From the Guidelines
The standard dose of albuterol nebulizer treatment for adults is 2.5–5 mg every 20 minutes for 3 doses, then 2.5–10 mg every 1–4 hours as needed, while for children, the dose is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, as recommended by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 1.
Key Considerations
- The medication should be diluted with normal saline to a total volume of 3 mL at a gas flow of 6–8 L/min for optimal delivery.
- Large volume nebulizers should be used for continuous administration.
- Albuterol can be mixed with ipratropium nebulizer solution.
- Potential side effects include tremor, tachycardia, and nervousness.
Administration
- Patients should be seated upright and instructed to breathe normally through the mouthpiece until the solution is completely nebulized, which typically takes 5-10 minutes.
- The onset of action is typically within 5-15 minutes, with effects lasting 4-6 hours.
Evidence-Based Recommendations
- The National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations provide the most recent and highest quality evidence for albuterol nebulizer treatment dosing 1.
- The guidelines recommend selective beta2-agonists, such as albuterol, for the treatment of asthma exacerbations.
- The guidelines also provide recommendations for the use of ipratropium bromide in combination with albuterol for severe exacerbations.
From the FDA Drug Label
Patient Package Insert Albuterol Sulfate Inhalation Solution, 0.083%* 2.5 mg*/3 mL *Potency expressed as albuterol, equivalent to 3 mg albuterol sulfate. Note: This is a unit-dose vial. No dilution is required. INSTRUCTIONS FOR USE Remove vial from the foil pouch. Twist the cap completely off the vial and squeeze the contents into the nebulizer reservoir More frequent administration or higher doses are not recommended.
The recommended dose for albuterol neb treatment is 2.5 mg (equivalent to 3 mg albuterol sulfate) per treatment, administered as needed 2.
From the Research
Albuterol Neb Treatment Dose
- The optimal dose of albuterol for neb treatment is not well established, with different studies suggesting various dosages 3, 4, 5, 6, 7.
- A study from 1995 compared high-dose continuous nebulization of albuterol (7.5 mg/h) to high-dose intermittent nebulization of albuterol (2.5 mg every 20 minutes) and found that both regimens were safe and efficacious in the early treatment of asthma in an emergency department 3.
- Another study from 2020 compared two continuous nebulized albuterol doses (10 vs. 25 mg/h) in critically ill children with status asthmaticus and found that the lower dose was associated with lower fluid bolus resuscitation without increased adjunctive therapies 4.
- A 2021 study examined the association of various weight-based doses of continuous albuterol on hospital length of stay and found no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles of weight-based dosage 5.
- A 1993 study tested the efficacy and safety of a continuous albuterol protocol for the treatment of acute adult asthma attacks and found that patients showed statistically significant increases in peak flow and statistically significant decreases in respiratory rate, pulse, and clinical severity 6.
- A 2006 study compared the efficacy of continuous nebulized albuterol (15 mg) versus continuous nebulized albuterol (15 mg) plus ipratropium bromide (2 mg) for the treatment of acute asthma and found no statistically significant difference in improvement of mean PEFR at 60 or 120 min between groups 7.