A nurse is teaching an adult patient newly prescribed inhaled fluticasone twice daily for asthma maintenance. Which patient instructions should the nurse include? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Option 1 is correct because a short-acting beta-2 agonist such as albuterol is the rescue medication for acute symptoms. Option 2 is incorrect because inhaled fluticasone is a controller and does not provide rapid bronchodilation during an acute attack. Option 3 is correct because a spacer improves medication delivery, and rinsing the mouth and spitting after each dose reduces oral candidiasis and dysphonia. Option 4 is incorrect because stopping and restarting the controller according to symptoms prevents consistent anti-inflammatory control. Option 5 is correct because the corticosteroid should be used every day even when the client feels well, and full benefit may take 2-4 weeks.
A spacer increases lung deposition (4–6 times more drug reaches the lower airways), reduces oropharyngeal deposition, and lessens the risk of oral candidiasis. Rinse-and-spit is the simplest preventive step; do not swallow the rinse. Common ICS adverse effects: oral candidiasis (thrush), dysphonia, and (at high doses) systemic effects including HPA axis suppression, growth suppression in children, and possible decreased bone mineral density. Step-up therapy: low-dose ICS → medium-dose ICS or low-dose ICS+LABA → medium- or high-dose ICS+LABA → add tiotropium or biologics. The two-medication household model — controller (ICS daily) plus rescuer (SABA as needed) — is taught with a written asthma action plan that includes green/yellow/red zones based on peak flow or symptoms.
An adult patient is newly prescribed inhaled fluticasone twice daily for asthma maintenance. The nurse provides teaching about correct use of the metered-dose inhaler and the role of the medication.
Inhaled Corticosteroid (ICS) — Anti-inflammatory controller medication for persistent asthma. Examples: fluticasone, budesonide, beclomethasone. Daily use even when asymptomatic; full effect develops over 2–4 weeks. Adverse effects: oral candidiasis, dysphonia, and at high doses systemic effects including HPA suppression.
Spacer Use and Rinse-and-Spit — A spacer increases lower airway drug deposition and reduces oropharyngeal deposition. Rinsing the mouth with water and spitting (not swallowing) after each dose markedly reduces oral candidiasis and dysphonia.
SABA Rescue Inhaler — Short-acting beta-2 agonists (e.g., albuterol) are bronchodilators used for acute symptoms. Onset within minutes. Frequent use (>2 days/week or >2 canisters/year) signals poorly controlled asthma and the need to step up controller therapy.