A patient with moderate persistent asthma on inhaled corticosteroid (budesonide) and a long-acting beta-agonist (LABA — formoterol) has well-controlled disease but develops oral candidiasis. The most practical intervention to prevent recurrence of oral candidiasis is:

• A Switch to systemic oral prednisolone which bypasses oropharyngeal deposition
• B Add prophylactic oral fluconazole 150 mg weekly
• C Discontinue budesonide and increase LABA dose for equivalent asthma control
• D Rinse mouth with water and spit after each inhaled corticosteroid use; use spacer device ✓

Explanation

Oropharyngeal candidiasis from inhaled corticosteroids results from local immunosuppression by steroid particles depositing in the oropharynx rather than reaching the lower airways. Rinsing the mouth with water and spitting immediately after inhalation removes residual oropharyngeal drug, dramatically reducing candidal colonization. Using a spacer (valved holding chamber) reduces oropharyngeal deposition by 50-80% by slowing the aerosol velocity and enhancing lower airway deposition of smaller particles. Both measures are evidence-based first-line preventive strategies.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.