Albuterol
ProAir / Proventil / Ventolin / AccuNeb
bronchodilator sabainhaled (MDI) · inhaled (SVN) · IV (not FDA-approved in US)Onset: 5–15 minutesDuration: 4–6 hours
Mechanism of Action
Selective beta-2 adrenergic agonist. Activates adenylyl cyclase → increases cAMP → smooth muscle relaxation and bronchodilation. Also stabilizes mast cells.
Dosing
Adult
MDI: 2 puffs (90 mcg/puff) q4–6h PRN; acute: up to 4–8 puffs. SVN: 2.5 mg in 3 mL NS q4–6h; acute/continuous: 10–15 mg/hr
Pediatric
SVN: 0.15 mg/kg (min 2.5 mg) q20 min × 3 for acute exacerbation, then q1–4h PRN
Continuous nebulization: 10–15 mg/hr for severe exacerbations
Indications
- Acute bronchospasm (asthma, COPD exacerbation)
- Exercise-induced bronchospasm (prophylaxis)
- Hyperkalemia (adjunct — drives K+ intracellularly)
- Bronchospasm during mechanical ventilation
Contraindications
- Hypersensitivity to albuterol
- Tachyarrhythmias (use with caution)
Side Effects
- Tachycardia
- Tremor (skeletal muscle)
- Hypokalemia (with high/repeated doses)
- Nervousness/anxiety
- Headache
- Paradoxical bronchospasm (rare)
- Hyperglycemia
Monitoring Parameters
- Heart rate and rhythm
- SpO2
- Serum potassium (with frequent dosing)
- Blood glucose (diabetic patients)
- Respiratory rate and breath sounds
- Peak flow / spirometry response
Drug Interactions
- Beta-blockers (antagonize bronchodilation)
- MAOIs and TCAs (potentiate cardiovascular effects)
- Diuretics (additive hypokalemia)
- Digoxin (hypokalemia increases toxicity risk)
Clinical Pearls
- First-line agent for acute bronchospasm — the NBRC gold standard SABA
- Shake MDI well before use; prime if new or unused >2 weeks
- Spacer/VHC increases lung deposition from ~10% to ~20%
- Hypokalemia most clinically significant with continuous or high-dose nebulization
- Onset distinguishes it from LABAs — appropriate for rescue therapy
- Can cause false elevation of peak flow by reducing dynamic hyperinflation
Mnemonic
💡 A-B-C: Albuterol Bronchospasm Crises — SABA #1
NBRC High-Yield
- Drug of choice for acute bronchospasm
- Side effect: tachycardia and tremor are most common
- Hypokalemia risk with high-dose/continuous use
- Beta-2 selective but has some beta-1 effects at high doses
- MDI technique: slow, deep breath; hold 10 seconds
- Used adjunctively for hyperkalemia in critical care