Albuterol for Bronchospasm in Influenza A

Patient Selection

• Patients with underlying asthma or COPD who develop influenza-related respiratory symptoms are appropriate candidates for albuterol, as they are at higher risk for bronchospasm 1, 2

Dosing and Administration

• The American Thoracic Society recommends nebulizer solution: 2.5 mg in 3 mL of saline every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed in adults 3
• The American Academy of Allergy, Asthma, and Immunology recommends MDI: 4-8 puffs every 20 minutes up to 4 hours, then every 1-4 hours as needed 3
• For severe exacerbations, the American College of Chest Physicians recommends doubling the nebulizer dose 4

Delivery Method Considerations

• The American Heart Association recommends MDI with spacer is as effective as nebulizer when proper technique is used and the patient can cooperate 5, 6
• The American Heart Association recommends nebulizer is preferred if prior MDI use has been ineffective or if the patient cannot coordinate MDI technique during acute distress 5, 6

Critical Safety Considerations

• The Centers for Disease Control and Prevention recommends that if prescribing zanamivir, patients with underlying airway disease must have a fast-acting bronchodilator like albuterol immediately available 7, 8

Adjunctive Therapy

• The American Heart Association recommends adding ipratropium to albuterol produces modest but clinically meaningful improvement in severe bronchospasm 5, 6
• The American Academy of Allergy, Asthma, and Immunology recommends dosing: 0.5 mg ipratropium every 20 minutes for 3 doses with albuterol, then as needed 3
• The American College of Chest Physicians recommends that ipratropium can be mixed in the same nebulizer with albuterol 3, 4

Monitoring and Follow-up

• The Infectious Diseases Society of America recommends considering hospital admission or escalation if patients have temperature >37.8°C, heart rate >100/min, respiratory rate >24/min, oxygen saturation <90% 1