Inhalars for bronchial asthma

INHALARS FOR BRONCHIAL
ASTHMA
Prepared by.
Dr.Afnan Shamraiz
PGr.1.
Paeds.ATH

Asthma Symptoms Result from
Inflammation and Bronchoconstriction
Reduced airway
opening
Thick
Muscle
Layer
Excess
Mucus
BRONCHIOLE
Tightened
muscle
Alveolus filled
with trapped air
Inflammation Bronchoconstriction

Lung function during early and late
phases of allergic response
BEFORE STIMULUS
BRONCHOSPASM
LATE PHASEEARLY PHASE
INFLAMMATION

History of Inhaled Therapy
4000 years ago: the smoke of ephedra sinica
was used for asthma therapy

Modern age
 Metered dose inhaler 1956 Medihaler
 Dry powder inhaler 1960
 Multidose dry powder inhaler 1970
 440 million boxes aerosols per year are
manufactured in the world

Why Inhalation Therapy?
 Targeted delivery of medication to the lungs
 Rapid onset of action
 Smaller doses
 Less systemic and GI adverse effects
 Relatively comfortable

Definition of an aerosol
 Aero air
 Sol solution
 Liquid or solid suspensions into gas medium
 Particles which are sufficiently small so as to
remain airborne for a considerable period of
time

PHARMACOKINETICS OF INHALED
DRUGS

Lung deposition of drug
 Particle
 size
 shape
 particle density
 solid or liquid phase
 Type of inhalation device
 Technique
 Airway obstruction
 Drug molecule

Device dependent factors
Device dependent factors Patient dependent factors
 Device
 pMDI:
 Portability,Treatment time, Drug
preparation, Reproducibility,
Coordination, Actuation, Drug
availability, Holding chamber,
Propellant
 DPI:
 Breath-actuation, Coordination,
Portability,Treatment time, Dose
counters, Flow requirement, Drug
availability, Resistance, Costs.
 Aerosol
1. Particle size,Velocity, Physico-
chemical characteristics
 Age
 co-operation
 compliance
 airway anatomy
 breathing patterns
 Disease

Lung Deposition of ICS
 Dose to the lungs
 MDIs
 Ciclesonide 52%
 Fluticasone 16%
 Budesonide 5-12%
 BDP HFA MDI 51%
 DPIs
 Different flow rates
 Budesonide Turbuhaler 17-39%
 Budesonide Novelizes 19-32%
 BudesonideAirmax 28-30%
 One flow rate
 Budesonide Clickhaler 27%
 Fluticasone Diskus 13%

Inhalation Devices
 Aim
 To make aerosol from the drugs solution or
solid particles
 1-Metered dose inhaler
 2-Dry powder inhaler
 3-Nebulizer

Asthma Medications and Supplies
Dry Powder Inhaler - DPIMeter Dose Inhalers - MDI

Asthma Medications and
Supplies
Spacers (use with MDIs
Nebulizer / Compressor

Inhaled treatment for asthma
 Preventers- inhalers
coloured in various shades
of brown, orange or
purple depending on their
strength) Should be used
twice each day to prevent
inflammation and long
term lung damage.
 Most Preventers are taken
morning and evening .

Reliever inhalers-(normal dose, 2
puffs of blue)
 To be given as and when necessary to relieve
cough, wheeze, breathlessness and chest
tightness.
 Take 5-10 mins work by relaxing the tightness if
the muscles causing constriction in the
bronchioles.
 Can be used before exercise .
 You should expect 2 puffs of blue reliever inhaler,
when taken properly, to last for 4 hours.
 For the duration of a cold an asthmatic child is
advised to take up to 2 puffs of their blue inhaler
every 4 hours

Medications
Rescuers
 Relax tightened muscles
 Short-Acting
 Nebulizer or Puffer
 Treat acute episodes and
symptoms
 Reduce inflammation in
airways
 Long-Acting
 Take on a regular basis
Controllers:

Metered dose inhalers
 Metered dose inhalers.These inhalers consist
of a pressurized canister containing
medication that fits into a boot-shaped
plastic mouthpiece.With most metered dose
inhalers, medication is released by pushing
the canister into the boot. One type of
metered dose inhaler releases medication
automatically when you inhale. Some
metered dose inhalers have counters so that
you know how many doses remain.

