Albuterol MDI Dosing for Pediatric Patients
Standard albuterol metered-dose inhalers deliver 90 mcg per puff, and for pediatric patients with acute asthma exacerbations, the recommended dose is 4-8 puffs (360-720 mcg) every 20 minutes for 3 doses, then every 1-4 hours as needed. 1, 2
Standard MDI Strength
- Each actuation of a standard albuterol MDI contains 90 mcg of albuterol 2
- This is the universal strength across manufacturers for standard albuterol MDIs 2
Acute Exacerbation Dosing Protocol
Initial Treatment Phase
- Administer 4-8 puffs (360-720 mcg total) every 20 minutes for 3 doses during the first hour 1, 2
- For children under 4 years, use a valved holding chamber (spacer) with face mask for optimal delivery 2
- The 20-minute interval refers to time between complete treatment sessions (all 4-8 puffs), not between individual puffs 2
Maintenance Phase
- After initial 3 doses, continue 4-8 puffs every 1-4 hours as needed based on severity and clinical response 1, 2
- Frequency should be adjusted based on symptom control and side effects 2
Administration Technique
- Administer all 4-8 puffs rapidly in succession (within 1-2 minutes) using a spacer device 2
- Wait 20 minutes before the next complete treatment session 2
- Ensure proper spacer technique with adequate seal and single actuation per inhalation 2
Equivalence to Nebulized Therapy
- In mild-to-moderate exacerbations, MDI with valved holding chamber is as effective as nebulized therapy when proper technique is used and coaching is provided 1, 2
- For severe exacerbations, nebulized therapy may be preferred 2
Critical Adjunctive Therapy
- Add systemic corticosteroids early (e.g., prednisone 1-2 mg/kg/day, maximum 60 mg/day) for 3-10 days 2
- Consider adding ipratropium bromide (4-8 puffs) for moderate-to-severe exacerbations: administer every 20 minutes for up to 3 hours 2
- Do not continue ipratropium once patient is hospitalized, as additional benefit has not been demonstrated 2
Common Pitfalls to Avoid
- Do not space individual puffs excessively during acute exacerbations - this delays treatment and may worsen outcomes 2
- Do not use albuterol as sole treatment for persistent asthma - increasing frequency signals inadequate disease control requiring inhaled corticosteroid therapy 3
- Ensure proper spacer seal, especially in young children with face masks 2
Monitoring Parameters
- Monitor for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 2, 3
- Assess clinical response after each treatment session including respiratory rate, work of breathing, and oxygen saturation 2
- Watch for signs of impending respiratory failure: inability to speak, altered mental status, intercostal retraction, worsening fatigue 1