Which statement compares inhaled and systemic corticosteroids in COPD/asthma management and lists key nursing considerations to prevent adverse effects?

• A. Inhaled steroids have greater systemic exposure; systemic steroids used for maintenance therapy.
• B. Inhaled steroids reduce systemic exposure; systemic steroids used for exacerbations; Nursing: monitor glucose, infection risk, oral thrush; use spacer; rinse mouth after inhalation; avoid unnecessary prolonged systemic therapy.
• C. Inhaled steroids replace antibiotics in COPD.
• D. Systemic steroids have fewer side effects than inhaled steroids.

Answer: (B)

Inhaled corticosteroids deliver medicine directly to the airways, giving strong local anti-inflammatory effects with much less systemic exposure than systemic corticosteroids. That makes them ideal for maintenance therapy in COPD and asthma, while systemic steroids are reserved for acute exacerbations or more severe disease where a broader, body-wide effect is needed. Nursing actions to prevent adverse effects align with this difference: ensure the patient uses inhalers correctly and, if appropriate, a spacer to maximize drug delivery and lessen oropharyngeal irritation; have the patient rinse the mouth after inhalation to reduce oral thrush and hoarseness; monitor for systemic side effects such as elevated blood glucose, increased infection risk, or bone loss, especially with higher-dose or long-term systemic therapy; and avoid unnecessary prolonged systemic treatment by using the lowest effective dose and tapering when possible. The other statements misstate how inhaled steroids differ from systemic steroids or their typical roles, which is why this approach is the best fit.