What is the recommended dosing of Ventolin (albuterol) for a 23-month-old child with asthma?

From the Guidelines

For a 23-month-old child with asthma, the recommended Ventolin (albuterol) dosing is 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed, via a metered-dose inhaler with a spacer and mask 1.

Key Considerations

• The child's age and weight should be considered when determining the dosage, with a minimum dose of 2.5 mg for nebulizer solution and 4-8 puffs for MDI 1.
• It is essential to use a spacer device with a mask for young children to ensure proper medication delivery, as they may have difficulty coordinating inhalation with actuation.
• Monitoring for side effects, such as increased heart rate, tremors, or irritability, is crucial, and if the child needs Ventolin more than twice weekly, it may indicate poor asthma control, and consultation with their pediatrician about adding controller medications is recommended.
• Keeping track of how often rescue medication is needed helps the doctor adjust the overall asthma management plan.
• Always shake the inhaler well before each use, and have the child take 5-6 normal breaths through the spacer mask after each puff to ensure proper medication delivery.

Dosage Administration

• For acute asthma episodes, the dosage can be increased to 2 puffs every 20 minutes for up to 1 hour if necessary, then return to the regular schedule.
• The use of a large volume nebulizer for continuous administration may be considered, and ipratropium nebulizer solution can be mixed with albuterol for severe exacerbations 1.

Important Notes

• Only selective beta2-agonists are recommended, and systemic therapy has no proven advantage over aerosol therapy 1.
• The addition of ipratropium has not been shown to provide further benefit once the patient is hospitalized, but it may be added to SABA therapy for severe exacerbations 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. Children weighing < 15 kg who require < 2.5 mg/dose (i.e., less than a full vial) should use albuterol inhalation solution, 0.5% instead of albuterol inhalation solution, 0. 083%. The dosing for a 23-month-old with asthma is not directly stated in the label, as the label only provides guidance for children 2 to 12 years of age and those weighing at least 15 kg. Since a 23-month-old is less than 2 years old and likely weighs less than 15 kg, the label does not provide a clear recommendation for this age group. Therefore, the dosing for a 23-month-old with asthma cannot be determined from the provided label information 2.

From the Research

Ventolin Dosing for 23-Month-Old with Asthma

• The provided studies do not directly address the dosing of Ventolin (albuterol) for a 23-month-old child with asthma 3, 4, 5, 6, 7.
• However, according to the study by 3, montelukast is approved for children ages ≥ 12 months, and inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for persistent asthma.
• The studies 4, 5, 6 compare the efficacy of metered-dose inhalers (MDIs) with spacers to nebulizers for delivering albuterol in pediatric patients with asthma exacerbations, but do not provide specific dosing information for a 23-month-old child.
• The study by 7 evaluates the efficacy and safety of an albuterol-budesonide fixed-dose combination rescue inhaler for asthma, but the age range of the participants is ≥ 12 years of age for the higher-dose combination group and 4-11 years of age for the lower-dose combination group.
• There is no specific information available in the provided studies to determine the appropriate Ventolin dosing for a 23-month-old child with asthma.