Suzanne Berman, M.D.
In healthy kids, the bronchial tubes are open and relaxed, allowing air to move in and out easily.
Sometimes, as part of an illness, the muscle around the bronchial tubes reacts by squeezing tight, making the airways, smaller. It’s harder to get air in and out, so kids will begin to make a wheezing sound when they breathe. They will cough more as they try to force air through small “pipes.”
Albuterol is a medication that is used as a bronchodilator — it opens up tight airway passages by relaxing the muscle that surrounds the airways. Albuterol is used most commonly for asthma, but it is sometimes prescribed for other conditions too.
How long will my child need the albuterol?
In general, your child may need some albuterol as long as the wheezing trigger lasts. For illnesses that run their course (like bad colds), it may take about a week. On the other hand, if your child is frequently exposed to things that cause wheezing (like cigarette smoke or animal dander), it may seem like he or she always needs albuterol. (In that case, the best thing to do is to get rid of the allergic trigger!)
How often should I use albuterol?
In general, a dose of albuterol (either 2 puffs from an inhaler or one breathing treatment) may be given every four to six hours as needed. Give it for dry, hacking cough (especially nighttime cough), wheezing you can hear, or if your child is working harder to breathe. Unlike some other medicines, albuterol is safe to use occasionally on an as-needed basis. It can be started when there is a need for acute relief, tapered as the child improves, and stopped when he is better. However, if your child seems to need it very frequently for more than a day or two, doesn’t seem to be getting better with it, or seems to have frequent wheezing spells, he or she may need other medications and should be checked again in the office.
Remember, albuterol only helps one cause of cough: tight airways. It won’t help other kinds of coughs, like coughing from nasal drainage from a bad cold.
What side effects does albuterol have?
Most kids do well with it, but the most common side effects are rapid heartbeat, lushing, and jitteriness. In some kids, the jitteriness becomes hyperactivity! In most kids, these side effects wear off, or at least are much less bothersome, after about 10-15 minutes. If your child experiences side effects that are bad enough that you don’t want to give him or her albuterol, please let us know.
Should my child get albuterol through an inhaler or a nebulizer machine?
In general, inhalers (with spacers and masks) work better in most situations than nebulizer machines. They are also more convenient, since it only takes a minute to administer a few puffs from an inhaler (while it can take 10-15 minutes to give a breathing treatment.) Occasionally, there are some circumstances in which breathing treatments may work better, however. If you are not sure which method is best for your child, or need a demo on how to use one or both devices properly, ask us.
Does this mean my child has asthma?
Not every child who wheezes has asthma.
Many infants and toddlers wheeze with bad colds and other respiratory viruses
but never wheeze again afterthey get to school-age. Other children who do have asthma start having wheezing spells as infants, and although it improves as they get older, they continue to have flare-ups from time to time as older kids. Because of this, we generally won’t diagnose asthma just based on one or two wheezing
episodes in a baby or toddler.
Kids with true asthma tend to have other allergic symptoms (like eczema, food allergies, and allergic rhinitis) and family members with asthma. They tend to have persistent coughs, even when they don’t have cold or other illnesses. Learn more about asthma here.
What about liquid albuterol (by mouth)?
Albuterol also comes in a liquid form that can be taken by mouth, and a few doctors still use this for wheezing in babies. However, studies show it doesn’t give nearly as much relief as inhaled albuterol, so most pediatricians don’t use it anymore. Also, oral liquid albuterol tends to have more bothersome side effects than the inhaled method.
What about Xopenex?
Xopenex is the brand name of a kind of albuterol which is more concentrated than regular albuterol. There are a few studies which show its side effects may be slightly less bothersome than regular albuterol. However, it’s also about ten times as expensive as regular albuterol, which seems to work just as well for symptom relief in almost all kids.