====== Albuterol (ProAir®, Ventolin®, Proventil®) ======

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<WRAP infobox>
^ Albuterol | {{:respiratory:beta2_agonists:albuterol-teaser.png?200|}} |
| Brand Names | ProAir®, Ventolin®, Proventil® |
| Drug Class | [[respiratory:beta2_agonists:saba|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 |
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</WRAP>

===== 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 [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]].

<WRAP clear></WRAP>

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===== 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

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===== Indications =====

  * Acute asthma symptoms
  * Exercise-induced bronchospasm prevention
  * COPD rescue therapy
  * Temporary treatment of hyperkalemia

Often used with:
  * [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]]
  * [[respiratory:antimuscarinics:start|Antimuscarinics]]

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<WRAP contra>
===== Contraindications =====

Absolute:
  * Hypersensitivity to albuterol

Relative / Caution:
  * Tachyarrhythmias
  * Ischemic heart disease
  * Hyperthyroidism

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<WRAP details>
===== 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

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<WRAP details>
===== Pharmacokinetics =====

Onset:
  * 3–5 minutes

Peak:
  * ~30 minutes

Duration:
  * 4–6 hours

Elimination:
  * Hepatic metabolism and renal excretion

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<WRAP details>
===== Adverse Effects =====

Adrenergic:
  * Tremor
  * Tachycardia
  * Palpitations
  * Anxiety

Metabolic:
  * Hypokalemia
  * Hyperglycemia (mild)

Other:
  * Headache

Dose dependent — more common with frequent use.

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<WRAP details>
===== Drug Interactions =====

Beta-blockers:
  * Reduced bronchodilator effect

MAO inhibitors / stimulants:
  * Increased tachycardia

Diuretics:
  * Increased hypokalemia risk

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<WRAP monitoring>
===== Monitoring =====

  * Rescue inhaler use frequency
  * Symptom control
  * Heart rate (high doses)
  * Potassium (continuous nebs)

</WRAP>

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<WRAP pearls>
===== 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

</WRAP>

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===== Comparison Within Class =====

Compared to [[respiratory:beta2_agonists:levalbuterol|Levalbuterol]]:
  * Less selective β2 activity
  * More tremor/tachycardia
  * Lower cost

Compared to [[respiratory:beta2_agonists:formoterol|Formoterol]]:
  * Shorter duration
  * Used for rescue rather than maintenance

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===== Related =====

  * [[respiratory:beta2_agonists|β2 Agonists]]
  * [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]]
  * [[respiratory:asthma|Asthma]]
  * [[respiratory:copd|COPD]]