Salbutamol (Albuterol): A Comprehensive Pharmacological and Clinical Monograph

Introduction

Salbutamol, known as albuterol in the United States, stands as a cornerstone in the management of respiratory diseases characterized by reversible airway obstruction. For over half a century, this short-acting β2-adrenergic receptor agonist (SABA) has been a first-line rescue medication, providing rapid and effective relief from the distressing symptoms of bronchospasm.[1] Discovered in 1966 by a team at Allen and Hanburys in the UK and launched in 1969 as Ventolin, its profound impact on patient care is underscored by its inclusion on the World Health Organization's List of Essential Medicines and its immense global utilization; in 2022, it was the seventh most commonly prescribed medication in the United States, with over 59 million prescriptions filled.[1]

The enduring success of salbutamol lies in its targeted and potent pharmacological action, which provides immediate bronchodilation and symptom relief, making it an indispensable tool for patients with asthma and chronic obstructive pulmonary disease (COPD).[1] However, the very efficacy that cemented its status as a life-saving medication has also revealed a critical paradox in its long-term use. The reliance on salbutamol for symptom relief can mask underlying chronic airway inflammation, the true driver of disease progression in asthma. This has led to a phenomenon of SABA over-reliance, which is now recognized as a marker of poor disease control and is associated with an increased risk of severe exacerbations and mortality.[2]