Recommended Dose of Nebulised Levosalbutamol in Children

Dosing Guidelines by Age

The American Academy of Allergy, Asthma, and Immunology recommends an initial dose of 0.075 mg/kg (minimum dose 1.25 mg) via nebulizer for children aged 3-11 years with acute asthma exacerbations, with a frequency of every 20 minutes for the first 3 doses, then every 1-4 hours as needed, up to a maximum of 5 mg per dose 1
For very young children (under 5 years), half doses may be appropriate when initiating therapy, as suggested by the British Thoracic Society 2, 3

The British Thoracic Society recommends that nebulized levosalbutamol should be delivered via oxygen-driven nebulizer when possible, with a gas flow of 6-8 L/min and a minimum dilution of 3 mL 3, 4
For optimal delivery, the American Academy of Allergy, Asthma, and Immunology suggests using large volume nebulizers for continuous administration if needed, with a dilution of at least 3 mL at a gas flow of 6-8 L/min 1

For severe or life-threatening asthma exacerbations, the American Academy of Allergy, Asthma, and Immunology recommends considering more frequent administration (up to every 20 minutes) and combining with ipratropium bromide (250 μg every 20 minutes for 3 doses), with a strength of evidence based on clinical trials 1

The American Academy of Allergy, Asthma, and Immunology notes that levosalbutamol has not been evaluated by continuous nebulization in most studies, and recommends monitoring for tachycardia, tremor, and other beta-adrenergic side effects, with a strength of evidence based on clinical trials 1
For children who cannot use nebulizers effectively, the British Thoracic Society suggests considering a metered dose inhaler with spacer as an alternative delivery method, with a strength of evidence based on clinical trials 4, 5