Albuterol MDI Dosage Per Puff
Standard albuterol metered-dose inhalers deliver 90 mcg of albuterol per puff. 1, 2
Standard Dosing Information
- Each actuation of a standard albuterol MDI contains 90 mcg of albuterol 1, 2
- Levalbuterol (R-albuterol) MDI contains 45 mcg per puff, which is half the dose of racemic albuterol 2
- Other beta-agonist MDIs have different strengths: pirbuterol delivers 200 mcg/puff and bitolterol delivers 370 mcg/puff 1
Clinical Dosing for Acute Exacerbations
For acute asthma exacerbations, the recommended dose is 4-8 puffs (360-720 mcg) every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2, 3
Dosing Algorithm by Severity:
- Mild-to-moderate exacerbations: 4-8 puffs every 20 minutes for 3 doses with valved holding chamber (VHC), which is as effective as nebulized therapy when proper technique is used 1, 2
- Severe exacerbations: Consider nebulized therapy over MDI, or use higher end of MDI dosing range (8 puffs) 2
- Maintenance therapy: Adjust frequency to every 1-4 hours as needed after initial treatment 1, 2
Administration Technique Considerations
- Always use a valved holding chamber (VHC) or spacer device to improve medication delivery, particularly in patients with difficulty coordinating inhalation 3
- For children under 4 years, use VHC with face mask 1
- Research demonstrates that only 2.3-5% of the nominal MDI dose reaches the lungs in mechanically ventilated patients, even with optimal spacing devices 4
Important Clinical Caveats
- Monitor for dose-related side effects: tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 2, 5
- In mechanically ventilated patients, doses up to 15 puffs (1,350 mcg) have been shown effective, though one study reported a hypotensive reaction at this dose 6
- The bronchodilator effect typically lasts 90-120 minutes and returns to baseline by 4 hours, supporting dosing intervals of every 4 hours for maintenance 7