Metered Dose Inhalers (pMDI
 Canister
 Propellent gas (liquid
under pressure)
 Drug
 Dissolved or solid
microparticules into
the gas
 Surfactant
 Physical stabilisation
 Prevent clustering

Propellant
Chloro fluoro carbon (CFC
Hydro fluoro alcan (HFA)
 CFC (freon gas)
 CFC not flammable
 Not include chloride
 Not disturbe Ozone layer

Freon (CFC)
 Oropharyngeal irritation, cough and
bronchospasm
 Harmfull for ozone layer
 Cardiac arrhytmia
 Less effective in cold climate

MDI
advantages Disadvantages
 Rapid application
 Handling
 Multidose
 Hand-breathe
coordinations
 İneffective use in poor
ventilated patients
 Oropharyngeal deposition
and local side effects
 Not include dosimeter

How Should a Child Use an
Inhaler?
If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-

Bronchodilator drugs
 open up the airways in the lung within minutes of inhalation of the drug, by
relaxing the smooth muscle that surrounds the airways. Stimulate adenyl
cyclase and increasing cAMP
Short-acting bronchodilators: The effect of the usual type of bronchodilator
lasts for 3-4 hours and these short-acting drugs (e.g. albuterol, metaproterenol,
terbutaline) are used as needed or before exercise to prevent wheezing. The
short-acting drugs provide rapid relief during a mild or moderately severe
asthma attack, but they do nothing for the cause of the attack -
inflammation. These "rapidrelievers" or "rescue inhalers" may be needed
repeatedly until the attack subsides spontaneously or is controlled by an anti-
inflammatory drug.
Long -acting bronchodilators: Although bronchodilators do not prevent asthma
attacks, certain long-acting bronchodilators (e.g. Serevent and Foradil) can
improve lung function over 10-12 hour periods. This drug must NEVER be used
for the emergency rescue from an acute attack of asthma. Salmeterol and
formoterol


Albuterol(generic)
 Generic: Albuterol
 Type: MDI; fast/short
acting beta-2 agonist
 Class: rescue/reliever
 Functions:
bronchodilator, works in
5-15 minutes via inhaler
or nebulizer, effects last
4-5 hrs
 Side
Effects/Suggestions:
shakiness of hands or
legs, fast heart beat,
anxiety, upset stomach,
headache , metallic taste
(rinse mouth)
 Similar to:Ventolin,
Proventil

Ventolin®
 Generic: /salbutamol
 Type: MDI; fast/long
 Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
 Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
 Also available in:Ventolin
rotahaler
 Similar to: Proventil,
Alupent, Maxair, Brethaire,
Metaprel

Salbutamol
 ••Salbutamol:preparationa
nddoses–
Availableas2,4and8mgtabl
ets–Syr.As 2mg/5ml–
Asmetereddoseinhaler–
100μg–200μ

Ventolinrotahaler®
 Generic: /salbutamol (?)
 Type: rotahaler; fast/long (?)
last 4-5 hrs
fast heart beat, anxiety, upset
stomach, headache, metallic
taste (rinse mouth)
 Also available in:Ventolin
inhaler
 Similar to: Proventil,
Alupent, Maxair, Brethaire,
Metaprel

Alupent®
 Generic: metaproterenol
sulfate
last 4-5 hrs
mouth)
 Similar to: Metaprel,
Ventolin, Proventil, Maxair,
albuterol, Brethaire

Brethaire®
 Generic: terbutaline
sulfate
 Type: MDI, fast/short
acting beta2-agonist
last 4-5 hrs
mouth)
Alupent, Maxair, Proventil,
Metaprel

Foradilaerolizer®
 Generic: formoterol
fumarate
 Type: formoterol aerolizer
 Class: controller/preventer
 Functions: long-acting
bronchodilator; acts w/in 3
mins, effective for at least
12 hrs.
tremors,  heart rate,
headache; if sensitive to
drug, may develop rash,
itchiness, &
bronchospasm; don’t use
for quick relief
 Similar to: Oxeze (and
related to Serevent)

Maxair®inhaler
 Generic: perbuterol
acetate
last 4-5 hrs
mouth)
 Also available in: Maxair
autohaler
Alupent, Brethaire,
Metaprel, Proventil

