What is the recommended dose of salbutamol (albuterol) for a 2-year-old patient with asthma?

Salbutamol Dosing for a 2-Year-Old

For a 2-year-old with asthma, administer salbutamol 2.5 mg via nebulizer for acute exacerbations, given every 20 minutes for up to 3 doses in the first hour. 1, 2, 3

Acute Exacerbation Dosing

Nebulized Administration (Preferred)

• Dose: 2.5 mg for children ≤2 years of age 1, 3
• Frequency: Every 20 minutes for up to 3 doses in the first hour 1, 2
• Delivery: Via oxygen-driven nebulizer diluted to 4 mL with saline 3
• After initial 3 doses, continue every 4-6 hours as needed based on response 4, 1

MDI with Spacer (Alternative)

• Dose: 4-8 puffs (400-800 mcg) via metered-dose inhaler with large volume spacer 1, 2
• Frequency: Every 20 minutes for 3 doses 1, 2
• MDI with spacer is equally effective to nebulization and may result in lower admission rates with fewer cardiovascular side effects 1
• This is particularly useful when a nebulizer is unavailable 5

Essential Concurrent Therapy

Always combine salbutamol with systemic corticosteroids for acute exacerbations: 1, 2

• Oral prednisolone 1-2 mg/kg (maximum 60 mg) given immediately 1, 2
• Do not delay corticosteroids while giving repeated bronchodilator doses alone 1

Add ipratropium bromide if: 1, 2

• Initial salbutamol treatment fails (no response after 2 doses) 1
• Severe exacerbation at presentation 2
• Dose: 100-250 mcg nebulized, repeated every 6 hours 1

Chronic/Maintenance Dosing

For chronic persistent asthma requiring nebulized therapy: 4

• Dose: 2.5 mg for children weighing <20 kg 4
• Given 2-4 times daily as needed 4
• This should only be used at Step 4 or above of asthma management after optimizing inhaled corticosteroids 4

Monitoring and Reassessment

Reassess 15-30 minutes after each dose: 1, 2

• Measure respiratory rate, oxygen saturation (maintain >92%), and work of breathing 1
• Peak expiratory flow if child can cooperate 2

Escalate care if: 1

• No response after 2 doses within the first hour 1
• Respiratory rate >50/min, pulse >140/min persist 1
• Child too breathless to talk or feed 1

Common Pitfalls to Avoid

• Do not use weight-based dosing (0.1 mg/kg) for nebulized salbutamol in acute settings—fixed dosing of 2.5 mg is equally efficacious and simpler 6
• Do not delay systemic corticosteroids while continuing repeated bronchodilator doses alone 1
• Do not use oral salbutamol for acute exacerbations—inhaled route is far superior for bronchodilation 7
• Ensure proper spacer technique if using MDI—inadequate technique is a common cause of treatment failure 5

Hospital Admission Criteria

Admit if: 1

• Persistent features of severe asthma after initial 3 doses 1
• Peak flow <50% predicted 15-30 minutes after treatment 1
• Inability to maintain oxygen saturation >92% 1