Management of Acute Asthma Exacerbation with Levosalbutamol MDI

Initial Treatment Protocol

The American Academy of Allergy, Asthma, and Immunology recommends that for acute asthma exacerbation, the maximum daily dosage of levosalbutamol MDI is equivalent to albuterol MDI dosing, which is 4-8 puffs every 20 minutes for 3 doses initially, then as needed 1, 2
For children, the initial treatment protocol involves 4-8 puffs every 20 minutes for up to 3 doses, then as needed 1
For adults, the initial treatment protocol involves 8 puffs every 20 minutes for up to 3 doses, then as needed 1, 2
Levosalbutamol is administered at one-half the mg dose of albuterol for comparable efficacy and safety 1
A valved holding chamber (spacer) should be used to improve medication delivery, especially for patients with difficulty coordinating inhalation 2

After the first hour of treatment, adjust frequency based on severity and response, with moderate exacerbations requiring administration every 60 minutes 3
For severe exacerbations, administration is hourly or consider continuous nebulization if available 3
Continue treatment for 1-3 hours, provided there is improvement 3

For severe exacerbations, consider adding ipratropium bromide to enhance bronchodilation, with a recommended dosage of 4-8 puffs every 20 minutes as needed for children and 8 puffs every 20 minutes as needed for adults, for up to 3 hours 1, 3
The addition of ipratropium has not been shown to provide further benefit once the patient is hospitalized 1

Regular monitoring of heart rate, tremor, and other side effects is essential, especially with frequent or high-dose administration 3

Failure to use a spacer device can reduce medication delivery and effectiveness 2