What is the normal size of a Metered-Dose Inhaler (MDI) of albuterol?

Standard Albuterol MDI Dose

A standard albuterol metered-dose inhaler (MDI) delivers 90 mcg of albuterol per puff. 1

Key Specifications

• Each actuation of a standard albuterol MDI contains 90 mcg of albuterol 1
• This is the universal standard dose across all albuterol HFA MDI formulations 2, 3
• Most albuterol MDIs contain 200 actuations per canister 3

Clinical Dosing Context

While each puff delivers 90 mcg, the therapeutic dosing varies by clinical scenario:

For Acute Exacerbations

• Adults and children ≥5 years: 4-8 puffs (360-720 mcg) every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 4
• Children under 5 years: 1-2 puffs every 4-6 hours, which may be increased during acute symptoms 4

For Maintenance Therapy

• Children under 5 years: 1-2 puffs every 4-6 hours as needed 4
• Regular use exceeding twice weekly indicates poor asthma control and need for controller medication adjustment 4

Comparison to Other Beta-Agonists

• Pirbuterol MDI delivers 200 mcg/puff 1
• Bitolterol MDI delivers 370 mcg/puff 1
• Levalbuterol (R-albuterol) MDI delivers 45 mcg/puff, which is half the dose of racemic albuterol for comparable efficacy 1

Administration Technique

• Use with a valved holding chamber (spacer) for optimal delivery, especially in children 1, 4
• MDI with spacer is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 1, 5
• For children under 4 years, use a valved holding chamber with face mask 1

Common Pitfall to Avoid

• MDIs contain more propellant than required for the labeled number of actuations, so medication remaining after 200 actuations may deliver subtherapeutic doses 2
• Modern MDIs with integrated dose counters help prevent this issue by accurately tracking remaining doses 2, 3