72.若王同學最近出現中度間歇性氣喘發作，仍想參加桌球練習1小時，最合適的預防措施為何？
(A)不建議參加桌球練習
(B)運動前使用inhaled pirbuterol 2 puffs
(C)運動前使用inhaled formoterol 2 puffs
(D)長期使用inhaled beclomethasone 2 puffs

幹你的王同學你一定要打桌球嗎

回5F

最新的GINA Guideline 有說LABA不可單用喔！

請問間歇性氣喘藥怎麼用藥??

我讀到的是SABA PRN><

GINA的寫法如下

The LABA component may be associated with tachycardia, headache or cramps. LABA and ICS are safe for asthma when used in combination. LABA should not be used without ICS in asthma (or in patients with asthma+COPD) due to increased risk of serious adverse outcomes

在UpToDate的Exercise-induced bronchoconstriction則提到

Quick relief and preventive treatment — Short-acting beta-agonists (SABAs; albuterol [salbutamol], levalbuterol) are the most effective therapy for quick relief of EIB. All patients who report exercise-related symptoms should have access to a SABA for quick relief and be instructed on correct technique. Two inhalations (eg, albuterol 90 mcg/inhalation) are generally sufficient; occasionally four inhalations are needed.

Patients who have well-controlled asthma, but frequently have asthma symptoms with exercise, should be instructed to use prophylactic treatment approximately 5 to 20 minutes before exercise, usually with two inhalations of a SABA (eg, albuterol, levalbuterol) [30,66]. An alternative is to use a combination budesonide-formoterol (160 mcg/4.5 mcg) inhaler, 1 inhalation 5 to 20 minutes prior to exercise 

Prolonged or recurrent exercise — Patients who exercise formore than three hours or more than once a day represent a challenge in that use of a SABA multiple times a day is likely to lead to tachyphylaxis. One might imagine that an inhaled LABA might be useful in this situation. However, in concert with current guidelines, we do not recommend regular use of LABAs (ie, once or twice daily) as monotherapy for EIB, because of concerns about a loss of bronchoprotective effect over time [30,72,73]. Thus, for patients who would require regular, daily dosing of a SABA or LABA to control EIB, we recommend concomitant use of inhaled glucocorticoid or a leukotriene receptor antagonist

我自己猜會不會是年代差異(?)

71.若王同學想參加桌球密集訓練，每次練習4小時，最合適之預防性措施為何？ 
(A)不建議參加桌球密集訓練
(B)運動前使用inhaled albuterol 4 puffs
(C)運動前使用inhaled salmeterol 2 puffs
(D)長期使用inhaled beclomethasone 2 puffs 

他的上一題不就是LABA單用嗎？

中度moderate -> step 3 -> low dose ICS + LABA

為甚麼不可以用LABA壓?