# 護理師查看新的門診氣喘處方：salmeterol inhaler每日兩次，但沒有吸入型皮質類固醇。優先行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391768&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

護理師查看新的門診氣喘處方：salmeterol inhaler每日兩次，但沒有吸入型皮質類固醇。優先行動是什麼？

## 選項

1. 改成需要時使用
2. 依醫囑給藥
3. 將劑量加倍以改善控制
4. 暫緩此治療並聯絡處方者；氣喘中LABA單一療法禁忌，且有嚴重氣喘惡化與死亡的黑框警告 **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (2): 氣喘中的LABA單一療法（salmeterol、formoterol單獨使用）禁忌，因FDA 黑框警告指出會增加嚴重氣喘惡化與氣喘相關死亡。LABA必須與吸入型皮質類固醇合併，如fluticasone/salmeterol、budesonide/formoterol。COPD中未合併ICS使用則可接受。(1,3,4) 不安全。

## 深入解析

Memory Tip 氣喘治療LABA + ICS是必要配對。LABA單獨使用 = 黑框警告。SABA（albuterol）適合作為PRN緩解藥。

## 臨床情境

Scenario 35歲女性，持續性氣喘。新處方：salmeterol DPI 50 mcg inhaled BID作為唯一控制藥，無吸入型皮質類固醇。

## 重要概念

- **LABA單一療法黑框警告** — FDA警告氣喘中不可單獨使用長效beta-2 agonist，因有死亡風險。
- **ICS/LABA合併** — Fluticasone/salmeterol、budesonide/formoterol、mometasone/formoterol，中重度氣喘需配對使用。
- **階梯式治療** — 氣喘管理階梯；LABA只在吸入型皮質類固醇已啟動後，step 3以上加入。

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