Salbutamol: everything you need to know

Salbutamol (also known as albuterol, brand names ProAir, Ventolin, Acuneb) is part of a group of medications known as short-acting beta-agonists (SABA). It is used as the first treatment for difficulty breathing, chest tightness, coughing, and wheezing associated with conditions like asthma and chronic obstructive pulmonary disease (COPD). 

SABAs are drugs that act as bronchodilators, meaning that they open up the airways and make it easier for air to pass through. Salbutamol usually starts working within about three minutes; its effect peaks after about 2.5 hours and lasts for up to six hours. If you find that this treatment does not alleviate your symptoms, or if you have more difficulty breathing after using this medication, seek medical attention immediately as it may be a sign that this medication is not working and an alternative treatment is necessary (Ejiofor, 2013). 

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SABAs work by relaxing the muscles in the airways, which can become constricted in conditions like asthma or COPD, narrowing the path for airflow and making it harder to breathe in and out. By relaxing these muscles, the airways can open up further, allowing more air in and out with each breath (NIH, n.d.). 

Salbutamol is used to treat two main conditions—asthma and COPD. In both conditions, patients experience periodic attacks during which their airways begin to constrict, making it difficult for air to pass through into their lungs. Salbutamol is used as a “rescue” treatment in these instances to open up the airways and allow more air into the lungs. While asthma is more commonly a disease that appears in childhood and can persist, COPD is most frequently associated with long-term inhalation of toxic substances, such as cigarette smoke, and usually appears in late adulthood in people with a long history of smoking (King Han, 2020).

Asthma is a condition characterized by very sensitive airways that react to certain triggers by swelling up. This makes the airways narrow, leaving less space for air to travel through and making it more difficult to breathe. 

Asthma is a relatively common condition that usually appears first in childhood and affects about 7% of the population (Yunginger, 1992; CDC, 2020). For some, the disease can be mild and even disappear over time, while for others, it can be debilitating and persist into adulthood (Fanta, 2020). 

For people with asthma, a trigger typically causes their airways to constrict, making it more difficult for them to breathe and resulting in shortness of breath, wheezing, and coughing. Some of the most common triggers of asthma include pollen, exercise, cold air, pet dander, pests (like cockroaches), mold, irritants like cigarette smoke (including secondhand smoke), acid reflux, certain medications (like NSAID painkillers and certain blood pressure medicines like beta blockers or ACE inhibitors). 

If your healthcare provider suspects you have asthma, they will likely run a range of tests to verify the diagnosis, including a test called spirometry, during which you will be asked to breathe into a machine to measure your lung function before and after using a medication like salbutamol. 

A diagnosis of asthma is given if the medication significantly improves your ability to breathe. Asthma is more common in people who have a history of allergic reactions to other things (like food allergies or seasonal allergies) (Fanta, 2020). Also, there is a genetic predisposition toward developing asthma, meaning that you are more likely to develop asthma if people in your family have a history of asthma (Duffy, 1990). 

If you are diagnosed with asthma, your healthcare provider may ask a series of questions in order to try to identify anything that might be triggering your asthma attacks. If you know what triggers your asthma, you may be able to avoid it or, if it is unavoidable (like cold air or exercise), use a medication like salbutamol before you are exposed to that trigger to avoid having an asthma attack (Fanta, 2020).

In the event that you do have an asthma attack, salbutamol can be used to alleviate the symptoms and restore your breathing to normal. Salbutamol is most commonly administered as an inhaler but is also available in pill form and as an injection. 

Depending on how severe your asthma symptoms are and how frequently you have attacks, your healthcare provider may also recommend the use of long-acting beta-agonists and/or steroids to treat this condition. It is important to remember that if you experience difficulty breathing and the salbutamol inhaler does not alleviate your symptoms, you must seek medical attention immediately. You may require additional treatment (Fanta, 2020). 

COPD is a condition that affects one out of every 20 people in the United States and is the fourth most common cause of death in the country. Unlike asthma, which is usually caused by the body’s reaction to normally harmless external triggers, COPD is usually the result of damage to the airways from toxic particles or gases, most commonly, cigarette smoke (King Han, 2020). 

Over time, cigarette smoke causes inflammation in the airways, which results in severe damage to the sensitive tissue of the lungs. It can result in the formation of scarring and break down the important structures in the lungs, making it difficult for us to breathe properly. 

While asthma attacks are reversible with treatment and typically don’t cause lasting damage, people with COPD have permanent lung damage that cannot be repaired. Like asthma attacks, COPD exacerbations are sudden-onset incidents of difficulty breathing that can be triggered by certain conditions or situations (King Han, 2020). 

The most common cause of sudden attacks of difficulty in breathing in COPD (known as COPD exacerbations) is a respiratory infection (caused by viruses or bacteria). Other important causes are environmental pollution and blood clots in the lungs (pulmonary embolisms) (Sapey, 2006). 