Proventil®
 Generic: albuterol
 Type: MDI; fast acting
beta-2 agonist
 Functions:
bronchodilator, works in
5-15 minutes via inhaler
or nebulizer, effects last
4-5 hrs
 Side
shakiness of hands or
legs, fast heart beat,
anxiety, upset stomach,
headache, metallic taste
(rinse mouth)
Alupent, Maxair,
Brethaire, Metaprel

Serevent®

 Generic: salmeterol xinafoate
 Type: MDI; long acting beta2-
agonist
 Functions: prevents
tightening of muscles around
lung tubes; takes 10-20 mins
to work, effective for at least
12 hrs.
headache; if sensitive to drug,
may develop rash, itchiness,
& bronchospasm; don’t use
for quick relief
 Also available in: Serevent
discus
 Similar to: related to Foradil
& Oxeze

DOSES
DRUG FORM DOSE
Salmeterol MDI 21ug/puff
DPI 50 ug/blister
1 to 2 puffs bd
1 blister bd
Formeterol DPI 12ug/single use
capsule
1 cap bd
Albuterol MDI 90 ug/puff 2 to 8 puffs every
20 minutes for 3
doses than every 1
to 4 hr as needed

Anti-inflammatory drugs
 work to reduce the irritability of the lung airways
by controlling the activities of inflammatory cells
in the airway walls. They are used to reduce
asthma severity over a period of time, and must
be used on a regular basis, usually 2-3 times per
day. These drugs do not provide immediate
relief from an asthma attack because they do not
act as bronchodilators. However, it is often
advised to temporarily increase the dose of the
anti-inflammatory drug during an acute
attack. Two types of anti-inflammatory drugs
exist -mast cell stabilizers, and corticosteroids.

Inhaled corticosteroids
 are the most effective means of
controlling asthma and are the
usual type of drug given in the
routine anti-inflammatory
management of moderate
asthma. Combined preparations
containing a corticosteroid and a
long acting bronchodilator
(Advair, Dulera and Symbicort) are
proving to be useful in limiting the
amount of corticosteroid needed
for control of asthma.
 MOA
 Reduces the synthesis
of arachidonic acid by
phospholipase A2
 Inhibit the expression
of COX-2 (anti-
inflammatory action)
 Postulated that: this
drugs increases the
responsiveness of beta
agonists in the airway

DRUGS USED IN ASTHMA
Arachidonic acid
Lipooxygenase Cyclooxygenase
Hydroxypeptidase Endoperoxidase
Leukotrienes Prostacycline
Thromboxane A2
Prostaglandin
Membrane
Lipid
Phospholipase
A2

Aerobid®
 Generic: flunisolide
 Type: corticosteroid
(Metered Dose Inhaler)
 Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways; long-term control
medication
hoarseness; thrush; rinse
mouth with water after use
 Also available in: mint flavor
 Similar to:Azmacort,
Beclovent, Flovent,
Pulmicort,Vanceril

Flunisolide
Strength Low Dose
Medium
Dose
High Dose
250 ug/puff
500-750 μg
(2-3 puffs)
1000-1250 μg
(4-5 puffs)
> 1250 μg (>5
puffs)

Aerobidmintflavor®
 Generic: flunisolide
 Type: corticosteroid
(Metered Dose Inhaler)
 Functions:anti-
medication
 Also available in: regular
Beclovent, Flovent,
Pulmicort,Vanceril

Azmacort®
 Generic: triamcinolone
acetonide
 Type: corticosteroid (Metered Dose
Inhaler)
medication
 Similar to: Aerobid,
Beclovent, Flovent,
Pulmicort,Vanceril

Triamcinolone
Strength Low Dose
Medium
Dose
High Dose
100 μg/puff
(MDI with
spacer
400-800 μg
(4-8 puffs
800-1200 μg
(8-12 puffs
>1200 μg (>
12 puffs

Beclovent®
 Generic:beclomethasone
dipropionate
 Type: corticosteroid (Metered
Dose Inhaler)
 Class:
controller/preventer
inflammatory; slow-
acting; reduce
hypersensitivity in
airways; long-term
control medication
 Side
mouth with water after
use
Azmacort, Pulmicort,
Vanceril

Vanceril®
dipropionate
Dose Inhaler)
airways
 Also available in: double
strength
Beclovent, Aerobid,
Pulmicort

