Are salbutamol and albuterol the same medication, and what is the appropriate rescue dosing for an adult with intermittent asthma?

Salbutamol and Albuterol: Same Medication, Different Names

Salbutamol and albuterol are identical medications—salbutamol is the international nonproprietary name (INN) used globally, while albuterol is the United States Adopted Name (USAN). 1, 2

Nomenclature Clarification

• Salbutamol is the term used in most countries worldwide, including Europe, Australia, and Asia 1, 2
• Albuterol is the term used exclusively in the United States 1
• Both names refer to the same chemical compound: a selective short-acting β2-agonist (SABA) bronchodilator 2
• The medication works identically regardless of which name appears on the label—it relaxes bronchial smooth muscle through β2-receptor stimulation 2

Appropriate Rescue Dosing for Adults with Intermittent Asthma

Metered-Dose Inhaler (MDI) Dosing

For acute symptom relief in adults with intermittent asthma, administer 4-8 puffs (360-720 mcg total) of albuterol/salbutamol MDI every 20 minutes for 3 doses, then every 1-4 hours as needed. 3

• Each standard albuterol/salbutamol MDI actuation delivers 90 mcg 3
• Always use a valved holding chamber (spacer) with MDI administration—this delivery method is as effective as nebulized therapy for mild-to-moderate symptoms when proper technique is employed 3
• Actuate only one puff at a time into the spacer, followed by slow deep inhalation and 10-second breath-hold 3
• The 20-minute interval refers to time between complete treatment sessions (all 4-8 puffs), not between individual puffs 3

Nebulizer Solution Dosing

For nebulized delivery, administer 2.5-5 mg of albuterol/salbutamol every 20 minutes for 3 doses during the first hour, then every 1-4 hours as needed based on symptom control. 3

• Dilute each dose in at least 3 mL of normal saline 3
• Use oxygen as the driving gas at 6-8 L/min flow when feasible 3
• Nebulized therapy may be preferred when respiratory distress is more severe or when the patient cannot coordinate MDI technique effectively 3

Key Clinical Considerations

Short-acting β2-agonists are the treatment of choice for acute symptom relief and prevention of exercise-induced bronchoconstriction in asthma. 1

• Use should be infrequent in well-controlled intermittent asthma—ideally less than 2 days per week for symptom relief (not counting pre-exercise use) 1, 4
• Increasing SABA use beyond 2 days per week generally indicates inadequate asthma control and warrants initiation of controller therapy 1
• For pre-exercise prophylaxis, administer 15 minutes before activity; protection typically lasts 2-4 hours 1

Monitoring and Safety

• Monitor for common side effects including tachycardia, tremor, and hypokalemia, especially with frequent dosing 3
• Most patients tolerate albuterol/salbutamol well, even at doses up to 1000-1200 mcg/day 4
• Regular scheduled use (versus as-needed) offers no demonstrated advantage and may lead to tolerance, increased airway responsiveness, and over-reliance on symptom relief rather than addressing underlying inflammation 4

Critical Pitfall to Avoid

Do not use only 2 puffs for acute exacerbations—this dose is inadequate and not equivalent to standard nebulizer treatment. 3 The evidence-based regimen of 4-8 puffs every 20 minutes for 3 doses provides maximal bronchodilator effect when airways are most constricted. 3