Medication | Dose form | 0 to <4 years | 4 to 11 years | Comments |
Metered dose inhaler (MDI) |
Albuterol (salbutamol) HFA MDI with spacer (valved holding chamber) | | - Home management – 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 4 to 8 inhalations every 20 minutes for 3 dosesΔ, then up to every 1 hour as needed
| - Home management – 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 4 to 8 inhalations every 20 minutes for 3 dosesΔ, then up to every 1 hour as needed
| - Differences in potencies exist, but products shown are essentially comparable on a per-puff basis.
- An increasing use or lack of expected effect indicates diminished control of asthma.
- Not recommended for long-term daily treatment. Regular use exceeding 2 days/week for symptom control (not prevention of EIB) indicates the need for additional long-term control therapy.
- Periodically clean mouthpiece as drug may plug orifice.
- Instructions for use, priming, and cleaning MDI vary by brand. For specific information, refer to UpToDate topic on use of inhaler devices in children, UpToDate Lexidrug, and patient leaflet included with MDI.
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Levalbuterol (levosalbutamol) HFA MDI with spacer (valved holding chamber) | | - Safety and efficacy not established in children <4 years
| - Home management – 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 4 to 8 inhalations every 20 minutes for 3 dosesΔ, then up to every 1 hour as needed
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Dry powder inhaler (DPI) |
Albuterol (salbutamol) breath-activated DPI | | - Safety and efficacy not established in children <4 years
| - Home management – 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
| - DPI alternative for prophylactic use prior to exercise in older children who are comfortable with and capable of properly using a breath-activated inhaler technique.
- Use of DPI is not advised as rescue therapy in an acute setting, as some children may be unable to generate sufficient inspiratory flow rate to assure optimal lung deposition of drug.
- NOTE: DPIs can contain lactose and trace milk proteins (ie, potential allergens).
- Also refer to information above on albuterol MDI.
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Nebulizer solution |
Albuterol (salbutamol) | - 0.63 mg/3 mL
- 1.25 mg/3 mL
- 2.5 mg/3 mL
- 5 mg/mL (0.5%)
| | - Home management – 2.5 to 5 mg, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 0.15 mg/kg per dose (minimum 2.5 mg, maximum 5 mg/dose) up to every 20 minutes for up to 3 doses, then 0.15 to 0.3 mg/kg (maximum 10 mg) every 30 minutes to 4 hours as needed or switch to continuous therapy if in a critical care setting
- Critical care setting and severe exacerbation – Continuous nebulizer treatment 0.5 mg/kg per hour (maximum 20 mg per hour) by large-volume nebulizer; weight-based dosing is also an option (refer to 0 to <4 years)
| - May mix with budesonide suspension, ipratropium solution, or cromolyn sodium solution for nebulization.
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Levalbuterol (levosalbutamol) | - 0.31 mg/3 mL
- 0.63 mg/3 mL
- 1.25 mg/0.5 mL
- 1.25 mg/3 mL
| - Home management – 0.63 to 1.25 mg, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 0.75 mg/kg per dose (minimum 1.25 mg, maximum 2.5 mg/dose) up to every 20 minutes for up to 3 doses, then 0.075 to 0.15 mg/kg (maximum 5 mg) up to every 30 minutes as needed
- Critical care setting and severe exacerbation – Continuous nebulizer treatment 0.25 mg/kg per hour (maximum 10 mg per hour) by large-volume nebulizer
| - Home management – 0.63 to 1.25 mg, can be repeated every 20 minutes for a total of 3 doses, then up to every 4 hours as directed¶
- Acute care setting – 0.75 mg/kg per dose (minimum 1.25 mg, maximum 2.5 mg/dose) up to every 20 minutes for up to 3 doses, then 0.075 to 0.15 mg/kg (maximum 5 mg) up to every 30 minutes as needed
- Critical care setting and severe exacerbation – Continuous nebulizer treatment 0.25 mg/kg per hour (maximum 10 mg per hour) by large-volume nebulizer
| - May mix with budesonide suspension, ipratropium solution, or cromolyn sodium solution for nebulization.
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