A 26-year-old woman using a budesonide dry powder inhaler twice daily presents with creamy white plaques over her buccal mucosa and palate. Which single modification to her inhaler technique would most effectively prevent recurrence?

• A Increasing inspiratory flow rate through the device
• B Switching to a breath-actuated metered dose inhaler
• C Taking the dose immediately before meals
• D Rinsing the mouth and spitting out water after each actuation ✓

Explanation

Oropharyngeal candidiasis is the commonest local adverse effect of inhaled corticosteroids and results from drug deposition on the oral and pharyngeal mucosa. Rinsing the mouth and spitting after each dose removes residual steroid from these surfaces and is the standard preventive advice. Increasing inspiratory flow increases oropharyngeal impaction rather than reducing it, and device switching alone does not address deposition.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.