Preparation and Administration of Nebulised Salbutamol for Asthma and COPD

Standard Preparation Protocol

The British Thoracic Society recommends diluting salbutamol to a minimum total volume of 3 mL using normal saline for nebulisation in adults and children 1, 2, 3
For adults, the standard dose is 2.5-5 mg salbutamol nebuliser solution, while for children, the dose is 0.15 mg/kg (minimum 2.5 mg) or 5 mg 1, 2, 4
The American Academy of Allergy, Asthma, and Immunology suggests using oxygen as the driving gas at 6-8 L/min flow rate for nebulisation in acute severe asthma 1, 3, 4

The European Respiratory Society recommends using a large volume nebulizer for continuous administration if required, and ensuring proper face mask fit for infants and young children 3, 7
For children over 4 years, a mouthpiece is preferred over face mask, and treatment typically takes 5-10 minutes to complete nebulisation 1, 2

The American College of Chest Physicians recommends adding ipratropium bromide 250-500 μg directly to salbutamol in the same nebulizer chamber for acute severe asthma with poor initial response to salbutamol alone 1, 3, 5
For adults, 500 μg ipratropium is added to salbutamol, while for children, 250 μg ipratropium is added 1, 2, 5

The National Asthma Education and Prevention Program recommends treatment intervals of every 20 minutes for the first 3 doses in acute severe cases, and reducing to every 1-4 hours as needed if improving 1, 3, 5
Important monitoring parameters include peak flow rate, heart rate, respiratory rate, and oxygen saturation 4, 7