Do salbutamol (albuterol) tablets help with asthma symptoms?

Oral Salbutamol for Asthma: Limited Role as Second-Line Treatment

Oral salbutamol tablets can help with asthma symptoms, but they should be considered only as second-line treatment to inhaled bronchodilators, as they act more slowly, are less effective, and cause more side effects than inhaled formulations. 1

Why Inhaled Salbutamol is Preferred

• Inhaled salbutamol is the treatment of choice for relief of acute asthma symptoms, providing rapid bronchodilation that typically begins within 5 minutes and peaks at approximately 1 hour 1, 2

• Oral formulations act more slowly than inhaled agents and are "much less suitable for short term relief of symptoms" 1

• Side effects are significantly more common with oral administration compared to inhalation therapy, particularly tremor, tachycardia, and hypokalaemia 3

• The FDA label confirms that less than 20% of an inhaled dose is systemically absorbed, while oral tablets result in much higher systemic exposure and consequently more adverse effects 2

When Oral Salbutamol May Be Appropriate

Oral salbutamol tablets have a specific niche role in patients who cannot coordinate inhaler use despite proper technique instruction and spacer devices 1, 3

• Oral formulations "still afford clinically significant bronchodilation" even though they are less efficacious than inhaled forms 3

• Controlled-release oral salbutamol tablets provide better symptom control and higher peak expiratory flow rates than standard immediate-release tablets, with comparable side effects 4

• The elimination half-life of oral salbutamol is 5-6 hours, providing sustained bronchodilation 2

Clinical Algorithm for Salbutamol Selection

1. First-line: Inhaled salbutamol via metered-dose inhaler for all patients capable of proper technique 1

2. If MDI technique inadequate: Add large volume spacer device 1

3. If MDI plus spacer still problematic: Consider dry powder inhaler or breath-actuated MDI 1, 5

4. Only if all inhaled options fail: Use oral salbutamol tablets as second-line treatment 1

Important Caveats

• Regular daily use of any short-acting beta-agonist is not recommended for chronic asthma control; use >2 days per week for symptom relief indicates inadequate control and need for anti-inflammatory therapy 1

• Oral salbutamol produces therapeutic effects similar to oral theophylline but without the need for serum level monitoring 1

• Never use oral salbutamol for acute severe asthma exacerbations—these require high-dose nebulized or inhaled beta-agonists plus systemic corticosteroids 1

• Intravenous salbutamol, despite occasional use in severe asthma, does not lead to significant improvements in clinical outcomes compared to inhaled routes 1