What are the recommended Albuterol (Salbutamol) nebulizer concentrations based on age?

Albuterol Nebulizer Concentrations by Age

For children under 5 years of age, use 0.63 mg/3 mL albuterol nebulizer solution; for children 5-11 years and adults, use 1.25-5 mg in 3 mL of saline, with 2.5 mg being the standard adult dose. 1

Age-Based Dosing Guidelines

Children Under 5 Years

• The standard concentration is 0.63 mg/3 mL, administered every 4-6 hours as needed for routine bronchospasm 1
• For acute exacerbations, this dose can be given every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• For severe exacerbations, the dose may be doubled 1

Children 5-11 Years

• The recommended concentration is 1.25-5 mg in 3 mL of saline 1
• The typical starting dose is 1.25 mg (0.5 mL of 0.5% solution diluted to 3 mL) for mild-moderate symptoms 1
• For acute exacerbations, doses up to 5 mg may be used 1

Adults

• The standard concentration is 2.5 mg in 3 mL of saline 1
• This represents one complete vial of 0.083% albuterol inhalation solution (3 mL) 2
• Administered three to four times daily by nebulization for routine management 2

Weight-Based Considerations

FDA-Approved Dosing

• Children weighing less than 15 kg should use 0.5% albuterol inhalation solution (not the 0.083% concentration) to allow for doses less than 2.5 mg 2
• Children weighing at least 15 kg can use the standard 2.5 mg dose (0.083% solution) 2

Acute Exacerbation Weight-Based Dosing

• For moderate to severe acute asthma, use 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses 3
• Maintenance dosing during exacerbations: 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 3
• Always use the minimum effective dose of 1.25 mg even if weight-based calculation yields a lower number 3

Critical Clinical Pearls

Mixing Compatibility

• Albuterol nebulizer solution can be mixed with cromolyn solution, budesonide inhalant suspension, or ipratropium solution in the same nebulizer 1
• For severe exacerbations, add ipratropium bromide 0.25-0.5 mg to albuterol every 20 minutes for the first 3 doses 3

Administration Technique

• Oxygen is the preferred gas source for nebulization 3
• The flow rate should be regulated (typically 6-8 L/min) so that the solution is delivered over approximately 5-15 minutes 2
• Dilute to a minimum of 3 mL total volume for optimal nebulization 4

Common Pitfalls to Avoid

• Do not use 0.083% concentration (2.5 mg/3 mL) in children under 15 kg who need less than a full vial - this leads to dosing errors 2
• Failure to use weight-based dosing in acute exacerbations may result in under-dosing, particularly in younger children 3
• Increasing use or lack of expected effect indicates worsening asthma control and requires reassessment, not just dose escalation 3

Monitoring Requirements

• Monitor for tachycardia, tremor, hypokalemia, and hyperglycemia 3
• Administration can be repeated and dose adjusted until desired clinical effect is achieved, unless symptomatic tachycardia develops 3