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How Much Albuterol is Too Much?

Posted by Mark Bubak, M.D. on May 30, 2017 2:21:15 PM

As all asthmatics know, it’s nice to have something that helps fix your shortness of breath, cough, wheezing, or chest tightness right away.  Like many asthmatics, your albuterol inhaler, which helps relieve these symptoms, can quickly become your very best friend!  But did you know that you can get too much of a good thing?  Read more to learn why.

When you can’t breathe, you know as well as any other asthmatic that you will do about anything to get your breathing back to normal.  Being a doctor that specializes in asthma treatment, I often look at my patient’s albuterol use to gauge how well their asthma control is going – less albuterol means better asthma control!  National and Global Asthma Guidelines indicate that a well-controlled asthmatic will need their rescue inhaler 2 or fewer times a week, often referred to as the ‘Rule of 2’ (of course, most patients prefer zero use of their inhalers each year!).  The ‘Rule of 2’ means using a maximum of 208 puffs of albuterol per year, which is less than one inhaler.  If you use more than one inhaler in a year, it means you need a better ‘controller’ or prevention program.  See your asthma specialist if you believe you are using your inhaler too often.

Another way I evaluate my patient’s asthma is by how often they need their albuterol. The old ‘Rule of 4’ says if you need to use your albuterol inhaler more than every 4 hours or more than 4 times in a 24-hour period that you need to get your asthma evaluated right away.  This indicates that a fast intervention is needed to gain control of your asthma.  The treatment provided is often systemic steroids or allergy avoidance (such leaving the home you are visiting with the cat).  Studies also show us that some patients who use albuterol 4 times a day as a routine may find their asthma getting worse just from this practice. 

Regarding albuterol and exercise: your asthma specialist likely advised you to utilize your inhaler prior to exercising. The 2 puffs of albuterol that you take before exercise do not count in the ‘Rule of 2’ or the ‘Rule of 4’.  However, if you find you are still having asthma attacks even after utilizing your inhaler prior to exercise then you should see your asthma specialist to adjust your asthma program.

To sum it all up: 

  • Use your albuterol before hard exercise
  • Use your albuterol when you need it 
  • Your program needs a change if you break either the Rule of 2 or the Rule of 4
  • Your program needs a change if your exercise control isn’t working 


Trust me, your albuterol inhaler won’t mind not being your best friend!  If you have questions or concerns about your asthma program, feel free to contact Dr. Bubak at Dakota Allergy and Asthma at 605-336-6385.  For additional information about how to control your asthma, CLICK HERE.  


Topics: Managing Asthma, Asthma