Indications
FDA-Approved Indications
Albuterol, also known as salbutamol, is approved by the U.S. Food and Drug Association (FDA) for treating and preventing acute or severe bronchospasm in patients with reversible obstructive airway disease, including exercise-induced bronchospasm.[1][2][3] In the absence of albuterol’s bronchodilatory effects, individuals may face the risk of catastrophic asphyxiation. This makes the drug highly desirable to be readily available for individuals experiencing recurrent obstructive airway symptoms, such as asthma.
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Off-Label Uses
Albuterol is used off-label as an adjuvant treatment for hyperkalemia.[4][5] Notably, albuterol is not recommended as monotherapy due to its potentially weakened potassium-lowering effect in patients with end-stage renal disease. Instead, it should be considered only after successfully attempting treatment with intravenous calcium to stabilize cardiac tissue. The rhythm of the cardiac tissue is highly dependent on potassium concentrations. Subsequently, the administration of insulin and glucose is advised to facilitate the intracellular transport of potassium.[6]
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Currie et al conducted a study on the treatment preferences of Canadian pediatric emergency department physicians for wheezing preschool patients. Most physicians opted for albuterol treatment both in the emergency department and upon discharge. The additional use of oral glucocorticoids ranged from 12% to 81%. Factors influencing this treatment choice included age, a history of atopy, and the type of wheezing, particularly continuous wheezing. Currie et al discovered that physicians expressed willingness to enroll their patients in a randomized clinical trial to obtain guidance on when to incorporate oral glucocorticoids as part of the treatment.[7]
The Global Initiative for Asthma (GINA) guidelines now advise against the use of short-acting beta-agonists (SABA) alone, without inhaled corticosteroids (ICS), for the treatment of asthma in adults, adolescents, and children aged 5 or older. This change is attributed to the heightened risk of severe asthma exacerbations, potentially necessitating emergency department visits and hospitalization, which can contribute to asthma-related fatalities. Incorporating ICS with SABA or long-acting beta-agonists (LABA) substantially reduces these risks. Albuterol is utilized in the bronchodilator responsiveness test. In contrast to pre-test levels, measurements are obtained 10 to 15 minutes after administering 200 to 400 mcg of albuterol. In adults, a positive response is defined as an increase in Forced Expiratory Volume in 1 second (FEV1) of >12% and >200 mL (preferably, >15% and >400 mL). A greater than 12% increase in predicted FEV1 indicates a positive responsiveness in children. To enhance reliability, it is recommended to withhold SABA for ≥4 hours before the test.[8]
The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend initiating short-acting inhaled β2-agonists (SABA), such as albuterol, either alone or in combination with short-acting anticholinergics (SAMA), as the primary bronchodilators for the immediate treatment of chronic obstructive pulmonary disease (COPD) exacerbations.[9]
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