What is the dose of salbutamol (albuterol) for adults and children?

Salbutamol Dosing

For adults and children ≥4 years, administer 2 inhalations (90 mcg/puff) every 4-6 hours as needed via metered-dose inhaler, or 2.5-5 mg via nebulizer every 4-6 hours for routine bronchospasm management. 1

Nebulized Salbutamol Dosing

Routine Bronchospasm Management

• Children <20 kg: Administer 2.5 mg diluted in 2-3 mL normal saline every 4-6 hours as needed 2, 3
• Children ≥20 kg and adults: Administer 5 mg diluted in 2-3 mL normal saline every 4-6 hours as needed 3, 4
• Weight-based alternative: 0.15 mg/kg (minimum 2.5 mg) can be used, though fixed dosing is equally effective for mild-moderate asthma 3

Acute Exacerbations

• Initial treatment: Administer 0.15 mg/kg (minimum 2.5 mg for <20 kg, 5 mg for ≥20 kg) every 20 minutes for 3 doses 3, 4
• Maintenance after initial 3 doses: Continue 0.15-0.3 mg/kg (up to 10 mg) every 1-4 hours based on clinical response 3, 4
• Severe exacerbations: Consider continuous nebulization at 0.5 mg/kg/hour (maximum 10-15 mg/hour) 3

Administration Technique

• Dilute salbutamol to minimum 3 mL total volume with normal saline for optimal nebulizer delivery 2, 3
• Use oxygen as the preferred gas source at 6-8 L/min flow rate 5, 4
• For children <4 years: Use face mask with proper seal rather than mouthpiece 3
• Maintain oxygen saturation >92% during treatment 3

Metered-Dose Inhaler (MDI) Dosing

Routine Use

• Adults and children ≥4 years: 2 puffs (90 mcg/puff = 180 mcg total) every 4-6 hours as needed 1
• Some patients may require only 1 inhalation every 4 hours 1

Acute Exacerbations

• Initial treatment: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 3, 4
• MDI with spacer is equally effective as nebulized therapy when used with proper technique 4, 6

Exercise-Induced Bronchospasm Prevention

• Administer 2 inhalations 15-30 minutes before exercise 4, 1

Critical Administration Requirements

• Children <5 years: Must use spacer/valved holding chamber with face mask—drug delivery is dramatically reduced without it 2, 4
• Children ≥4 years: Use spacer/holding chamber to ensure proper delivery 3
• Prime inhaler with 4 test sprays before first use and if unused for >2 weeks 1

Levalbuterol (Levosalbutamol) Alternative

Levalbuterol provides comparable efficacy at half the milligram dose of racemic salbutamol 5, 2, 4:

• Children <20 kg: 0.63-1.25 mg via nebulizer 2, 4
• Children ≥20 kg and adults: 1.25 mg via nebulizer 2
• Acute exacerbations: 1.25 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 2

Combination Therapy for Severe Cases

• Add ipratropium bromide 0.25-0.5 mg to salbutamol nebulization for severe exacerbations 4, 7
• Salbutamol can be mixed with ipratropium, budesonide, or cromolyn in the same nebulizer 2, 4

Special Clinical Situations

Preoperative Use

• For children <6 years with upper respiratory infections: Administer 2.5 mg (<20 kg) or 5 mg (≥20 kg) 30 minutes before anesthesia to reduce perioperative bronchospasm by approximately 50% 2, 3

Intravenous Route (Severe Refractory Cases)

• A single study showed 15 mcg/kg IV bolus over 10 minutes reduced recovery time from 11.5 hours to 4 hours in children with severe acute asthma unresponsive to initial nebulized treatment 8
• This route is reserved for severe cases where inhaled therapy has failed 8

Monitoring Requirements

• Assess heart rate, respiratory rate, oxygen saturation, and work of breathing after each treatment 2, 3
• Watch for tachycardia, tremor, hypokalemia, hyperglycemia, and headache with frequent administration 2, 4
• Critical warning: Increasing use or lack of expected effect indicates deteriorating asthma control requiring escalation to controller medications 4, 1
• Regular use exceeding 2 days per week for symptom control indicates need for controller medication adjustment 4

Common Pitfalls to Avoid

• Never use oral salbutamol formulations for acute bronchospasm—they have slower onset, reduced effectiveness, and increased systemic side effects compared to inhaled routes 2
• Do not use ultrasonic nebulizers—only jet nebulizers are effective 4
• Discard MDI when dose counter reaches zero 1
• Clean and dry MDI mouthpiece weekly to prevent medication buildup and blockage 1
• For children <2 years, MDI with spacer and face mask may provide faster response than nebulizer (90% vs 71% success at 1 hour) 6

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