II. Indications
- Acute Asthma rescule Inhaler
- Short acting agents are for rescue use only
- Exercise Induced Bronchospasm (pretreatment prophylaxis)
-
Hyperkalemia
- See Hyperkalemia for dosing
III. Mechanism
- Inhaled Bronchodilators target Beta 2 Adrenergic Receptors
- Adverse effects (e.g. Tachycardia) are related to Beta 1 Adrenergic Receptor activity
IV. Medications
- Albuterol Nebulizer Solution
- Albuterol solution alone (0.5% solution or 5 mg/ml)
- Albuterol available in 0.5 ml vials and 20 ml bottles
- Dilute 0.5 ml of 0.5% solution (contains 2.5 mg Albuterol) in 2.5 ml Normal Saline
- Final solution concentration 0.083% Albuterol (3 ml)
- Albuterol premixed with saline
- Available in 3 ml vials containing 0.63 mg, 1.25 mg or 2.5 mg vials (in boxes of 30 to 60 vials)
- Albuterol solution alone (0.5% solution or 5 mg/ml)
- Albuterol Inhalers (Generic in 2019)
- ProAir HFA Albuterol Inhalers
- ProAir RespiClick (Dry Powder Inhaler or DPI, released 2015)
- Requires deep inhalation, but no spacer needed
- Approved age 12 years and older
- Each DPI actuation delivers 117 mcg of Albuterol sulfate (97 mcg of Albuterol base)
V. Dosing: Albuterol Inhaler (Ventolin, Proventil, ProAir HFA, ProAir RespiClick)
- See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
- Rescue Inhaler: 2 puffs every 4 to 6 hours as needed
- Exercise Induced Asthma: 2 puffs used 10 to 30 minutes before Exercise
- Severe COPD or Asthma Exacerbation
- Use 6 to 8 puffs every 1-2 hours (max) OR
- Use 2 puffs every 20 minutes as needed for up to 3 doses every 1 to 4 hours
VI. Dosing: Albuterol Nebulizer
- Dilute Albuterol solution (5 mg/ml) in Normal Saline (NS) as described above
- Weight <10 kg or age under 12 months (0.15 mg/kg)
- Albuterol 1.25 mg (0.25 cc) in 2 cc NS q1-4 hours
- Weight 10-35 kg or age 12 months to adult (Typical, standard dose)
- Albuterol 2.5 mg (0.5 cc) in 2 cc NS q1-4 hours
- Weight >35 kg or age over 10 years (High Dose)
- Albuterol 5.0 mg (1.0 cc) in 2 cc NS q1-4 hours
- Standard dose of 2.5 mg is used instead in most cases
- Continuous Nebulizer
- Dose 10 to 15 mg/hour until improvement (typically first hour)
- Intensive monitoring including telemetry within emergency department or ICU
VII. Medications: Co-administered Medications (May add to Nebulizer)
- Ipratropium (Atrovent) 250 mcg (1.25 ml) q6-8 hours
- Cromolyn Sodium (Intal) (10 mg/ml) 2cc q6 hours
- Flunisolide (Nasalide) (.25%=250 ug/ml) 1-2 ml q6 hours
- Antiinflammatory was added to nebulizer in RSV (which has since fallen out of favor)
- Study showed significant improvement with fewer hospitalizations
- Reijonen T (1996) Arch Pediatr Adolesc 150:512-7 [PubMed]
VIII. Pharmacokinetics: Inhaled Bronchodilator
- Onset: Within 15 minutes
- Duration 3 to 4 hours
IX. Adverse Effects
- See Short Acting Bronchodilator
X. Efficacy
- Albuterol HFA is at least as effective as the CFC Inhalers they replaced
- HFA replaces CFC Inhalers due to ozone depletion
- Less force and smaller plume than CFC Inhaler
- However small particle allows 2-3x lung deposition
- Less coordination needed in HFA firing and inhaling
- Spacer devices should still be used with HFA Inhalers
- Albuterol MDI as effective as Nebulizer in ER and home
- Used with spacer (and mask in younger children)
- Studied Wheezing children aged two years and younger
- Albuterol MDI has significant advantages over Nebulizer
- No special equipment or maintenance
- Uses only 10% of the amount Albuterol Nebulized
- Minimal risk of contamination
- Reduced efficacy of Bronchodilators in the 20% of patients with arginine Genotype
- References
XI. Safety
- Pregnancy Category C
- Unknown safety in Lactation
XII. Resources
- Albuterol Nebulizer Solution (DailyMed)
- Albuterol MDI (DailyMed)
XIII. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 88
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2022) Comparison of Asthma Medications, Presc Lett, #381217
- (2022) Inhaled Medications for COPD, Presc Lett, #381116
- (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44
- (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200
Images: Related links to external sites (from Bing)
Related Studies
| albuterol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ALBUTEROL 2.5 MG/0.5 ML SOL | Generic | $0.35 each |
| ALBUTEROL 5 MG/ML SOLUTION | Generic | $2.32 per ml |
| ALBUTEROL HFA 90 MCG INHALER | Generic | $3.23 per gram |
| ALBUTEROL SUL 0.63 MG/3 ML SOL | Generic | $0.14 per ml |
| ALBUTEROL SUL 1.25 MG/3 ML SOL | Generic | $0.20 per ml |
| ALBUTEROL SUL 2.5 MG/3 ML SOLN | Generic | $0.04 per ml |
| ALBUTEROL SULF 2 MG/5 ML SYRUP | Generic | $0.04 per ml |
| ALBUTEROL SULFATE 2 MG TAB | Generic | $0.32 each |
| ALBUTEROL SULFATE 4 MG TAB | Generic | $0.45 each |
| ventolin (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VENTOLIN HFA 90 MCG INHALER | Generic | $1.86 per gram |
| proventil (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PROVENTIL HFA 90 MCG INHALER | Generic | $3.23 per gram |