Table 75-6.
Dosages of Bronchodilators Commonly Used for Asthma Exacerbations
| Medications | Adult Dose | Child Dose | Onset of Action | Duration | Comments |
|---|---|---|---|---|---|
| Inhaled Short-Acting β2-Agonists | |||||
| Albuterol nebulizer 5.0 mg/mL 2.5 mg/3 mL 1.25 mg/3 mL 0.63 mg/3 mL |
2.5-5.0 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hr continuously | 0.15 mg/kg (minimum dose, 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed or 0.5 mg/kg/hr by continuous nebulization | 15 minutes | 3-4 hours | Only selective β2-agonists are recommended. For optimal delivery, dilute aerosols to minimum of 4 mL at gas flow rates of 6-8 L/min |
| Albuterol via MDI 90 μg/puff |
2-8 puffs every 20 minutes up to 4 hours, then every 1-4 hours as needed | 2-8 puffs every 20 minutes for 3 doses, then every 1-4 hours inhalation maneuver. A spacer or holding chamber should be used | 15 minutes | 3-4 hours | As effective as nebulized therapy if patient is able to coordinate |
| Levalbuterol via nebulizer 0.31 mg/3 mL 0.63 mg/3 mL 1.25 mg/3 mL |
Adults: 0.63 mg 3 times/day, may be increased to 1.25 mg | Children 6-11 years: 0.31 mg 3 times/day every 6-8 hours Children >12 years: 0.63 mg 3 times/day, may be increased to 1.25 mg |
15 minutes | 5-6 hours | 0.63 mg of levalbuterol is equivalent to 1.25 mg of racemic albuterol in both efficacy and side effects |
| Levalbuterol via MDI | 1-2 puffs every 4-6 hours as needed | 1-2 puffs every 4-6 hours as needed | 5-10 minutes | 3-6 hours | Children 2-11 years: in a randomized, double-blind, single-dose, crossover study, doses ranging from 0.16 to 1.25 mg were used safely with clinically significant improvements in pulmonary function test values |
| Anticholinergics | |||||
| Ipratropium bromide Nebulizer solution (0.25 mg/mL) |
0.5 mg every 30 minutes for 3 doses, then every 2-4 hours as needed | 0.25 mg every 20 minutes for 3 doses, then every 2-4 hours | 1-3 minutes | 3-6 hours | May mix in same nebulizer with albuterol. Should not be used as first-line therapy. Should be added to β2-agonist therapy |
| MDI (18 μg/puff) | 2-8 puffs as needed | 4-8 puffs as needed | 1-3 minutes | 3-6 hours | Dose in MDI is low and has not been studied in asthma exacerbations |
MDI, metered-dose inhaler.
Adapted from National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 96-4051). Bethesda, MD, U.S. Department of Health and Human Services, National Institutes of Health, 1997, 2002.