What is the dosing protocol for nebulization with Asthalin (salbutamol)?

Nebulized Asthalin (Salbutamol) Dosing Protocol

For acute asthma or COPD exacerbations, administer nebulized salbutamol 2.5-5 mg every 20 minutes for three doses initially, then every 4-6 hours as needed, driven by oxygen in asthma or air in COPD. 1

Initial Treatment for Acute Exacerbations

Asthma

• Start with salbutamol 2.5-5 mg nebulized every 20 minutes for the first hour (3 doses total) 1
• Use oxygen as the driving gas at 6-8 L/min to simultaneously treat hypoxemia and bronchospasm 1
• For severe cases or poor initial response, add ipratropium bromide 500 µg to each nebulization 2, 1
• After the first hour, continue salbutamol 5 mg every 4-6 hours until peak flow reaches >75% predicted 2

COPD Exacerbations

• Use salbutamol 2.5-5 mg every 4-6 hours for 24-48 hours or until clinical improvement 2, 1
• Critical: Drive nebulizer with compressed air, NOT oxygen, to prevent worsening CO2 retention and acidosis 2, 1
• If supplemental oxygen is needed, administer low-flow oxygen (4 L/min) via nasal cannula simultaneously with air-driven nebulization 1
• Consider adding ipratropium bromide 500 µg for more severe exacerbations, especially with poor response to beta-agonist alone 2

Pediatric Dosing

For children, use weight-based dosing of 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for three doses, then every 1-4 hours as needed 2, 3

• For a typical 9-month-old infant (8-10 kg), this translates to 1.2-1.5 mg per dose 3
• Avoid using the adult fixed dose of 5 mg in infants—this represents excessive dosing and increases risk of tachycardia and tremors 3

Practical Administration Details

Dilution and Delivery

• Dilute salbutamol in a minimum of 2-3 mL normal saline for adequate nebulization 2
• Use mouthpiece for cooperative patients; use tight-fitting face mask for acutely breathless patients or young children 1
• Continue nebulization until aerosol production ceases (typically 5-10 minutes) 2

Continuous Nebulization for Severe Cases

• For refractory severe asthma, consider continuous nebulization at 0.5 mg/kg/hour up to 10-15 mg/hour 2
• Dilute in 25-30 mL saline for one hour of continuous delivery 2

Monitoring and Reassessment

Reassess patients at 15,30,60,120,180, and 240 minutes after initiating treatment 1

• Measure peak expiratory flow before and after each treatment 2
• Monitor for side effects: tachycardia (heart rate >110/min in adults), tremor, palpitations 2, 4
• In hospitalized COPD patients, measure arterial blood gases; if CO2 retention is present, confirm air-driven nebulization 1

Transition to Discharge

Switch from nebulizer to metered-dose inhaler 24-48 hours before hospital discharge 2, 1

• Once peak flow reaches >75% predicted with <25% diurnal variability, transition to hand-held devices 2
• After initial stabilization (24 hours post-admission), consider as-required dosing rather than scheduled dosing to reduce total drug exposure and side effects 5

Common Pitfalls to Avoid

• Never routinely use oxygen-driven nebulizers in COPD—this can precipitate respiratory failure from CO2 retention 1
• Do not continue high-frequency nebulization beyond the acute phase; transition to less frequent dosing once improvement occurs 2
• Higher doses (7.5 mg) provide no additional benefit over standard 2.5 mg doses in most patients and increase side effects 6
• The optimal dose for bronchodilation with minimal side effects is 2.5-3 mg, not the commonly used 5 mg 4