From the Guidelines
Albuterol dosing for children should be 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization, as recommended by the most recent guidelines 1.
Key Considerations
- The dose of albuterol for children is based on their weight and the delivery method used.
- For nebulizer solutions, the recommended dose is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization 1.
- For MDI (90 mcg/puff), the recommended dose is 4–8 puffs every 20 minutes for 3 doses, then every 1–4 hours as needed 1.
- It is essential to use a spacer device with inhalers for young children to improve medication delivery and to seek medical advice if symptoms do not improve or worsen after treatment.
Delivery Methods
- Nebulizer solution: 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization 1.
- MDI (90 mcg/puff): 4–8 puffs every 20 minutes for 3 doses, then every 1–4 hours as needed 1.
Important Notes
- Always follow the recommended dosing guidelines and consult with a healthcare professional if there are any concerns or questions.
- Albuterol works by relaxing the smooth muscles in the airways, making breathing easier during asthma attacks or bronchospasm.
- Side effects may include increased heart rate, tremors, or nervousness 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 recommended dose of albuterol for kids is:
- 2.5 mg administered three to four times daily by nebulization for children weighing at least 15 kg
- Albuterol inhalation solution, 0.5% for children weighing < 15 kg who require < 2.5 mg/dose 2
From the Research
Albuterol Dose for Kids
- The National Heart Lung and Blood Institute Asthma Guidelines suggest 0.5 mg/kg/h as the recommended dosage of continuous albuterol for pediatric status asthmaticus 3.
- A study found that weight-based dosage quintiles of continuous albuterol ranged from 0.07-0.29 mg/kg/h to >0.76-3.2 mg/kg/h, with no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles 3.
- Another study used a modified pediatric asthma score (PAS) to initiate/stop continuous albuterol as part of a score-based, RT-driven asthma pathway, with an initial albuterol dose of 15 (10-20) mg/h 4.
- A randomized double-blind study compared two doses of nebulized albuterol (0.30 mg/kg body weight and 0.15 mg/kg) in children with moderate to severe acute asthma, and found that the high-dose hourly regimen resulted in significantly greater improvement in the forced expiratory volume in 1 second (FEV1) 5.
- A randomized controlled double-blind multicenter study found that lower doses of albuterol via metered-dose inhalers (6-12 puffs) were effective, and higher doses (9-18 puffs) were safe in children with moderate to severe acute asthma 6.
Dosage Considerations
- The ideal dosing of albuterol for acute childhood asthma is not well established, and further studies are needed to determine the optimal dose 6.
- Higher albuterol dosage regimens did not result in lower admission rate or shorter length of stay in the ER, but showed similar safety profile for children with moderate to severe acute asthma 6.
- The use of anti-inflammatory reliever (AIR) therapy, which combines an inhaled corticosteroid (ICS) such as budesonide with a reliever as either albuterol or formoterol, may be an effective treatment option for asthma 7.