Albuterol Rescue Inhaler Dosage Guidelines

Dosing Guidelines by Delivery Method

The American Academy of Allergy, Asthma, and Immunology recommends that adults use 4-8 puffs (90 mcg/puff) of albuterol every 20 minutes for up to 4 hours during acute symptoms, then every 1-4 hours as needed 2, 3
For children aged 5-11 years, the recommended dosage is 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 4
Children under 5 years should use 1-2 puffs every 4-6 hours, which may be increased during acute symptoms 5, 6
Using a valved holding chamber (spacer) with a metered-dose inhaler (MDI) is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 2

Adults should use 2.5-5 mg of albuterol every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed 1, 2
Children should use 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed 1, 7
For severe exacerbations, continuous nebulization of 10-15 mg/hour for adults and 0.5 mg/kg/hour for children is recommended 2, 3

For nebulizer solutions, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min for optimal delivery 2, 3
Large volume nebulizers should be used for continuous administration 1
Ipratropium bromide may be mixed with albuterol in the same nebulizer for severe exacerbations 1, 2

Regular use of a rescue inhaler exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 5, 6
Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 5
Patients should be monitored for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 5, 6