Treatment of acute asthma exacerbations in children with a pressurized metered dose inhaler and spacer: safe and effective dosing of Salbutamol

Abstract

Aim and Objectives: Inhaled short-acting beta 2-agonists are the mainstay of treatment of acute asthma exacerbations. Salbutamol (also known as albuterol) is the most frequently used of these drugs in acute settings, however the recommended dose is still the subject of debate. The aim of this study is to determine the safe and effective dose of salbutamol delivered by a metered-dose inhaler with a spacer. Data sources: TRIP Database, National Guideline Clearinghouse, Guidelines Finder, The Cochrane Library, DARE, Bandolier, MEDLINE. Methods of the review: bibliographic search using the MeSH terms: "Asthma/therapy" and "Albuterol/administration and dosage". The search was limited to articles published between January 2001 and 2011 in English, Spanish, French and Portuguese. The Strength of Recommendation Taxonomy of the American Family Physician Journal was used to assess the Level of Evidence. Results: Seven articles were evaluated including five guidelines and two clinical trials. The dose recommended by the guidelines was between two and ten puffs every 20 minutes. Each puff is equivalent to 100 µg of salbutamol by inhalation. In the clinical trials, the recommended doses are higher to those referred to by the guidelines. Adverse effects were not reported with these doses. Conclusions: There is some heterogeneity of the included studies. Some guidelines recommend two to four puffs, others two to six puffs, and others four to eight puffs at a time. The clinical trials report on higher doses, up 20 puffs per dose. The authors consider that it is safe to administer four to eight puffs per dose in the treatment of a child with a mild to moderate exacerbation of asthma (Strength of Recommendation B). Each dose should not be more than ten puffs (Strength of recommendation B).