Controller versus reliever
Asthma treatment uses two different kinds of inhaler. The reliever, here salbutamol (albuterol), is a short-acting beta-2 agonist that relaxes airway smooth muscle within minutes and is used when symptoms occur. The controller, here fluticasone, is an inhaled corticosteroid that reduces airway inflammation gradually over days to weeks and is taken every day on schedule. A client who says she will take extra puffs of fluticasone when she wheezes has confused the controller with the reliever, so she needs further teaching. Extra steroid puffs do not open the airway during an attack, and relying on them delays the salbutamol she actually needs.
Why the other statements are correct
Calling the clinic when she needs salbutamol more and more often is exactly right: increasing reliever use is a sign of poor control and means the treatment plan should be reviewed. Rinsing the mouth with water and spitting after fluticasone prevents oral candidiasis and hoarseness from steroid deposited in the mouth and throat. Continuing the controller twice a day even when she feels fine is also correct, because inflammation persists between symptoms and stopping the controller when she feels well is one of the most common causes of repeat exacerbations.
| Feature | Salbutamol (reliever) | Fluticasone (controller) |
|---|
| Drug class | Short-acting beta-2 agonist | Inhaled corticosteroid |
| Onset | Minutes | Days to weeks |
| When used | As needed for wheeze or breathlessness | Every day, even without symptoms |
| Key teaching | Rising use means poor control | Rinse mouth and spit after use |
Teaching a client with limited reading skills
She finished elementary school and says she is not good with reading, so the nurse should rely on teach-back and demonstration rather than written instructions alone. Labeling the inhalers (for example, "every day" and "when wheezing"), using simple pictures on the written asthma action plan, and having her show the spacer technique all support understanding. The question itself is a teach-back check: the nurse asks her to explain the plan in her own words and listens for the error.
Exam takeaway
Key point! For "needs further teaching" questions, find the statement that is unsafe or incorrect. In asthma, the classic error is using the inhaled corticosteroid as a rescue drug or stopping it when symptoms improve. Wheezing is treated with the reliever; the controller is taken every day regardless of symptoms. Rising reliever use reported to the clinic, steroid mouth rinsing, and daily controller use all show correct understanding.