# A nurse reviews a new outpatient asthma regimen of salmeterol inhaler twice daily without an inhaled corticosteroid. Which is the nurse's priority action?

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse reviews a new outpatient asthma regimen of salmeterol inhaler twice daily without an inhaled corticosteroid. Which is the nurse's priority action?

## Option

1. Switch to as-needed dosing
2. Administer the dose as ordered
3. Double the dose for better control
4. Hold the regimen and contact the provider — LABA monotherapy in asthma is contraindicated and carries a boxed warning for severe asthma exacerbation and death **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): LABA monotherapy in asthma (salmeterol, formoterol alone) is contraindicated due to an FDA boxed warning — increased risk of severe asthma exacerbation and asthma-related death. LABAs must be combined with an inhaled corticosteroid (e.g., fluticasone/salmeterol, budesonide/formoterol). COPD use without ICS is acceptable. (1,3,4) Unsafe.

## In-depth explanation

Memory Tip LABA + ICS = required pair in asthma. Standalone LABA = boxed warning. SABA (albuterol) is appropriate as PRN reliever.

## Clinical scenario

Scenario 35-year-old female with persistent asthma. New outpatient prescription: salmeterol DPI 50 mcg inhaled BID as sole controller, no inhaled corticosteroid.

## Key concepts

- **LABA monotherapy boxed warning** — FDA warning against single-agent long-acting beta-2 agonist in asthma due to mortality risk.
- **ICS/LABA combination** — Fluticasone/salmeterol, budesonide/formoterol, mometasone/formoterol — required pairing in moderate-severe asthma.
- **Step therapy** — Asthma management ladder; LABA added only as step 3+ AFTER inhaled corticosteroid initiated.

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