Bronchodilator / Beta-2 Agonist Inhaled
Salbutamol Sulphate
Salbutamol
CPG Reference
Salbutamol Sulphate (Ventolin) — Authorised Medications
Indications
- ✓ Bronchospasm in acute Asthma and Chronic Obstructive Pulmonary Disease (COPD)
- ✓ Bronchospasm in Anaphylaxis
- ✓ Smoke inhalation
- ✓ Salt Water Aspiration Syndrome (SCUBA divers)
Contraindications
- ✕ Known hypersensitivity to salbutamol
- ✕ Cardiogenic pulmonary oedema
- ✕ Age <12 months
Precautions
- ⚠ A spacer / MDI is the preferred route for salbutamol administration where the patient presents with influenza like illness
- ⚠ The use of a Metered Dose Inhaler (MDI) and spacer is equally as effective as nebulisation, in all asthma situations, where the patient is still able to adequately inhale
- ⚠ Use of a nebuliser is recommended where the patient loses the ability to adequately inhale from MDI — NOTE: nebulised route is outside EHS scope
- ⚠ If hypoxic, nebulise in preference over MDI to address both hypoxia and bronchospasm — NOTE: nebulised route is outside EHS scope
- ⚠ Hypokalaemia risk with high dose
- ⚠ Consider risk of hypokalaemia and metabolic acidosis with continuous nebulisation
Dosing
Adult
Amount 4–12 inhalations (400–1200 microg)
Route Inhaled — Metered Dose Inhaler (MDI) via Spacer only
Repeat Repeat every 20 minutes for the first hour, then every 1–4 hours according to clinical response. May give repeat dose sooner if indicated.
Max dose No single-session maximum stated; titrate to clinical response
EHS volunteers are authorised to administer via MDI and spacer ONLY. Nebulised route is not authorised for EHS.
Paediatric (6 years and over)
Amount 4–12 inhalations (400–1200 microg)
Route Inhaled — Metered Dose Inhaler (MDI) via Spacer only
Repeat Repeat every 20 minutes for the first hour, then every 1–4 hours according to clinical response. May give repeat dose sooner if indicated.
Max dose No single-session maximum stated; titrate to clinical response
EHS volunteers are authorised to administer via MDI and spacer ONLY. Nebulised route is not authorised for EHS.
Paediatric (12 months to 5 years)
Amount 2–6 inhalations (200–600 microg)
Route Inhaled — Metered Dose Inhaler (MDI) via Spacer only
Repeat Repeat every 20 minutes for the first hour, then every 1–4 hours according to clinical response. May give repeat dose sooner if indicated.
Max dose No single-session maximum stated; titrate to clinical response
EHS volunteers are authorised to administer via MDI and spacer ONLY. Not authorised for children under 12 months. Nebulised route is not authorised for EHS.
Onset: 2–5 minutes
Side Effects & Notes
Side Effects
- • Hypokalaemia (risk increases with high doses)
- • Metabolic acidosis (risk with continuous nebulisation — not applicable to EHS)
Clinical Notes
- → MDI via spacer is the ONLY authorised route for EHS — nebulised salbutamol is outside EHS scope of practice.
- → If patient cannot adequately inhale from MDI, nebulisation would be indicated — this requires escalation to Intermediate Care or above.
- → If doubt exists as to whether the patient is experiencing asthma or anaphylaxis, treat as per Anaphylaxis CPG.
- → Asthma is uncommon in those under 12 months of age; wheezing in this age group is more likely bronchiolitis which does not respond to bronchodilators.
- → When administering in anaphylaxis: ALWAYS give adrenaline auto-injector FIRST, then salbutamol for bronchospasm.
- → SpO2 is not a reliable isolated indicator of severity — a patient with normal SpO2 can still be time critical.
- → For patients with Asthma–COPD overlap, avoid uncontrolled oxygen therapy where possible and consider CSPSCC consultation.
- → Ventilate an asthmatic patient gently at no more than 4–6 breaths per minute to allow adequate exhalation and avoid air trapping.
- → Use resuscitation mask attachment on spacer if patient cannot form a seal around the mouthpiece.