What is the dose of salbutamol (albuterol) 0.5% solution for acute cough?

Salbutamol 0.5% Solution Dosing for Acute Cough

Salbutamol should NOT be routinely used for acute cough unless there is evidence of bronchospasm, wheezing, or underlying asthma/COPD, as it provides no benefit for uncomplicated acute bronchitis and may cause unnecessary side effects. 1

When Salbutamol is NOT Indicated

• In most patients with acute bronchitis and cough without wheezing, β2-agonist bronchodilators should not be routinely used (Grade D recommendation from ACCP guidelines) 1
• Studies in non-asthmatic children with acute cough show oral albuterol does not reduce cough frequency or duration compared to placebo, while causing more tremors and shaking 2
• The Cochrane review on acute bronchitis found no significant benefit from β2-agonists on daily cough scores or number of patients still coughing after 7 days 1

When Salbutamol MAY Be Appropriate

Select adult patients with acute bronchitis who have wheezing accompanying their cough may benefit from β2-agonist treatment (Grade C recommendation) 1

Dosing for Acute Bronchospasm/Asthma with Cough:

Adults:

• Nebulized salbutamol 5 mg (equivalent to 1 mL of 0.5% solution), repeated every 4-6 hours if improvement occurs 1
• For severe cases not responding: repeat at 30 minutes, then consider hourly dosing 1
• May add ipratropium bromide 500 μg if response to salbutamol alone is inadequate 1, 3

Children:

• Nebulized salbutamol 5 mg OR 0.15 mg/kg (whichever is appropriate for weight), repeated 1-4 hourly if improving 1
• For inadequate response: repeat at 30 minutes after adding ipratropium bromide 250 μg 1

Critical Clinical Algorithm

1. First, determine if bronchospasm is present:

   • Wheezing on examination 1
   • Known asthma or COPD 1, 4
   • Evidence of airflow obstruction 1

2. If NO bronchospasm: Do not use salbutamol - consider antitussives instead (Grade C recommendation) 1

3. If bronchospasm present: Use salbutamol 5 mg nebulized (1 mL of 0.5% solution diluted in normal saline to total 2-4 mL for nebulization) 1

4. Assess response at 30 minutes:

   • Good response: continue every 4-6 hours 1
   • Poor response: add ipratropium and consider hospital admission 1, 3

Important Safety Considerations

• In elderly patients, first treatment should be supervised as β-agonists may rarely precipitate angina 1
• Tremor, nervousness, and shakiness are more common with β-agonist treatment 1, 2
• In COPD patients with CO2 retention, drive nebulizer with air, NOT oxygen, to prevent worsening hypercapnia 3, 5

Common Pitfall to Avoid

The most common error is prescribing salbutamol for simple acute cough without evidence of bronchospasm. This provides no clinical benefit, delays appropriate diagnosis, exposes patients to unnecessary side effects (tremor in up to 17% of patients), and is explicitly not recommended by ACCP guidelines. 1, 2