Change to hand-held inhaler 24-48 hours before discharge once peak flow >75% predicted and diurnal variability <25% 1
• Home nebulizer therapy: Only prescribe after formal assessment by respiratory specialist demonstrating ≥15% improvement in peak flow over baseline 1, 7