What is the recommended dosage and administration of albuterol (salbutamol) for a 6-month-old infant with respiratory issues such as asthma or wheezing?

Albuterol Dosing for a 6-Month-Old Infant

For a 6-month-old infant with wheezing or respiratory distress, administer albuterol via nebulizer at 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed based on clinical response. 1

Initial Dosing Algorithm

For acute wheezing or respiratory distress:

• Use nebulized albuterol at 0.15 mg/kg per dose (minimum 2.5 mg even if weight-based calculation is lower) 1
• Administer every 20 minutes for the first 3 doses 1
• After initial 3 doses, continue every 1-4 hours as needed based on clinical improvement 1

Alternative MDI approach (if nebulizer unavailable):

• Use MDI with valved holding chamber and face mask delivering 4-8 puffs every 20 minutes for 3 doses 1
• This method is as effective as nebulization when proper technique is used 2
• Critical: Never use MDI without a valved holding chamber and face mask in infants, as delivery will be inadequate 1

Administration Technique

Nebulizer setup:

• Dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min 1
• Albuterol can be mixed with ipratropium in the same nebulizer for severe cases 1
• Delivery should occur over approximately 5-15 minutes 3

For infants weighing less than 15 kg requiring less than 2.5 mg/dose:

• Use albuterol inhalation solution 0.5% instead of 0.083% concentration 3

Clinical Monitoring Parameters

Assess at 15-30 minutes post-treatment:

• Improvement in wheezing and accessory muscle use 1
• Respiratory rate reduction 4
• Oxygen saturation (maintain above 92%) 1
• Heart rate and rhythm 1

Expected response:

• Significant improvement in accessory muscle use and oxygen saturation after first dose 4
• Respiratory rate should decrease by approximately 8-20% 4
• Wheezing score should improve progressively with each treatment 5

Safety Considerations and Side Effects

Common side effects to monitor:

• Mild tachycardia (heart rate may increase by approximately 8 beats/minute) 4
• Transient oxygen desaturation 1
• Tremors 1
• Rare ventricular ectopy 6

No significant concerns with:

• Hypokalemia 6
• QT or QTc prolongation 6
• Blood glucose changes 6

When to Escalate Treatment

Immediate escalation indicators:

• Deteriorating clinical status despite treatment 1
• Persistent hypoxia (oxygen saturation <92%) 1
• Exhaustion, confusion, or decreased level of consciousness 1
• Respiratory arrest or impending respiratory failure 1
• Transfer to intensive care if any of these are present 1

Consider adding:

• Ipratropium bromide for severe exacerbations 1, 2
• Systemic corticosteroids should not be delayed in severe exacerbations 1

Critical Pitfalls to Avoid

• Do not use MDI without proper spacer and face mask - delivery will be inadequate in infants 1
• Do not delay systemic corticosteroids in severe exacerbations 1
• Do not rely solely on rescue medication - if albuterol is needed more than twice weekly, this indicates inadequate control and requires controller medication adjustment 2
• Do not ignore treatment failure - if previously effective dosing fails to provide relief, this signals seriously worsening disease requiring immediate reassessment 3

Follow-Up Requirements

• Reassess within 24-48 hours to evaluate response and adjust therapy 1, 7
• Schedule follow-up with primary care provider within 1 week 1
• Consider step-up therapy if symptoms persist despite appropriate albuterol use 7