Vancerildoublestrength®
dipropionate
Dose Inhaler)
airways
hoarseness;
 Also available in: regular
strength
Beclovent, Aerobid,
Pulmicort

Beclomethasone
Strength Low Dose
Medium
Dose
High Dose
42, 84
μg/puff cfc
40,80
μg/puff
HFA-
propellant
84-336 μg
(2-8 puffs
of 42
μg/puff
or1-4 puffs
of 84
μg/puff)
336-672 μg
(8-16 puffs
of 42
μg/puff or
4-8 puffs of
84 μg/puff)
>672 μg (>
16 puffs of
42 μg/puff
or> 8 puffs
of 84
μg/puff)

Flovent®
 Generic: fluticasone
propionate
 Type: corticosteroid MDI
medication
Azmacort, Beclovent,
Pulmicort,Vanceril

Fluticasone
Strength Low Dose
Medium
Dose
High Dose
44, 110, 220
μg/puff (MDI)
88-176 μg (2-4
puffs of 44
μg/puff
176-440 μg (4-10
puffs of 44
μg/puff or2-4
puffs of 110
μg/puff or1-2
puffs of 220
μg/puff
440 μg (>4 puffs
of 110 μg/puff or
> 2 puffs of 220
μg/puff)
DPI
50,100,150ug./in
halation
100 to 200 ug 200 to 400 ug More than 400
ug

fluticasone
Flovent 220 -
fluticasone 220
mcg/ puff
Flovent 110 -
fluticasone 110
mcg/puff
Flovent 44 -
fluticasone 44
mcg/puff
Flovent
Rotadisks 50
fluticasone,50mcg
100mcg 250mcg
Flovent
Rotahaler

Pulmicort®
 Generic: budesonide
Dose Inhaler)
 Class:
inflammatory; slow-
acting; reduce
hypersensitivity in
airways
 Side
mouth with water after
use
Azmacort, Beclovent,
Vanceril

Budesonide
Strength Low Dose
Medium
Dose
High Dose
Turbuhaler
(DPI200 μg
/inhalation
200-400 μg
(1-2
inhalations)
400-800 μg
(2-4
inhalations)
> 800 μg
(>4
inhalations)
Respules
(nebulizer
0.5 μg 1μg 2μg

MUSCARINIC ANTAGONISTS
 Useful in 1/3 to 2/3
of asthmatic patients
(especially children)
 No effect on the
inflammatory aspects
of asthma
 Useful in many COPD
patients
More effective
and less toxic
than β agonists
MUSCARINIC
ANTAGONISTS
 Ipatropium
 Quaternary
antimuscarinic drug
 Delivered to the
airways by
pressurized aerosol
 Have little systemic
action
 Tiotropium
 Newer longer-acting
analog

Atrovent®
 Generic: ipratropium
bromide
 Type: anti-cholinergic
MDI
 Functions:
bronchodilator (relaxes
smooth muscle bands
around bronchial tubes),
works in 5-15 minutes
 Side
dryness of mouth,
metallic taste, avoid
contact with eye

Mast cell stabilizers
• Inhaled medications that work to prevent bronchial
tube swelling as part of a regular maintenance plan
• Also taken before exercise
MOA
Decrease in the release of mediators (leukotrienes and
histamine) from mast cells
Prevents both early and late responses to challenge
Intal
cromolyn sodium
inhalation aerosol
Metered dose
800 mcg/inhalation
Metered dose
1.75 mg/actuation
Tilade
nedocromil
sodium

Intal®
 Generic: Cromolyn sodium
 Type: non-steroidal MDI
inflammatory, inhibits
immediate & non-
immediate
bronchoconstrictive
reactions to inhaled
antigens; long-term
control medication
throat irritation, cough; use
before exercise or contact
with a known trigger
 Also available in: nebulizer
form, Intal Forte
 Similar to:Tilade

Tilade®
 Generic: Nedocromil
sodium
 Class:
immediate & non-
immediate
bronchoconstrictive
antigens; long-term
control medication
 Side
unpleasant taste, may
cause stomach upset
 Similar to: Intal

IntalForte®
 Intal Forte ®
 Generic: Cromolyn sodium
immediate & non-
immediate
bronchoconstrictive
antigens; long-term
control medication
throat irritation, cough; use
before exercise or contact
with a known trigger
 Also available in: nebulizer
form, regular strength Intal
 Similar to:Tilade
®

