Asthaline vs Salbutamol: Equivalence and Dosing
Asthaline is a brand name for salbutamol (albuterol) and contains the same active ingredient as generic salbutamol, though one study found Asthaline caused more throat irritation and cough despite producing superior bronchodilation compared to Ventolin. 1
Brand Equivalence
- Asthaline, Ventolin, and other generic salbutamol inhalers contain the same active medication (salbutamol/albuterol) 1
- A randomized double-blind study found that Asthaline actually produced the highest improvements in FEV1 and PEFR with longest duration of effect compared to Ventolin and another generic (Salomol) 1
- However, 15 out of 17 patients reported cough sensation after using Asthaline, which may affect compliance despite its superior efficacy 1
- The key difference between brands is not efficacy but tolerability—Asthaline's particle size and formulation may cause more airway irritation 1
Recommended Rescue Inhaler Dosing for Intermittent Asthma
Standard Rescue Dosing (Non-Acute)
- For adults and adolescents with intermittent asthma requiring rescue therapy more than 2-3 times daily, this indicates inadequate control and need for maintenance inhaled corticosteroids, not just increased rescue inhaler use 2
- When rescue therapy is needed, use salbutamol via metered-dose inhaler (MDI), typically 1-2 puffs (100-200 mcg) as needed 3
- A spacer device should be used with MDI to improve medication delivery 2
Acute Severe Asthma Dosing
- Adults with acute severe asthma should receive 5 mg salbutamol via oxygen-driven nebulizer, repeated every 15-30 minutes if not improving 4, 3
- Alternatively, MDI with spacer can deliver 1 puff every few seconds until improvement occurs (maximum 20 puffs = approximately 2 mg), which is equally effective as nebulized therapy 4
- For doses calculated based on lower airway delivery, 2.4 mg via MDI-spacer is equivalent to 6 mg via nebulizer 5
Chronic Persistent Asthma
- For chronic persistent asthma requiring regular nebulized therapy, the dose is typically 2.5 mg salbutamol 4
- Doses above 1 mg salbutamol may be given more conveniently by nebulizer than by multiple MDI actuations 4
Critical Management Points
- If using short-acting beta-agonists more than 2-3 times daily, add inhaled corticosteroids (beclomethasone 400-800 mcg/day) rather than increasing rescue inhaler frequency 2
- Verify proper inhaler technique before escalating therapy—poor technique is a common cause of apparent treatment failure 2
- In acute severe asthma, approximately 70% of patients respond to ≤2.4 mg salbutamol within 1 hour, while 30% show poor response regardless of dose 6
- The 30-minute response to initial salbutamol treatment is the most important predictor of outcome, not the severity of initial presentation 6
Common Pitfalls
- Do not continue escalating rescue inhaler use without adding controller therapy—this addresses bronchoconstriction but not underlying inflammation 7
- Nebulizer therapy produces higher plasma salbutamol levels and more side effects (tremor, anxiety) compared to MDI-spacer for equivalent bronchodilation 5
- Generic formulations may have different tolerability profiles despite equivalent active ingredient—patient-reported throat irritation with Asthaline may reduce adherence 1