What is the recommended nebulization dose of Asthalin (Salbutamol) for a 9-month-old patient?

Nebulized Salbutamol Dosing for a 9-Month-Old Infant

For a 9-month-old infant with acute asthma or wheezing, administer nebulized salbutamol (Asthalin) at 0.15 mg/kg per dose, which translates to approximately 1.0-1.5 mg per dose for most infants this age, given every 20 minutes for up to 3 doses initially. 1

Weight-Based Dosing Calculation

• The British Thoracic Society recommends 0.15 mg/kg as the standard weight-based dose for nebulized salbutamol in children. 1
• For a typical 9-month-old weighing 8-10 kg, this calculates to 1.2-1.5 mg per dose. 1
• The alternative fixed dose of 5 mg mentioned in guidelines is intended for older children and adults, not infants. 1

Initial Treatment Protocol for Acute Exacerbation

• Administer the calculated dose (0.15 mg/kg) every 20 minutes for 3 doses as initial therapy. 2, 3
• Use oxygen as the driving gas whenever possible to maintain oxygen saturation >92%. 1
• Reassess the infant 15-30 minutes after each dose to determine response. 2, 3

Important Considerations for Infants

• A metered-dose inhaler with spacer and face mask is actually preferred over nebulization in infants when tolerated, as it is equally effective and more convenient. 1
• However, if the infant cannot tolerate a face mask with spacer, nebulization is the appropriate alternative. 1
• Some infants may require a mouthpiece rather than face mask for nebulization, though most 9-month-olds will need a face mask. 1

When to Escalate Therapy

• If the infant fails to respond adequately after 2-3 doses of salbutamol, add ipratropium bromide 250 mcg to the nebulization and initiate systemic corticosteroids immediately. 1, 2
• Do not delay corticosteroids while continuing repeated salbutamol doses alone if initial treatment fails. 2
• Features indicating severe exacerbation in infants include: too breathless to feed, respiratory rate >50/min, pulse >140/min, and use of accessory muscles. 1, 2

Ongoing Treatment After Initial Doses

• If symptoms improve after initial treatment, continue nebulized salbutamol at the same weight-based dose (0.15 mg/kg) every 4-6 hours as needed. 1
• For severe cases requiring frequent dosing, doses up to 0.3 mg/kg/hour have been used safely in monitored settings, though this requires intensive care supervision. 1

Common Pitfalls to Avoid

• Do not use the adult fixed dose of 5 mg in a 9-month-old infant—this represents excessive dosing and increases risk of tachycardia and tremors without additional benefit. 1
• Do not continue repeated salbutamol doses beyond 3 initial treatments without adding ipratropium and corticosteroids if response is inadequate. 2, 4
• Receiving fewer than 3 doses of nebulized salbutamol in the emergency setting is associated with treatment failure in children with severe exacerbations. 4