Albuterol Dosing for Pediatric Patients
For children weighing ≥15 kg, administer 2.5 mg of albuterol via nebulizer every 4-6 hours for routine bronchodilation, or 2.5 mg every 20 minutes for 3 doses during acute exacerbations, followed by every 1-4 hours as needed. 1
Standard Dosing by Weight and Age
Nebulizer Solution Dosing
Children ≥15 kg:
- Routine maintenance: 2.5 mg (one 3 mL vial of 0.083% solution) administered 3-4 times daily 1
- Acute exacerbations: 2.5 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 2
- For severe exacerbations, consider doubling the dose 2
Children <15 kg:
- Use 0.5% albuterol solution instead of 0.083% to allow for weight-based dosing below 2.5 mg 1
- Weight-based dosing: 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses during acute exacerbations 2
- Always use the minimum dose of 1.25 mg even if weight-based calculation yields a lower number 2
Children under 5 years:
- 0.63 mg/3 mL every 4-6 hours as needed for routine use 2
- For acute situations: every 20 minutes for 3 doses, then every 1-4 hours 2
Metered-Dose Inhaler (MDI) Dosing
Children under 5 years:
- Routine: 1-2 puffs (90 mcg per puff) every 4-6 hours as needed 2
- Acute exacerbations: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours 2
- Critical requirement: Must use spacer/holding chamber with face mask for children <4 years 2, 1
Children 5-11 years:
- Routine: 2 puffs every 4-6 hours as needed 2
- Acute exacerbations: 4-8 puffs every 20 minutes for 3 doses 2
Administration technique: Puffs can be taken in 10-15 second intervals 2
Severe Exacerbations and Status Asthmaticus
Continuous Nebulization
For severe status asthmaticus requiring continuous therapy:
- 0.5 mg/kg/hour up to 10-15 mg/hour 2
- Dilute in 25-30 mL saline for 1 hour of nebulization 2
- Research supports that doses ranging from 0.07-3.2 mg/kg/hour have been used, though no optimal dose has been definitively established 3
- High-dose continuous albuterol (up to 3.7 mg/kg/hour) has been shown safe with low rates of mechanical ventilation and short PICU stays 4
Adjunctive Therapy
Add ipratropium bromide for severe exacerbations:
- 0.25-0.5 mg via nebulizer every 20 minutes for 3 doses, then every 6 hours 5, 2
- Can be mixed with albuterol in the same nebulizer solution 2
- This combination is particularly important for bronchospasm resistant to epinephrine or in moderate-to-severe presentations 5
Critical Administration Considerations
Delivery Method Optimization
- Oxygen-driven nebulizer preferred: Use 6-8 L/min flow rate 2
- MDI with spacer is equally effective as nebulized therapy when used with proper technique 6
- Failure to use spacer with face mask in children <4 years dramatically reduces drug delivery 2
Monitoring Requirements
- Monitor heart rate, respiratory rate, work of breathing, and oxygen saturation after each treatment 7
- Watch for adverse effects: tachycardia, tremor, hypokalemia, hyperglycemia 2
- Maintain oxygen saturation ≥90-92% throughout treatment 7, 2
Common Pitfalls and Caveats
Weight-based dosing errors: At 12 months of age, weight-based calculations may yield doses below the minimum effective threshold—always use at least 1.25 mg for nebulized treatments 2
Spacer technique failures: For children under 4 years, improper spacer use or omitting the face mask results in inadequate drug delivery and treatment failure 2
Escalating use as warning sign: Increasing albuterol requirements or lack of expected effect indicates deteriorating asthma control and necessitates immediate reassessment 2, 1
Concurrent corticosteroids: Always administer systemic corticosteroids (prednisolone 1-2 mg/kg/day, maximum 40 mg) concurrently for moderate to severe exacerbations 6, 7
Alternative Formulation
Levalbuterol (R-albuterol):