Albuterol Nursing Considerations & Patient Teachings

Albuterol (also referred to as Salbutamol) is a fast-acting bronchodilator that prevents and manages wheezing and shortness of breath brought on by breathing difficulties (such as asthma, and chronic obstructive pulmonary disease). It is also used to prevent exercise-induced asthma. Albuterol relaxes the airways’ muscles, allows them to open, and facilitates breathing.

Generic names: Albuterol Sulfate (Salbutamol Sulfate)

Brand names: AccuNeb, Airomir, Apo-Salvent, Gen-Salbutamol, Nu-Salbutamol, PMS-Salbutamol, ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA, Vospire-ER

Pharmacologic class: Sympathomimetic (beta2-adrenergic agonist)

Therapeutic class: Bronchodilator, antiasthmatic

Mechanism of action: Albuterol relaxes bronchial (lung) smooth muscle by stimulating beta2-receptors in the lungs. Albuterol opens airways and dilates blood vessels, relieving bronchial spasms.

Indications for use: Treatment and prevention of bronchospasm in patients with reversible obstructive airway disease (asthma). Prevention of exercise-induced bronchospasm. Off-label uses include chronic obstructive pulmonary disease (COPD), hyperkalemia with renal failure, and preterm labor management.

Precautions and contraindications: Do not use if sensitive to other bronchodilators, or severe hypersensitivity to milk protein (powder for inhalation). Take caution in patients with hypertension, cardiovascular disease, diabetes, heart failure, arrhythmias, hyperthyroidism, glaucoma, seizure disorders, exercise-induced bronchospasm, and prostatic hypertrophy.

Elderly patients, pregnant or breastfeeding patients, and children should be careful in using albuterol.

Drug Interactions

• Albuterol coupled with beta-adrenergic blockers causes severe bronchospasm in asthmatic patients by inhibiting albuterol action 
• Digoxin and albuterol can lower digoxin levels in the blood
• MAOIs can increase cardiovascular adverse effects
• Severe hypotension due to oxytoxics (stimulants of the uterus)
• Potassium-wasting diuretics can increase ECG changes and hypokalemia
• Theophylline with albuterol can increase theophylline toxicity risk
• Increased stimulant effects can be a result of albuterol with food or beverages containing caffeine 
• St. John’s wort decreases albuterol effects
• Ephedra and yohimbe may stimulate CNS (central nervous system)

Adverse Effects

• Dizziness, headache, hyperactivity, insomnia
• Hypertension, palpitations, tachycardia, chest pain
• Conjunctivitis, dry and irritated throat
• Nausea, vomiting, heartburn, dry mouth, increased appetite
• Hypokalemia, muscle cramps
• Cough, dyspnea, wheezing, paradoxical bronchospasm (constriction of the airways after a bronchodilator is given)
• Pallor, hives, rash, swelling under the skin (angioedema), flushing, sweating
• Tooth discoloration, hypersensitivity reactions

Administration Considerations

Available preparations: Inhalation aerosol, inhalation powder, inhalation solution, oral solution, syrup, tablets, and extended-release tablets 

Dosages for adults and children 12 years or older: Dosage is dependent on use. 

For prevention of exercise-induced bronchospasm: 2 inhalations 15 minutes before exercise. For prevention and relief of bronchospasm in asthma: 

• Tablets—2-4 mg P.O. 3-4 times daily; Maximum 32 mg daily
• Extended-release tablets—4-8 mg P.O. every 12 hours; Maximum: 32 mg daily
• Syrup—2-4 mg (1-2 tsp or 5 to 10 ml) 3-4 times daily; 
• Aerosol—1-2 inhalations every 4-6 hours for relief; 2 inhalations QID for prevention
• Inhalation solution—2.5 mg 3-4 times daily by nebulization, delivered over 5-15 minutes

Dosages for elderly and with sensitivity to beta-adrenergic stimulants: Adjustment accordingly.

Dosages for children 6-12 years: Dosage is dependent on weight and use.

Dosages for children 2-12 years old: Dosage is dependent on weight and use. For prevention and relief of bronchospasm in asthma: With weight >15 kg (33 lb): Inhalation solution: 2.5 mg 3-4 times/day by nebulization.

Dosages for children 2-6 years old: For prevention and relief of bronchospasm in asthma: Syrup: 0.1 mg/kg P.O. TID; Maximum dosage is 4 mg (2 tsp) TID.

Dosages for adults and children 4 years old or older with Powder Breath Activated Inhalation (ProAir HFA): For treatment of acute bronchospasm: 2 inhalations every 4-6 hours; For prevention of exercise-induced bronchospasm: 2 inhalations 15-30 minutes before exercise.

Nursing Considerations for Albuterol

Related Nursing Diagnoses:

• Ineffective airway clearance
• Impaired gas exchange
• Risk for ineffective peripheral tissue perfusion
• Risk for unstable blood pressure, insomnia as potential side effects of albuterol

Nursing Assessment:

1. Assess for allergies to bronchodilators and paradoxical bronchospasm.
2. Assess the characteristics of respirations (rate, depth, rhythm, and use of accessory muscles)
3. Auscultate lung sounds. 
4. Assess vital signs for baseline.
5. Check sputum for amount, color, and consistency.
6. Monitor for EKG changes.
7. Monitor changes in serum potassium, glucose, and ABGs.
8. Assess sleeping patterns.

Nursing Interventions:

1. Prepare extended-release tablets without breaking, crushing, dissolving, or dividing.
2. Shake the aerosol container before inhalation.
3. Administer nebulization over 5-15 minutes.
4. Evaluate the effects of albuterol after administration.
5. Prepare resuscitation equipment at the bedside for possible emergencies.
6. Implement fall and safety precautions albuterol may cause dizziness.

Patient Teaching Associated with Albuterol

1. Advise the patient not to take extended-release tablets with food.
2. Educate the patient to take the extended-release tablets whole. Do not break, crush, dissolve or divide the tablet.
3. Encourage an increase in oral fluid intake.
4. Teach the client the proper preparation and administration of MDI or nebulizers.
5. Recommend the use of a spacer with a metered-dose inhaler (MDI).
6. Remind the patient to wait for 2 minutes before inhaling the next dose, allowing for maximum bronchial absorption.
7. Instruct the patient not to take more than 2 inhalations at a time to prevent paradoxical bronchoconstriction
8. Ask the patient to rinse their mouth with water immediately after using their inhalation device to prevent dryness and infection of the mouth/throat.
9. Spacer is not recommended for inhalation powder preparations.
10. Advise the patient not to wash or submerge any part of the inhaler in water.
11. Teach the client to stop albuterol and report signs of difficulty breathing after use.
12. Notify the provider if there is a failure to relieve the symptoms after taking albuterol. This is a sign of worsening bronchospasms in asthma.
13. Emphasize limiting caffeine intake and avoid taking herbs unless directed by a physician.
14. Advise the patient to avoid driving and strenuous activities upon initiation of albuterol until the effects have been evaluated.
15. If insomnia occurs, do not take albuterol close to bedtime.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

1. Kizior, R. J., & Hodgson, K. J. (2019). Saunders Nursing Drug Handbook 2019. Elsevier Health Sciences.
2. Schull, P. (2013). McGraw-hill nurses drug handbook (7th ed.). McGraw Hill Professional.