An adult client with persistent asthma is starting fluticasone HFA inhaler 2 puffs twice daily as a controller. Which client statement indicates correct use?

Inhaled corticosteroids (fluticasone, budesonide, beclomethasone, mometasone, ciclesonide) are first-line controllers for persistent asthma; they reduce airway inflammation but do not relieve acute bronchospasm — that is the role of a short-acting beta agonist (SABA, eg. albuterol). Key teaching: (1) take daily even when symptomatic relief is felt because controller benefit is cumulative, (2) use a spacer or valved holding chamber to improve lung deposition and reduce oropharyngeal deposition, (3) wait about 1 minute between puffs to allow optimal dispersal, (4) rinse mouth and gargle with water (and spit) after every dose to prevent oral candidiasis (thrush) and dysphonia, (5) clean the mouthpiece weekly, (6) when using a SABA + ICS combination, take the SABA first to open the airway only when both are short-acting separate inhalers; with fixed-dose ICS-formoterol regimens follow the prescriber plan, (7) report increased rescue inhaler use, nighttime symptoms, or activity limitation as signs of poor control, (8) ICS at standard doses minimally suppresses HPA axis but high-dose chronic use can cause growth suppression in children, cataracts, and bone loss. Stopping when symptoms improve is incorrect because asthma control deteriorates without daily controller dosing.

Rinse and spit after each ICS dose, use a spacer, and never use it as a rescue inhaler. These three rules sum up the most commonly tested ICS items on NCLEX.