A nurse is reinforcing discharge instructions for a client with asthma who is starting beclomethasone metered-dose inhaler (MDI) therapy. Which of the following findings should the nurse instruct the client to monitor and report immediately as a potential adverse effect of beclomethasone?

Beclomethasone is an inhaled corticosteroid used as a maintenance controller medication for asthma. Because it is a steroid deposited directly in the oropharyngeal cavity during inhalation, it suppresses local immune defenses and creates an environment favorable to fungal overgrowth. The most important adverse effect to monitor and report is oral candidiasis (thrush), which presents as white patches in the mouth or throat. Clients should be instructed to rinse their mouth with water and spit after each use of the inhaler to reduce drug deposition in the oral mucosa and minimize this risk. If white patches develop, antifungal treatment is needed. Mouth dryness without lesions is a minor, non-urgent side effect and does not require immediate reporting. Increased coughing during exertion is more likely related to exercise-induced bronchospasm and is not a recognized adverse effect specific to inhaled corticosteroids. Mild hand tremors are associated with short-acting beta-2 agonists such as albuterol, not with inhaled corticosteroids like beclomethasone. Understanding which side effects are medication-specific helps nurses provide accurate client education and recognize when follow-up or treatment is needed.