A nurse is teaching a client who has asthma about using a beclomethasone inhaler along with an albuterol inhaler. Which of the following instructions should the nurse include about the beclomethasone inhaler?

Choice A rationale Beclomethasone is a corticosteroid that reduces inflammation in the airways, but it can also suppress local immunity in the oral pharynx. This creates an environment conducive to the growth of Candida albicans, leading to oral candidiasis, also known as thrush. Gargling with water after each use helps to wash away residual medication particles, thereby minimizing the risk of this fungal infection by preventing the drug from lingering in the mouth and throat. Choice B rationale Spacers are recommended for use with most metered-dose inhalers, including beclomethasone, to improve drug delivery and reduce the amount of medication deposited in the oropharynx. Using a spacer allows for a slower, deeper inhalation, which increases the proportion of the dose that reaches the lungs. This enhanced delivery not only improves therapeutic efficacy but also reduces the risk of systemic side effects and local complications like thrush. Choice C rationale Beclomethasone is a long-term control medication for asthma, not a rescue inhaler. Its anti-inflammatory effects take time to develop and are not fast enough to address an acute bronchospasm. For acute incidents of shortness of breath, a short-acting beta-2 agonist like albuterol is the appropriate medication because it works quickly to relax the smooth muscles of the airways and relieve bronchoconstriction. Choice D rationale The albuterol inhaler, a short-acting bronchodilator, should be used before the beclomethasone inhaler. Using the bronchodilator first opens the airways, allowing the subsequent inhaled corticosteroid to penetrate deeper into the lungs and reach the target tissues more effectively. This sequencing optimizes the delivery of the anti-inflammatory medication, enhancing its therapeutic effect and maximizing its clinical benefit.