Salbutamol Nebule Dosing and Administration for Acute Bronchospasm
For acute asthma exacerbations in adults, administer salbutamol 2.5-5 mg via nebulizer every 20 minutes for 3 doses, then every 4-6 hours until recovery. 1, 2
Initial Dosing by Clinical Severity
Acute Severe Asthma (Adults)
- Start with 5 mg salbutamol nebulized every 20 minutes for the first hour (3 doses total) 1, 2
- Add ipratropium bromide 500 mcg to each dose if poor initial response or life-threatening features present 1
- After initial hour, continue 2.5-5 mg every 4-6 hours until peak flow >75% predicted 1
Acute Severe Asthma (Children)
- Dose: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1, 2
- Then 0.15-0.3 mg/kg every 1-4 hours as needed 1
COPD Exacerbations
- Mild exacerbations: Use MDI with spacer (200-400 mcg) rather than nebulizer 1
- Severe exacerbations: 2.5-5 mg salbutamol every 4-6 hours for 24-48 hours 1, 2
- Unlike asthma, adding ipratropium provides no additional benefit in acute COPD exacerbations 1
Critical Administration Details
Driving Gas Selection (ESSENTIAL)
- Asthma patients: Use oxygen as driving gas at 6-8 L/min (these patients are hypoxic) 1, 2
- COPD patients: Use compressed air, NOT oxygen, to prevent worsening CO2 retention and acidosis 1, 2
- If COPD patient needs supplemental oxygen during air-driven nebulization, give low-flow oxygen (4 L/min) via nasal cannula simultaneously 2
Delivery Interface
- Face masks preferred for acutely breathless patients who cannot hold mouthpiece 1, 2
- Mouthpieces theoretically better (avoid nasal deposition) but no clinical advantage demonstrated 1
Escalation Protocol for Suboptimal Response
If inadequate response after first dose:
- Repeat nebulization within minutes, or use continuous nebulization until stable 1
- Add ipratropium 500 mcg if not already included 1
- Lack of response to repeated treatments mandates senior clinician review and consideration of noninvasive ventilation or ICU 1
Transition to Discharge
Switch to MDI with spacer 24-48 hours before hospital discharge once patient stabilized (peak flow >75% predicted, diurnal variability <25%) 1, 2
This early transition permits earlier discharge and is equally effective once acute phase resolved 1
Common Pitfalls to Avoid
Dosing Errors
- Do NOT use oxygen-driven nebulizers routinely in COPD—this is a critical safety error that worsens hypercapnia 2
- Measure arterial blood gases in hospitalized patients; if CO2 retention present, mandatory air-driven nebulization 2
Inappropriate Continuation
- Nebulizers offer no advantage over MDI with spacer once patient can coordinate technique 1
- Continuing nebulizers beyond clinical stabilization delays discharge unnecessarily 1