Written by Joshua Belfer
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Continuous albuterol at 10 mg/h in children hospitalized with severe asthma led to similar clinical outcomes compared to 15 mg/h, but with a shorter duration of therapy and lower overall medication exposure.
A lower dose, a shorter course, but the same results
Continuous albuterol is a mainstay in treating severe pediatric asthma, but the optimal dose remains unclear. Dosing is often extrapolated from adult practice, and higher doses may increase side effects. Could less be more?
This retrospective cohort study from Riley Hospital for Children compared outcomes between children receiving 10 mg/h vs. 15 mg/h of continuous albuterol as initial treatment for critical asthma. Among 1,486 encounters––adjusting for confounding by propensity score modeling and inverse probability weighting––there was no significant difference in clinical improvement at 24 hours (PASS score change) and no difference in PICU or hospital length of stay, but a shorter duration of continuous albuterol in the 10 mg/h group (treatment effect 1.29, 95%CI 1.14–1.45). In other words, the 15mg/h group was on treatment 29% longer than the 10mg/h group. Subgroup analysis by age showed similar findings.
Limitations include missing outcome data (29.3% lacked 24-hour PASS scores), retrospective design, and single-center setting, which may limit generalizability. Additionally, a portion of the 10 mg/h group was later escalated to 15 mg/h, which could bias against the lower dose.
How will this change my practice?
Ah, asthma––our favorite frequent flyer. Over the last year, important studies on SMART therapy have already shifted how we manage asthma at home. Now, this study brings helpful guidance for dosing continuous albuterol in the hospital. While a larger, prospective trial would strengthen these findings, the potential to start with a lower dose––limiting side effects and possibly shortening hospital stays––feels like a win. I’m excited about this “less is more” mindset when it comes to continuous albuterol.
Source
Estimating the Effects of Continuous Albuterol Dosage on Clinical Outcomes for Pediatric Critical Asthma Exacerbation: A Retrospective Cohort Study. Pediatr Pulmonol. 2025 Sep;60(9):e71293. doi: 10.1002/ppul.71293. PMID: 40931966; PMCID: PMC12424099.
