Pharmacotherapy. 2017 May;37 (5): 607-610.
Albuterol in bottles used for multiple dosing contains benzalkonium chloride (BAC) as a preservative. The authors say that many pediatric hospitals use this kind of albuterol when preparing solutions for continuous nebulized albuterol for asthma patients. This is done today — for the hospital’s convenience — in spite of knowing that BAC causes bronchoconstriction since at least as far back as 1987!! (Beasley et al, 1987)
QUOTE: “… most health care providers would not be able to differentiate whether poor outcomes are spontaneous or are exacerbated by BAC.”
QUOTE: “In the absence of a double-blind randomized study and based on the compelling evidence that high doses of BAC exert a detrimental effect on airway function, we recommend that the preservative-free products be used in a large-volume nebulizer.”
NOTE: By the way, the authors also note that the FDA has never approved the use of continuous nebulized albuterol, and that no data on its efficacy and safety has been submitted to them. In spite of that, this treatment has become a standard treatment in the U.S. If you or your child must receive this treatment, someone should go along with you to make sure that the hospital prepares it without the BAC preservative — insist on it!