To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

A. Explain that the client should not use the discus more than twice daily: The fluticasone-salmeterol discus is a maintenance inhaler, typically prescribed for twice-daily use to control chronic asthma symptoms. Exceeding this frequency increases the risk of systemic side effects and does not improve acute symptom relief. B. Offer the discus to the client for use during an acute asthma attack: This medication combination is not intended for rapid relief of bronchospasm. Salmeterol is a long-acting beta-agonist, and fluticasone is an inhaled corticosteroid; neither works quickly enough to manage acute attacks. A short-acting bronchodilator should be used in emergencies. C. Clients using the discus may experience decreased blood pressure: Hypotension is not a typical side effect of inhaled corticosteroid and long-acting beta-agonist therapy. More common adverse effects include oral thrush, hoarseness, and throat irritation. D. When using the discus, have the client breathe out rapidly into the mouthpiece: Exhaling into the mouthpiece introduces moisture into the powdered medication, causing it to clump and reducing dose delivery. The correct technique is to exhale fully away from the device before inhalation.