Albuterol acute asthma exacerbations

The National Asthma Education and Prevention Program recommends inhaled SAB As be used as needed for acute asthma exacerbation. The usual dose is 360 to 720 pg per four to eight puffs every 20 minutes up to 4 hours for albuterol metered-dose inhaler (MDI). This recommendation contrasts with previous ones for regular use of 180 pg per two puffs for albuterol MDI three to four times daily. Regular use of SABAs has been a standard approach without the scientific basis since 1970s [12]. Current guidelines indicate that inhaled LABAs (usual dose, 84 pg per two puffs for salmeterol MDI twice daily) should be combined with ICSs for asthma control, rather than used as a stand-alone therapy. 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

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