Nebulisation dosage
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adult nebulisation dosage salbutamol ipratropium budesonide hypertonic saline standard doses
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I have enough comprehensive data to compile a thorough response. Here is the complete adult nebulisation dosage reference:
Adult Nebulisation Dosage Guide
1. Short-Acting Beta-2 Agonists (SABAs)
Salbutamol (Albuterol)
| Indication | Dose | Frequency | Notes |
|---|---|---|---|
| Acute asthma / COPD exacerbation | 2.5 mg (0.5 mL of 0.5% solution diluted to 3 mL with NS) | Every 20 min x 3 doses initially, then Q1-4h PRN | Continuous nebulisation (5-10 mg/hr) in severe/life-threatening asthma |
| Maintenance / mild exacerbation | 2.5-5 mg | Q4-6h | Dilute to 3 mL total with NS |
| Solution available | 5 mg/mL (0.5%) respirator solution |
Terbutaline (nebulised)
| Dose | Frequency |
|---|---|
| 5-10 mg | Q4-6h |
2. Short-Acting Muscarinic Antagonists (SAMAs)
Ipratropium Bromide
| Indication | Dose | Frequency | Notes |
|---|---|---|---|
| COPD / asthma exacerbation | 250-500 mcg | Every 4-6h (Q4-8h) | Combined with salbutamol at initiation improves outcomes and reduces hospitalisation |
| COPD maintenance | 250-500 mcg | TID-QID | |
| Combi nebuliser (Ipratropium 0.5 mg + Albuterol 2.5 mg / 3 mL) | 1 vial (3 mL) | QID, up to 6 doses/day PRN | |
| Solution available | 250 mcg/mL | Do NOT mix with cromolyn sodium |
Ipratropium can be mixed with salbutamol, terbutaline, or budesonide in the same nebuliser within 1 hour.
3. Inhaled Corticosteroids (ICS)
Budesonide (Pulmicort Respules)
| Indication | Dose | Frequency | Notes |
|---|---|---|---|
| Mild-moderate asthma (maintenance) | 0.5-1 mg | Once or twice daily | Total daily dose: 0.5-2 mg |
| Severe asthma / initiation / weaning oral steroids | 1-2 mg/day | Once or twice daily | May increase further in very severe cases |
| COPD maintenance (nebulised) | 360-1600 mcg/day | Once or twice daily | |
| Available strengths | 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL | Can be mixed with NS, salbutamol, terbutaline, ipratropium, or cromoglycate |
4. Long-Acting Beta-2 Agonists (LABAs) - Nebulised
Formoterol (nebulised) - COPD
| Dose | Frequency |
|---|---|
| 20 mcg | Twice daily |
5. Epinephrine (Adrenaline) - Nebulised
| Indication | Dose | Notes |
|---|---|---|
| Croup (also used in anaphylaxis / acute upper airway oedema) | 1 mg/mL (1:1000): 5 mL | Administer neat or diluted in 3 mL NS; monitor for rebound |
| Acute severe bronchospasm (when beta-2 agonists unavailable) | 1 mg (1 mL of 1:1000) diluted to 5 mL NS | Not first-line; cardiac monitoring required |
6. Mucolytics / Airway Clearance
N-Acetylcysteine (NAC)
| Dose | Frequency | Notes |
|---|---|---|
| 3-5 mL of 20% solution or 6-10 mL of 10% solution | TID-QID | Can cause bronchospasm; pre-treat with bronchodilator |
Hypertonic Saline
| Concentration | Dose | Frequency | Indication |
|---|---|---|---|
| 3% | 4 mL | BD-TID | COPD, bronchiectasis, mucus clearance |
| 6% | 4 mL | Twice daily | Cystic fibrosis, bronchiectasis |
| 7% | 4 mL | Twice daily | CF (standard protocol) |
Pre-treat with salbutamol 2.5 mg 15 minutes before each hypertonic saline dose to prevent bronchospasm.
Dornase Alfa (rhDNase)
| Indication | Dose | Frequency |
|---|---|---|
| Cystic fibrosis | 2.5 mg | Once daily (some patients BD) |
7. Antibiotics (Nebulised)
Tobramycin (TOBI)
| Dose | Frequency | Indication |
|---|---|---|
| 300 mg / 5 mL | BD for 28 days on / 28 days off | P. aeruginosa in CF |
Colistin (Colistimethate sodium)
| Dose | Frequency | Notes |
|---|---|---|
| 75-150 mg | Q12h | MDR P. aeruginosa / Acinetobacter pulmonary infections; generally better tolerated than IV |
Aztreonam Lysine (Cayston)
| Dose | Frequency | Indication |
|---|---|---|
| 75 mg | TID (at least 4h apart) for 28 days on / 28 days off | P. aeruginosa in CF |
8. Antiviral / Anti-infective
Pentamidine
| Indication | Dose | Frequency |
|---|---|---|
| PCP prophylaxis | 300 mg in 6 mL sterile water | Once monthly |
| PCP treatment (adjunct) | 600 mg daily | Daily |
9. Summary: Key Practical Points
- Diluent: Always dilute to 3-5 mL total volume with 0.9% NS unless the solution is ready-to-use.
- Flow rate: Jet nebulisers require 6-8 L/min oxygen or air; mesh nebulisers are flow-independent.
- Drug combinations: Salbutamol + ipratropium + budesonide can be mixed in the same nebuliser. Do NOT mix ipratropium with cromolyn.
- Acute severe asthma: SABAs + ipratropium together at initiation reduce hospitalisation rates (Murray & Nadel's).
- COPD exacerbation (GOLD guidelines): SABA ± SAMA (ipratropium) is first-line bronchodilator.
- Monitoring: ECG/cardiac monitoring for epinephrine; serum potassium after repeated salbutamol nebulisation (risk of hypokalaemia).
Sources: Murray & Nadel's Textbook of Respiratory Medicine | Goldman-Cecil Medicine, Table 762 | Tintinalli's Emergency Medicine | Park's Textbook of Preventive & Social Medicine | Washington Manual of Medical Therapeutics | Mayo Clinic / NCBI StatPearls (Ipratropium)
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