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Continuous Albuterol

Question 2:

What are the maximum doses of continuous albuterol?

Inpatient asthma team recommendation: 
EPR-3 (2007) recommends the following dosages for intermittent and continuous albuterol:

  • Child dose (≤ 12 years of age)—0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses then 0.15 to 0.3 mg/kg up to 10 mg every 1 to 4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization with a maximum of 10 mg/hour continuously.

  • Adult dose (> 12 years of age)—2.5 to 5 mg every 20 minutes for 3 doses, then 2.5 to 10 mg every 1 to 4 hours as needed, or 10 to 15 mg/hour continuously.

EPR-3 (2007) recommends only selective beta2-agonists (albuterol, levalbuterol, pirbuterol). For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6–8 L/min. Use large volume nebulizers for continuous albuterol administration. The inpatient asthma team concurs with these recommendations, including the use of 15 mg/hour as the maximum dose per hour of continuous albuterol. The inpatient asthma team values amelioration of symptoms while minimizing adverse effects of the medication. This is a strong recommendation based on high quality evidence (EPR-3, 2007).

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.