Introduction: Pediatric asthma exacerbations sometimes require aggressive intervention including continuous albuterol, a cornerstone therapy for reversing airway obstruction. However, pediatric dosing typically follows adult guidelines, with limited evidence for specific dosing ranges. This study aimed to compare the clinical outcomes of a reduced initial dose (10 mg/hr) of continuous albuterol with a standard dose (15 mg/hr) in children hospitalized for critical asthma exacerbations. Methods: This retrospective cohort study was conducted at Riley Hospital for Children, analyzing pediatric patients (ages 2-18) admitted with critical asthma exacerbations between 2014 and 2022. Stabilized inverse probability weighting (SIPW) was used to adjust for confounding factors between groups. The primary outcome was the percentage change in the Pediatric Asthma Severity Score (PASS) at 24 hours, with secondary outcomes including the duration of continuous albuterol, PICU length of stay, and hospital length of stay. Results: Analysis of 1,486 encounters revealed no significant difference in percent PASS changes at 24 hours between the 10 mg/hr and 15 mg/hr groups (Additive Treatment Effect of 1.69, 95% CI: -0.93-4.31, p = 0.207). PICU and hospital lengths of stay were also similar. However, the 10 mg/hr group showed a significantly shorter duration of continuous albuterol therapy compared to the 15 mg/hr group (Multiplicative Treatment Effect of 1.29, 95% CI: 1.14-1.45, p < 0.001). Conclusions: Findings suggested that starting continuous albuterol at 10 mg/hr provides clinical outcomes comparable to 15 mg/hr in managing pediatric critical asthma exacerbations. A lower starting dose may optimize resource use and reduce treatment-related adverse effects.