SABAs |
Albuterol nebulizer solution | 2.5–5 mg every 20 min for 3 doses, then 2.5–10 mg every 1–4 h PRN, or 10–15 mg/h continuously | 0.15 mg/kg (minimum dose 2.5 mg) every 20 min for 3 doses, then 0.15–0.3 mg/kg (up to 10 mg) every 1–4 h PRN, or 0.5 mg/kg/h by continuous nebulization | Directly supervised MDI is equivalent to nebulizer for most patients, no data in most severe patients however (Chest. 2005;127:335) |
Albuterol MDI | 4–8 puffs every 30 min up to 4 h, then every 1–4 h PRN | 4–8 puffs every 20 min for 3 doses, then every 1–4 h PRN | Use valved holding chamber-type spacer for children ≤4 years old. |
Levalbuterol (Xopenex) nebulizer solution | 1.25–2.5 mg every 20 min for 3 doses, then 2.5–5 mg every 1–4 h PRN, or 5–7.5 mg/h continuously | 0.075 mg/kg (minimum dose 1.25 mg) every 20 min for 3 doses, then 0.075–0.15 mg/kg (up to 5 mg) every 1–4 h PRN, or 0.25 mg/kg/h by continuous nebulization | Majority of studies indicate no efficacy or tolerability advantage vs. albuterol (Formulary. 2009;44:108); individual exceptions may be encountered; 2.5 mg albuterol = 1.25 mg levalbuterol |
Levalbuterol MDI (Xopenex) | 4–8 puffs every 30 min up to 4 h, then every 1–4 h PRN | 4–8 puffs every 20 min for 3 doses, then every 1–4 h PRN |
Short-Acting Anticholinergics (SAMAs) |
Ipratropium bromide nebulizer solution | 500 μg every 30 min for 3 doses, then every 2–4 h PRN | 250 μg every 20 min for 3 doses, then 250 μg every 2–4 h | Must use with albuterol. May mix in same nebulizer with 0.5 mL albuterol 0.5% solution. |
Ipratropium bromide MDI (Atrovent) | 4–8 puffs PRN every 2–4 h | 4–8 puffs PRN every 2–4 h | Use valved holding chamber-type spacer for children ≤4 years old. |
Corticosteroids |
Prednisone tablets/Prednisolone oral solution (15 mg/5 mL) | 40–80 mg/day ... |