A client with persistent asthma is prescribed salmeterol twice daily but has no inhaled corticosteroid in the medication list. Which action should the nurse take?
1Start salmeterol twice daily and stop albuterol because the long-acting drug replaces short-acting rescue therapy.
2Start salmeterol alone and add an inhaled corticosteroid only if nighttime symptoms continue for two weeks.
3Hold the prescription and contact the provider because salmeterol monotherapy is contraindicated in asthma.✓ Correct answer
4Use salmeterol for sudden wheezing because its long duration makes it preferable to a short-acting bronchodilator.
Explanation
Salmeterol is a long-acting beta2 agonist. For asthma, use without a concomitant inhaled corticosteroid is contraindicated because LABA monotherapy increases the risk of serious asthma-related outcomes. Salmeterol is maintenance therapy, not a rescue drug for acute bronchospasm. The nurse should hold the unsafe monotherapy plan and contact the provider for an appropriate corticosteroid-containing controller regimen.
Clinical reasoning A LABA provides prolonged bronchodilation but does not treat the underlying airway inflammation. In asthma, salmeterol monotherapy is unsafe and is not a substitute for a rescue inhaler.
Decision rule For persistent asthma, salmeterol must accompany an inhaled corticosteroid. Hold a LABA-only asthma order and clarify the controller plan.
Scenario 35-year-old female with persistent asthma. New outpatient prescription: salmeterol DPI 50 mcg inhaled BID as sole controller, no inhaled corticosteroid.
LABA monotherapy boxed warning — FDA warning against single-agent long-acting beta-2 agonist in asthma due to mortality risk.