Salbutamol

Salbutamol is a fast-acting beta-2 sympathomimetic (SABA) used as an emergency medication for acute shortness of breath. It widens the narrowed bronchi within minutes, allowing you to breathe freely again.

The medication is mainly used as a metered-dose inhaler (spray). It should be used as needed, not as regular long-term therapy.

Well-known brand names are Sultanol®, Ventolin® and numerous generics.

Salbutamol works by activating the beta-2 receptors in the bronchial muscles:

Mechanism of action: 1. Salbutamol binds to beta-2 adrenoceptors in the bronchi 2. This activates adenylate cyclase and raises the cAMP level in the cells 3. The smooth muscle of the bronchi relaxes 4. The narrowed airways open up

Time course:

• Onset of action: 1-5 minutes after inhalation
• Peak effect: 15-30 minutes
• Duration of action: 4-6 hours

Additional effects:

• Inhibits the release of mediators from mast cells
• Improves mucociliary clearance (removal of mucus)
• No relevant anti-inflammatory effect

Salbutamol is suitable for:

• Acute asthma attacks (emergency treatment)
• COPD exacerbations
• Exercise-induced asthma (before sports)
• As an as-needed medication for shortness of breath

Important areas of use:

• Bronchial asthma
• Chronic obstructive pulmonary disease (COPD)
• Bronchospasm of various causes

Not suitable as:

• The only treatment for asthma (controller therapy needed!)
• Long-term therapy for regular symptoms
• A replacement for corticosteroid inhalers

Warning sign: If salbutamol is needed more than 2 times a week, asthma control is inadequate – have your therapy reviewed!

Metered-dose inhaler (spray):

• 100 µg per puff
• Pack sizes: 200 puffs

Dry powder inhaler:

• 100 µg or 200 µg per dose

Inhalation solution (for nebulizers):

• 1.25 mg, 2.5 mg or 5 mg per ampule

Recommended dosage:

• Adults and adolescents aged 12 and over: 1-2 puffs as needed
• Children aged 4 to 11: 1 puff as needed
• Maximum: 12 puffs per day for adults and adolescents, 6 puffs per day for children (if needed regularly, see a doctor!)
• The maximum amount may differ depending on the product, please follow the package leaflet

Correct inhalation technique (metered-dose inhaler): 1. Remove the protective cap, shake the spray 2. Breathe out deeply 3. Close your lips around the mouthpiece 4. Release the puff while breathing in slowly and deeply 5. Hold your breath for 10 seconds 6. Breathe out slowly 7. Wait 30 seconds before a second puff

With a spacer (recommended):

• Spray into the spacer
• Breathe in and out normally 5-6 times
• Better distribution of the active ingredient, fewer side effects

For acute shortness of breath:

• 2-4 puffs, repeat after 10-20 minutes if necessary
• For severe shortness of breath, call emergency medical services immediately!

Before sports:

• 1-2 puffs 15-30 minutes before exercise

Salbutamol must not be used in case of:

• Hypersensitivity to salbutamol or any of the ingredients

Caution in case of:

• Severe cardiovascular disease
• Hyperthyroidism (overactive thyroid)
• Pheochromocytoma
• Diabetes mellitus (can raise blood sugar)
• Hypokalemia (low potassium)
• QT prolongation

Pregnancy: Can be used if there is an appropriate indication. In asthma, controlling the disease is more important than theoretical risks.

Breastfeeding: Use is possible; only minimal amounts of the active ingredient pass into breast milk.

Common (1-10%):

• Tremor (shaking, especially of the hands)
• Palpitations, tachycardia
• Headache
• Muscle cramps

Uncommon (0.1-1%):

• Restlessness, nervousness
• Dizziness
• Dry mouth
• Nausea

Rare:

• Cardiac arrhythmias
• Hypokalemia (at high doses)
• Paradoxical bronchospasm
• Allergic reactions

Note: Many side effects occur more frequently when taken orally than when inhaled. Local use minimizes systemic effects.

Interactions with:

• Beta blockers – can cancel out the effect of salbutamol
• Avoid non-selective beta blockers in asthma!
• MAO inhibitors – increased cardiovascular effects
• Tricyclic antidepressants – increased effect on the heart
• Corticosteroids, diuretics – increased risk of hypokalemia

Synergistic effect with:

• Inhaled corticosteroids (useful combination)
• Anticholinergics (e.g. ipratropium)

Note: In stable asthma, salbutamol should be needed as rarely as possible – frequent need indicates inadequate control.