Albuterol (ProAir®, Ventolin®, Proventil®)
| Albuterol |  |
|---|---|
| Brand Names | ProAir®, Ventolin®, Proventil® |
| Drug Class | Short-Acting β2 Agonist (SABA) |
| Primary Indication | Acute bronchospasm |
| Receptor Target | β2 adrenergic receptor |
| Mechanism | ↑ cAMP → Bronchodilation |
| Onset | ~3–5 minutes |
| Duration | 4–6 hours |
| Route | Inhaled (MDI, DPI, Neb) |
| Potassium Effect | ↓ Serum K⁺ (cellular shift) |
| FDA Approval | 1981 |
Overview
Albuterol is the first-line rescue bronchodilator for acute bronchospasm in asthma and COPD.
It provides rapid airway smooth muscle relaxation but does not treat airway inflammation, making it a symptom reliever rather than a controller medication.
Frequent use indicates poorly controlled disease and need for anti-inflammatory therapy such as Inhaled Corticosteroids.
Mechanism of Action
Receptor Activated
- β2 adrenergic receptor
Cellular Effects
- ↑ cAMP
- Smooth muscle relaxation
- ↓ mediator release from mast cells
- ↑ mucociliary clearance
Systemic Effect
- Drives potassium intracellularly
Net effect:
- Rapid bronchodilation and relief of airflow obstruction
Indications
- Acute asthma symptoms
- Exercise-induced bronchospasm prevention
- COPD rescue therapy
- Temporary treatment of hyperkalemia
Often used with:
Contraindications
Absolute:
- Hypersensitivity to albuterol
Relative / Caution:
- Tachyarrhythmias
- Ischemic heart disease
- Hyperthyroidism
Dosing
Metered-Dose Inhaler:
- 1–2 puffs every 4–6 hours PRN
Nebulizer:
- 2.5 mg every 4–6 hours PRN
Exercise prevention:
- 2 puffs 15 minutes prior to activity
Frequent use (>2 days/week):
- Indicates uncontrolled asthma
Pharmacokinetics
Onset:
- 3–5 minutes
Peak:
- ~30 minutes
Duration:
- 4–6 hours
Elimination:
- Hepatic metabolism and renal excretion
Adverse Effects
Adrenergic:
- Tremor
- Tachycardia
- Palpitations
- Anxiety
Metabolic:
- Hypokalemia
- Hyperglycemia (mild)
Other:
- Headache
Dose dependent — more common with frequent use.
Drug Interactions
Beta-blockers:
- Reduced bronchodilator effect
MAO inhibitors / stimulants:
- Increased tachycardia
Diuretics:
- Increased hypokalemia risk
Monitoring
- Rescue inhaler use frequency
- Symptom control
- Heart rate (high doses)
- Potassium (continuous nebs)
Clinical Pearls
- First drug used in asthma exacerbation
- Frequent use = need controller therapy
- Spacer significantly improves lung delivery
- Nebulizer easier to inhale — not stronger
- Useful temporary treatment for hyperkalemia
Comparison Within Class
Compared to Levalbuterol:
- Less selective β2 activity
- More tremor/tachycardia
- Lower cost
Compared to Formoterol:
- Shorter duration
- Used for rescue rather than maintenance