I don't use albuterol all the time, just when I'm getting sick and can't walk around without it. At that point I normally need more than 2 puffs for it to be helpful and I do a couple every few hours. You can def do 3 or 4 per dose, depending on how often you take it, but beyond that you have to be careful because it ups your heart rate. The effect varies person by person so check with your doc, you might be able to handle more. I know that I get fewer side effects now that I use it more often. If you need to be on a lot long term you might want to switch your rx to xopenex. It doesn't have as much of an impact on your heart but it is more expensive. I've been on nebulized xopenex as often as every 2 hrs in the hospital for a few days and been ok. They do give nebulized albuterol that often, but so much makes me jittery and shaky, or at least it used to. I don't get nearly the side effects I did when I was only using albuterol every couple months.