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

Salbutamol Dosing for a 2-Year-Old Child

For a 2-year-old child with acute asthma or bronchospasm, administer 2.5 mg of nebulized salbutamol every 20 minutes for 3 doses, then every 1-4 hours as needed based on clinical response. 1

Weight-Based Dosing Approach

The most current guidelines recommend a weight-based calculation of 0.15 mg/kg (minimum dose 2.5 mg) for acute exacerbations, which ensures adequate dosing even for smaller children. 1 Since most 2-year-olds weigh less than 20 kg, the practical dose is 2.5 mg per nebulization. 1, 2

Administration Methods

Nebulized Therapy (Preferred for Age 2)

• Dilute the 2.5 mg dose in 2-3 mL of saline for adequate nebulization 1
• Use oxygen as the gas source at 6-8 L/min flow rate for optimal delivery 1
• Use a face mask rather than a mouthpiece for 2-year-olds who will not tolerate a mouthpiece 1
• Administer every 20 minutes for the first 3 doses, then reassess 1

Metered-Dose Inhaler Alternative

If nebulization is unavailable, 4-8 puffs (90 mcg/puff) via MDI with spacer and face mask is equally effective when administered every 20 minutes for 3 doses, then every 1-4 hours as needed. 1, 2 This delivery method requires proper technique and coaching but provides comparable efficacy to nebulized therapy. 1

Dosing Schedule Algorithm

Initial Treatment (First Hour):

• Give 2.5 mg nebulized every 20 minutes for 3 doses 1
• Assess clinical response after each dose 1
• Monitor oxygen saturation, maintaining >92% 1

Ongoing Treatment (After First Hour):

• If good response: Continue 2.5 mg every 1-4 hours as needed 1
• If inadequate response: Continue every 15-30 minutes 1
• Consider adding ipratropium bromide 0.5 mg if life-threatening features present 1

Severe Cases:

• For continuous nebulization: 0.5 mg/kg per hour (maximum 10-15 mg/hour) 1, 2
• Maximum daily dose: 40 mg/day during acute exacerbations 1

Critical Monitoring Parameters

Monitor the following with each dose:

• Respiratory rate and work of breathing 1
• Heart rate (watch for tachycardia) 1
• Oxygen saturation (maintain >92%) 1
• Clinical response 15-30 minutes after each dose 1

Important Caveats

Avoid underdosing: The minimum dose of 2.5 mg applies even to very small children, as lower doses may result in inadequate bronchodilation and treatment failure. 1 A fixed dose of 2.5 mg is as effective as weight-based dosing in mild to moderate acute asthma. 1

Avoid overdosing: Excessive dosing can lead to tachycardia, tremors, and hypokalemia. 1 Stick to the recommended frequency and reassess response rather than increasing individual doses.

Never use oral syrup for acute bronchospasm: Nebulized salbutamol or MDI with spacer is strongly preferred over oral syrup, as inhaled delivery provides superior bronchodilation with fewer systemic side effects. 1

Transfer to hospital if: Life-threatening features are present, persistent severe features despite 3 doses, or deterioration despite treatment. 1