Status Asthmaticus Management

Guideline Recommendations

The National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 recommends that both albuterol (salbutamol) and levalbuterol (levosalbutamol) are acceptable short-acting beta-2 agonists (SABAs) for acute asthma exacerbations, including status asthmaticus, with levosalbutamol administered at half the milligram dose of salbutamol to provide comparable efficacy and safety 1, 2, 3
The American College of Allergy, Asthma, and Immunology guidelines note that levosalbutamol administered in half the milligram dose of albuterol provides comparable efficacy and safety 1, 2, 3
For status asthmaticus in adults, the guidelines suggest levosalbutamol 1.25-2.5 mg every 20 minutes for 3 doses, which is equivalent to salbutamol 2.5-5 mg every 20 minutes for 3 doses 2, 3
For children, levosalbutamol 0.075 mg/kg (minimum 1.25 mg) is equivalent to salbutamol 0.15 mg/kg (minimum 2.5 mg) 1, 2, 3
Neither drug is listed as "preferred" over the other; they are presented as equivalent therapeutic options 4, 1, 2, 3

The National Asthma Education and Prevention Program (NAEPP) guidelines state that levosalbutamol has not been evaluated by continuous nebulization, which is a critical limitation since continuous nebulization is often used in severe status asthmaticus 1, 2, 3
For continuous nebulization protocols (0.5 mg/kg/hour in children or 10-15 mg/hour in adults), only standard salbutamol has guideline support 2, 3
Levosalbutamol may be used for intermittent dosing every 20 minutes initially, then every 1-4 hours 1, 2, 3

The American College of Allergy, Asthma, and Immunology recommends using either salbutamol or levosalbutamol based on availability and cost, as they are clinically equivalent 4, 1, 2, 3
Initial treatment (first hour): salbutamol 2.5-5 mg nebulized every 20 minutes × 3 doses, or levosalbutamol 1.25-2.5 mg nebulized every 20 minutes × 3 doses 2, 3
If requiring continuous nebulization, use salbutamol 10-15 mg/hour (levosalbutamol not studied for this) 2, 3
Add ipratropium bromide 0.5 mg to the first 3 doses for severe exacerbations 2, 3