Doses.
Drug form dose
chromyl MdI 1mg/puff
Nebulizer
20mg/amp
1to2puffs tid/qid
1 amp tid/qid
nedocromil MDI 1.75 mg/puff 1to 2 puffs bid/qid

Combivent®
 Generic: ipratropium
bromide & albuterol
sulfate
 Type: anticholinergic &
beta2-agonist MDI
 Class: combination
last 4-5 hrs
headache, dizziness,
nausea, cough, dry mouth
 Similar to: (kind of similar
to Advair)

Symbicort
 Generic: budesonide, a
steroidal anti-
inflammatory agent, and
formoterol, a
bronchodilator
 Type: steroid & beta2-
agonist MDI
 Class:
combination"controller
last 4-5 hrs
headache, dizziness,
nausea, cough, dry mouth

Xaltide Inhalar
 Albuterol:50mcg/actu,
Beclomethasone
(Dipropionate):100mcg
/actu
 Indicated for the long-
term management of
asthma only when the
need for inhaled
corticosteroid and
bronchodilator therapy
has been established

Autohaler
 This is a breath activated
device, and thus had the advantage
that breathing and pressing don’t
need to be co-ordinated.
 Shake the device
 Remove the cap
 Prime the device – pull the red lever
up so that it clicks
 Whilst sat upright, take a normal
breath out.
 Inhale slowly and deeply – don’t be
put off by the click. Keep breathing
in to a full inspiration, and then hold
your breath for 10 seconds
 Push the red lever back
down. Replace the cap
 Remember the tell the patient they
wont feel the spraying sensation
at the back of the throat and that
this is normal. They may still be
able to taste the drug though.

Maxairautohaler®
 Generic: pirbuterol acetate
 Type: autohaler; fast/short
last 4-5 hrs
mouth)
 Also available in: Maxair
inhaler
Alupent, Brethaire,
Metaprel, Proventil

MDI spacer
Decrease of oropharyngeal
deposition
Proposing inhaled CS

MDI Spacer
 A spacer not only allows for better co-
ordination of breathing and dispensing the
drug, but it also has a molecular effect. Larger
molecules of drug are the ones that normally
deposit themselves on the mucosa, and thus
these are the ones that can lead to candida,
hoarseness of the voice or systemic effects if
swallowed. But in a space, the larger
molecules remain in the spacer, and only the
smaller drug molecules are actually inhaled

How Should a Child Use an Inhaler –
with a Spacer?
• Ask child to breathe out
• Have child place spacer in
mouth
• Press down on inhaler
• Ask child to take a slow deep
breath
• Encourage child to hold breath
for five (5) seconds
• Remove spacer for exhalation
• Wait one minute before
repeating the process if there
is a second puff ordered

With a spacer
 Need to be replaced every couple of months
 Need to be washed every day in soapy warm
water, and only let them dry by
evaporation (drip drying) – do not wipe it
dry! –this causes build up of static electricity
 They reduce the velocity of the drug particles,
and thus reduce the number of particles
being deposited on the mouth and pharynx

Washing the mouth
 If you rinse out your mouth with water after
using the inhaler this reduces the risk of
thrush and irritation to the mucosa of the
mouth and pharynx.

Dry-powder inhaler – Breath-
activated inhalers
 This kind of inhaler uses just dry-powder and no
propulsion system at all. All you have to do is
take a deep, fast breath which will make you
inhale a single dose. they usually rely on a
manual mechanism to insert one dose of dry-
powder drug into the mouthpiece.
The most common systems are the turbohaler
and the diskhaler. In both systems, you have to
turn or twist the body until a “click” sound
signals that a dose has been inserted and is
ready to be inhaled

DRY POWDERED INHALERS (DPIs
 With DPIs the patient's breath (rather than
hand action) actuates delivery of the
medication.You cannot see the spray because
the only way to get the medication is to inhale
it from the mouthpiece. Within the DPI
category, there are two broad types:DPIType
1): the medication is contained within the
inhaler device at all times, until inhaled, or
DPIType 2): the medication comes in a
separate capsule that must be placed into the
inhaler device at the time of use.

