# 情境 持續性氣喘成人個案開始以fluticasone HFA吸入器2 puff BID作為controller。正確使用的陳述為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375109&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 持續性氣喘成人個案開始以fluticasone HFA吸入器2 puff BID作為controller。正確使用的陳述為何?

## 選項

1. 使用spacer、puff間隔1分鐘、每次用後漱口並含漱以預防口腔念珠菌症。 **✔ 正確答案**
2. 每當我感到喘鳴或呼吸急促時，我就會吸兩口，應該在幾分鐘內就能緩解我的症狀。
3. 既然吸入器把藥物直接送到呼吸道，我就不需要漱口，因為藥物不會留在口腔裡。
4. 只要呼吸感覺好轉，我就會停用吸入器，這樣就不用面對體重增加這類副作用了。

**正確答案: 1**

## 解析

吸入皮質類固醇(fluticasone、budesonide、beclomethasone、mometasone、ciclesonide)為持續性氣喘的第一線控制藥，可減輕氣道發炎，但無法緩解急性支氣管痙攣，那是短效型β2受體促進劑(SABA，例如albuterol)的角色。教學要點：(1) 控制效果為累積，症狀改善亦需每日使用；(2) 使用spacer或附閥保留器提升肺部沉積並減少口咽部殘留；(3) puff間隔約1分鐘以利最佳分散；(4) 每次使用後以水漱口含漱並吐出以預防口腔念珠菌症與聲音改變；(5) 每週清洗吸嘴；(6) 同時有SABA與ICS分別吸入器時SABA先用以擴張氣道(固定劑量ICS-formoterol依處方執行)；(7) 救援吸入器使用增加、夜間症狀或活動受限是控制不佳的徵象，需回報；(8) 標準劑量ICS對HPA軸抑制少，但高劑量長期使用會抑制兒童生長、引起白內障與骨流失。症狀改善即停用會因每日控制中斷導致氣喘控制變差，並不正確。

## 深入解析

每次ICS後漱口、使用spacer、不可作為救援吸入器，是NCLEX最常考的ICS三大原則。

## 重要概念

- **fluticasone HFA** — 吸入ICS、氣喘/COPD第一線控制藥、預防thrush須漱口、建議使用spacer
- **oral candidiasis (thrush)** — ICS後口腔念珠菌、漱口加含漱可預防、出現時開立nystatin
- **spacer** — MDI輔助腔、增加肺沉積、減少口咽殘留、輔助兒童/長者協調吸入

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