The management of asthma should normally follow a stepwise program, and patient response should be monitored clinically and by lung function tests.
Increasing use of short-acting inhaled β2 agonists to control symptoms indicates deterioration of asthma control. Under these conditions, the patient's therapy plan should be reassessed. Sudden and progressive deterioration in asthma control is potentially life threatening and consideration should be given to starting or increasing corticosteroid therapy. In patients considered at risk, daily peak flow monitoring may be instituted.
Patients receiving treatment at home with salbutamol solution for inhalation must be warned that if either the usual relief is diminished or the usual duration of action reduced, they should not increase the dose or its frequency of administration, but should seek medical advice.
Salbutamol solution for inhalation should be used with caution in patients known to have received large doses of other sympathomimetic drugs.
Salbutamol should be administered cautiously to patients with thyrotoxicosis.
A small number of cases of acute angle closure glaucoma have been reported in patients treated with a combination of nebulized salbutamol and ipratropium bromide. A combination of nebulized salbutamol with nebulized anticholinergic should be used cautiously. Patients should receive adequate instruction in correct administration and be warned not to let the solution or mist enters the eye.
Potentially serious hypokalemia may result from β2 agonist therapy mainly from parenteral and nebulized administration. Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia.
It is recommended that serum potassium levels are monitored in such situations.