Type 1 medication is contained within
the inhaler device ..eg pulimcort
DPIType 2. Medication is separate from the inhaler,
in a capsule eg he widely used drug Spiriva
(tiotropium bromide)
•Turbuhaler

Classification of Dry Powder Inhalers,
Based on Design and Function
 Single-Dose Devices
 Aerolizer formoterol capsule
single
 HandiHaler tiotropium capsule
single

Multiple-Dose Devices
 Turbuhaler budesonide
reservoir 200
 Turbuhaler
budesonide/formoterol
reservoir 120
 Diskus salmeterol
blister
strip 60
 Diskus
salmeterol/fluticasone blister
strip 60

Dry powder inhaler (DPI)
Multi doses

Sereventdiscus®
 Generic: salmeterol
xinafoate
 Type: dry powder discus;
long acting beta2-agonist
 Functions: prevents
tightening of muscles
around lung tubes; takes
10-20 mins to work,
effective for at least 12 hrs.
headache; if sensitive to
drug, may develop rash,
itchiness, &
bronchospasm; don’t use
for quick relief
 Also available in: Serevent
inhaler
 Similar to: related to
Foradil & Oxeze

Combination
(fluticasone and salmeterol)
SereventFlovent
+
=
Advair
Inhaled Corticosteroids with
Long-acting Bronchodilator

Advair®
 Generic: fluticasone &
salmeterol
 Type:combination, powder
discus
 Class: controller/rescue
inflammatory; open
airways for at least 12
hours
hoarseness; rinse mouth
with water after use; never
increase the puffs unless
directed
 Also available in: purple,
blue; 100, 250, 500 mcg
 Similar to: Combivent
(ipratropium bromide &
albuterol sulfate)

DOSES
DRUG FORM DOSE
Fluticasone/salme
terol
DOI 100,250,or
500ug/50 ug
1 Inhalation bid

Adverse Effects
LOCAL SYSTEMIC
INH CS Candidiasis
Dysphonia
Adrenal suppression
Growth retardation
(large doses)
INH B2
AGONIST
Sympathetic
stimulation- tremor
Tachicardia
Hypokalemia

PROPELLANT-FREE "SOFT MIST"
INHALERS
 This is the latest type of
inhaler for asthma and
COPD. At this writing
there is only one soft mist
inhaler marketed in the
United State
 COMBIVENT budesonide
+ formoterol
 RESPIMAT does not
contain any of these
harmful propellants and
uses a spring mechanism
to release the medication

Nebulizer
 Compressor nebulizer is the most
commonly used and this consists of
an air compressor that is connected
to a cup provided for medication.
This cup is attached to a
mouthpiece or face mask.The
compressor produces compressed
air that is passed through the cup
with liquid medicine.As the air
comes in contact with the liquid
medicine, an aerosol mist is formed
and this mist is inhaled by the
patient through the mouthpiece or
face mask. In case of nebulizer
treatments for infants, usually a face
mask is used and not the
mouthpiece.
 in short, nebulizer
converts liquid
medicine to aerosol
mist that can go deep
into the airways and
alleviate inflammation.

VENTOLIN®
Respirator Solution VENTOLIN NEBULES
 Respirator Solution/
 5 mg salbutamol
 base/ml
 The average dose for a single
treatment is 0.25 to 0.5 mL of
 VENTOLIN®
 Respirator Solution (1.25 to 2.5 mg of
salbutamol) diluted in 2 to 5 mL or
 more of sterile normal saline. For
more refractory cases, the single dose
ofVENTOLIN®
 Respirator Solution may be increased
to 1 mL (5 mg of salbutamol).
Treatment may be
 repeated four times a day if necessary.
 Nebules/unit dose/
 2.5 or 5.0 mg
 salbutamol base/ 2.5 mL
 Children requiring a single dose of 2.5
mg may be administered
 the contents of a singleVENTOLIN®
 Respirator Solution unit dose
(VENTOLIN
 NEBULES®
 P.F. 2.5 mg of salbutamol). For more
refractory cases children may use a
 5 mg unit dose (see dosage above).
Treatment may be repeated 4 times a
day if necessary

Dose (mg) of
Salbutamol
(per treatment)
Volume (mL) of
Ventolin respirator
Solution
(per treatment)
Volume* (mL) of Sterile
Normal Saline to be
added as diluen
1.25 0.25 2-5 mL or mor
2.5 0.50 2-5 mL or mor
5 1.00 2-5 mL or mor

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