Usual doses of short-acting bronchodilators for asthma in adolescents and adults*

Drug name(s)	Preparation(s)^¶	Dose
Albuterol MDI^Δ	MDI: 90 mcg/inhalation (United States) MDI: 100 mcg/inhalation (Canada)	Usual dose: 2 inhalations every 4 to 6 hours as needed Acute exacerbation at home: 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then as directed^◊ Acute care setting: 4 to 8 inhalations every 20 minutes for 3 doses^§, then taper depending on response to therapy
Albuterol DPI	DPI^Δ: 90 mcg/actuation (United States)	Usual dose: 2 inhalations every 4 to 6 hours, as needed Acute exacerbation at home: 2 to 4 inhalations, can be repeated every 20 minutes for a total of 3 doses, then as directed^◊ Acute care setting: 4 to 8 inhalations every 20 minutes for 3 doses^§, then taper depending on response to therapy
Albuterol DPI (Canada)	DPI: 200 mcg/actuation (Canada)	Usual dose: 1 inhalation every 4 to 6 hours, as needed Exercise-induced bronchoconstriction: 1 inhalation 15 minutes prior to exercise
Albuterol solution for nebulization	Nebulizer solutions: 0.083% (2.5 mg/3 mL) 0.5% (2.5 mg/0.5 mL) concentrate; must be diluted in 2.5 mL saline	Usual dose: 2.5 mg every 4 to 6 hours, as needed Acute exacerbation at home: Administer 2.5 mg, can repeat every 20 minutes for total of 3 doses, then decrease frequency to every 1 to 4 hours, as tolerated^¥ Acute care setting: Administer 2.5 to 5 mg, can repeat every 20 minutes for total of 3 doses, then decrease frequency to every 1 to 4 hours, as tolerated Acute care setting (critically ill): Continuous nebulizer treatment: Use a large volume nebulizer, 10 to 15 mg/hour in monitored setting
Albuterol-budesonide MDI	MDI: Albuterol 90 mcg and budesonide 80 mcg/actuation (United States)	Usual dose: 2 inhalations every 4 to 6 hours as needed Acute exacerbation at home: 2 inhalations, can be repeated every 20 minutes for a total of 3 doses, then as directed^¥
Levalbuterol MDI^Δ	45 mcg/inhalation (United States)	Usual dose: 2 inhalations every 4 to 6 hours, as needed Acute exacerbation at home: 2 to 4 inhalations; can be repeated every 20 minutes for a total of 3 doses, then as directed^◊ Acute care setting: 4 to 8 inhalations every 20 minutes for 3 doses, then taper depending on response to therapy^§
Levalbuterol solution for nebulization	Nebulizer solution: 0.63 mg/3 mL 1.25 mg/3 mL 1.25 mg/0.5 mL concentrate; must be diluted in 2.5 mL saline	Usual dose: Administer 0.63 to 1.25 mg (equivalent to 1.25 to 2.5 mg albuterol) every 6 to 8 hours, as needed (up to 3 doses per 24 hours) Acute exacerbation at home: Administer 1.25 mg; can be repeated every 20 minutes for a total of 3 doses, then decrease frequency to every 1 to 4 hours, as tolerated^¥ Acute care setting: Administer 1.25 mg to 2.5 mg (equivalent to 2.5 to 5 mg of albuterol); can repeat every 20 minutes for total of 3 doses, then decrease frequency to every 1 to 4 hours, as tolerated
Terbutaline DPI	DPI: 0.5 mg/actuation (Canada)	Usual dose: 1 inhalation every 4 hours, as needed If no effect after 5 minutes, can repeat dose
Ipratropium-albuterol SMI	SMI: Ipratropium 20 mcg and albuterol 100 mcg/inhalation (United States)	Usual dose (off-label): 2 inhalations every 6 hours, as needed Acute exacerbation (off-label): 4 to 8 inhalations every 20 minutes for 3 doses, and then as needed for up to 3 hours
Ipratropium-albuterol solution for nebulization	Nebulizer solution: Ipratropium 0.5 mg and albuterol 2.5 mg per 3 mL/vial^‡	Usual dose (off-label): Administer 1 vial (3 mL) every 4 to 6 hours, as needed Acute exacerbation (off-label): Administer 1 vial (3 mL), every 20 minutes for 3 doses, and then as needed for up to 3 hours^¥

MDI: metered-dose inhaler; DPI: dry-powder inhaler; SMI: soft mist inhaler.

* Oral formulations of albuterol and terbutaline are less effective than inhaled formulations and are not recommended in asthma. Inhaled epinephrine (MDI or nebulized) is not recommended for routine use.

¶ Doses shown and strengths (ie, mcg per puff or inhalation) are based upon product descriptions approved in the United States and Canada as noted, which may differ from how strengths are described for products available in other countries. Consult local product information before use.

Δ Agent can also be used to prevent exercise-induced bronchoconstriction, 2 inhalations 5 to 20 minutes prior to exercise.

◊ Typically, two puffs are used for mild-to-moderate symptoms and four puffs for more severe symptoms; over the course of the first hour, the patient can determine (based on action plan or clinician guidance) whether to continue self-care at home or seek additional medical attention.

§ The number of inhalations is based on the severity of respiratory impairment, number of inhalations the patient has already used, and availability of monitoring. When administering an albuterol MDI for acute asthma exacerbation in an office or acute care setting, use of a valved holding chamber and careful attention to technique are recommended.

¥ Over the course of the first hour, the patient can determine (based on action plan or clinician guidance) whether to continue self-care at home or seek additional medical attention.

‡ Nebulizer solution in Canada is ipratropium 0.5 mg and albuterol 2.5 mg per 2.5 mL.

Graphic 72467 Version 27.0

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Usual doses of short-acting bronchodilators for asthma in adolescents and adults*