| Medication | Dose form | 0 to <4 years | 4 to 11 years | Comments |
| Inhaled short-acting beta2-agonists (SABAs) |
| Metered dose inhaler (MDI) |
| Albuterol (salbutamol) HFA MDI with spacer (valved holding chamber) | | - 2 puffs up to every 4 hours as needed
| - 2 puffs up to every 4 hours 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.
- Inhaler should be administered using a valved holding chamber; add a mask for children <4 years of age.
- Instructions for use, priming, and cleaning MDI vary by brand. For specific information, refer to UpToDate topic on use of inhaler devices in children, Lexicomp, and patient leaflet included with MDI.
|
| Levalbuterol (levosalbutamol) HFA MDI with spacer (valved holding chamber) | | - Safety and efficacy not established in children <4 years
| - 2 puffs up to every 4 hours as needed
|
| Dry powder inhaler (DPI) |
| Albuterol (salbutamol) breath-activated DPI | | - Safety and efficacy not established in children <4 years
| - 2 puffs up to every 4 hours as needed
| - 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.
|
| Nebulizer solution |
| Albuterol (salbutamol) | - 0.63 mg/3 mL
- 1.25 mg/3 mL
- 2.5 mg/3 mL
- 5 mg/mL (0.5%)
| - 0.63 to 2.5 mg up to every 4 hours, as needed
| - 1.25 to 5 mg up to every 4 hours, as needed
| - May mix with budesonide suspension, ipratropium solution, or cromolyn sodium solution for nebulization.
|
| Levalbuterol (levosalbutamol) | - 0.31 mg/3 mL
- 0.63 mg/3 mL
- 1.25 mg/0.5 mL
- 1.25 mg/3 mL
| - 0.31 to 1.25 mg up to every 4 hours, as needed
| - 0.31 to 0.63 mg up to every 4 hours, as needed
| - May mix with budesonide suspension for nebulization.
|
| Combination inhaled rapid-onset long-acting beta agonist and glucocorticoid |
| Budesonide-formoterol MDI | - Budesonide 80 mcg-formoterol 4.5 mcg/puff
| - Safety and efficacy not established in children <6 years
| - 1 to 2 inhalations every 4 hours, as needed, in addition to 2 inhalations daily as maintenance therapy (maximum total daily dose 8 puffs)
| - Single maintenance and reliever therapy (SMART) is off-label in the US. Studies of SMART used DPI, but only the MDI is available in the US. There is a small amount of variability in the amount of drug dispensed with each MDI actuation, whereas the DPI dosing is consistent. Thus, 2 puff dosing is preferred for the MDI.
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