Treatment for COPD involves stopping smoking, the use of steroids (such as prednisone), and receiving vaccinations against the seasonal flu (influenza virus) and pneumococcus. During COPD exacerbations, your healthcare provider will likely recommend that you use a short-acting beta-agonist inhaler like salbutamol to alleviate your difficulty breathing. Very often, antibiotics will also be prescribed (Stoller, 2019).  

In rare cases, some people can have an imbalance of potassium in their blood. Too much potassium in the blood (known as hyperkalemia) is usually a side effect of certain medications or dialysis treatment and can cause serious heart problems. While there are other treatments for this condition, if they don’t work, healthcare providers may use salbutamol to lower the amount of potassium in your blood (UpToDate, 2020). 

For people who have experienced anaphylactic allergic reactions (involving swelling in the face and throat), a healthcare provider will likely prescribe epinephrine in the form of an EpiPen for use in the event that you have another allergic reaction. They may also prescribe you a salbutamol inhaler. 

It is important to remember to use the epinephrine first and seek medical attention immediately. While the salbutamol can make it easier to breathe, it is not a treatment for an allergic reaction, which can be a life-threatening event (UpToDate, 2020). 

The side effects of salbutamol depend on the manner in which you take it, and the dosage administered. The most common side effects include (UpToDate, 2020): 

• Excitement and nervousness

• Tremor

• Shakiness, headache, dizziness 

• Nausea or vomiting 

• Cough, throat irritation

• Unpleasant taste in the mouth

Even though salbutamol is used to make it easier to breathe, rarely, salbutamol can make it even more difficult to breathe. If you experience increased difficulty breathing despite using your inhaler, seek medical attention immediately as this medication might not be sufficient for controlling your breathing problems. 

Other serious side effects can include (UpToDate, 2020): 

• Fast heartbeat

• Chest pain

• Rash

• Itching/hives

• Swelling in the throat, face, tongue, eyes, or hands/feet

• Trouble swallowing

• High blood pressure

• Increased difficulty breathing 

It is important to remember that these are only some of the possible side effects. Consult with your health care provider if you experience any issues when using salbutamol. 

If you have any of the following conditions, discuss them with your healthcare provider before starting treatment with salbutamol (UpToDate, 2020): 

• Milk allergy: Some patients experience an allergic reaction to the ingredients in the inhaler. This is more common among people who have a milk allergy since some dry powder inhalers contain milk proteins. If you have a milk allergy, tell your healthcare provider before using this medication. 

• Diabetes: Salbutamol has been shown to increase blood sugar levels, which can be problematic for people with diabetes. If you have uncontrolled diabetes, your healthcare provider may recommend a different treatment option until your diabetes is under control. 

• Heart disease: This medication should be used with caution in people who have heart disease or have had a heart attack, as there is some evidence that it can cause further damage to the heart. 

• Glaucoma: If you have a history of glaucoma, this medication should be used with caution as it can increase the pressure in the eye and make glaucoma worse. 

• Hyperthyroidism: Tell your healthcare provider if you have a history of hyperthyroidism or Graves disease as this medication can raise the level of thyroid hormones in the blood. 

• Kidney disease, diuretic use, excessive alcohol consumption: If you have kidney disease, take diuretic medications, a history of excessive alcohol use, or a history of low blood potassium (hypokalemia), tell your healthcare provider as this medication can further lower your blood potassium. 

• Seizures: If you have a history of seizures, consult with your healthcare provider before using this medication as it may cause excessive stimulation/excitation that contributes to the development of seizures in people who have had seizures in the past.

It is important to note that this list is not exhaustive, and there are other conditions in which a person should not use salbutamol. Consult your healthcare provider and provide them with your full medical history before beginning any treatment. 

If you use salbutamol and your difficulty breathing persists, seek medical attention immediately as this may be a sign that your medication is not working. If you find that you need to use the medication more frequently, contact your healthcare provider as this may be a sign of deterioration of your condition and a need for other treatment options (UpToDate, 2020). 

Salbutamol can be given as a tablet or syrup taken by mouth (typically taken three or four times per day) or extended-release tablets that you take twice daily. It can also be given as a liquid for inhalation using a device called a jet nebulizer or as an aerosol spray or powder inhaled using an inhaler (MedLinePlus, 2016). 

In these forms, it’s typically administered as needed in the event that you develop difficulty breathing, or 15–30 minutes before exercise or any other known triggers to prevent an asthma attack. 

Aerosol inhalers typically contain either 60 or 200 doses, while powder inhalers contain 200 doses (MedlinePlus, 2016). Most insurance plans cover salbutamol, which costs between $20–$80 per month, depending on where you purchase it and whether or not you have insurance (GoodRx, 2020). 

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Current version

September 16, 2020

Written by

Yael Cooperman, MD

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewers

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.