Recommended Duration of Nebulizer Treatment with Bronchodilators During Asthma Attacks

Standard Treatment Protocol

The recommended duration for a nebulizer treatment with bronchodilators such as albuterol during an asthma attack should be 5-10 minutes, continuing until about one minute after "spluttering" occurs rather than until complete dryness, as per the British Thoracic Society guidelines 1, 2
Nebulization should take approximately 5-10 minutes, with an upper time limit specified, according to the British Thoracic Society 1
Patients should continue nebulization until about one minute after "spluttering" occurs, rather than using complete dryness as an endpoint, as recommended by the British Thoracic Society 1
Patients should tap the nebulizer cup towards the end of treatment to ensure maximum medication delivery, as suggested by the British Thoracic Society 1
Most nebulizers work effectively with drug volumes of 2-5 ml; if the system has a residual volume >1.0 ml, the drug volume should be made up with 0.9% sodium chloride to a minimum of 4.0 ml, according to the British Thoracic Society guidelines 1

The standard dose for adults with acute asthma is 5 mg salbutamol (albuterol) or 10 mg terbutaline, as recommended by the British Thoracic Society 3, 4
The response to treatment should be monitored 15-30 minutes after nebulization, according to the British Thoracic Society guidelines 3, 4
If signs of acute severe asthma persist, treatment may be repeated with the addition of ipratropium bromide 0.5 mg, as suggested by the British Thoracic Society 3, 4
The standard dose for children with acute asthma is 5 mg salbutamol (0.15 mg/kg) or 10 mg terbutaline (0.3 mg/kg), according to the British Thoracic Society guidelines 5
Treatment can be repeated 1-4 hourly if improvement is seen in children with acute asthma, as recommended by the British Thoracic Society 5

For severe asthma, nebulized β-agonist (5 mg salbutamol or 10 mg terbutaline) should be administered, as recommended by the British Thoracic Society 6, 7
If improvement occurs, repeat treatments 4-6 hourly until peak expiratory flow (PEF) >75% predicted normal or best and PEF diurnal variability <25%, according to the British Thoracic Society guidelines 7
If poor response, repeat nebulized β-agonist plus ipratropium bromide (500 μg), as suggested by the British Thoracic Society 7

Oxygen should be used as the driving gas whenever possible for patients with acute severe asthma, as recommended by the British Thoracic Society 6
If oxygen is unavailable, electrical compressors or compressed air should be used, according to the British Thoracic Society guidelines 6
For patients with chronic obstructive pulmonary disease (COPD) and carbon dioxide retention, nebulizers should be driven by air rather than high-flow oxygen, as suggested by the British Thoracic Society 7
β-agonists may rarely precipitate angina in elderly patients; first treatment should be supervised, according to the British Thoracic Society guidelines 5