A 24-year-old asthmatic started on fluticasone propionate inhaler returns after 3 weeks complaining of a sore mouth and white patches on the buccal mucosa. Which measure most directly reduces this adverse effect?

• A Switching from MDI to dry powder inhaler
• B Rinsing the mouth with water after each inhalation ✓
• C Adding a long-acting beta-agonist to the regimen
• D Taking the inhaler immediately before meals

Explanation

Oropharyngeal candidiasis and dysphonia are the commonest local adverse effects of inhaled corticosteroids, caused by direct deposition of drug on the oral and laryngeal mucosa. Rinsing the mouth and gargling with water after each dose washes away residual steroid and markedly reduces candidal overgrowth. Using a spacer also helps by reducing oropharyngeal deposition. Switching device class, adding a LABA, or timing doses around meals does not address local drug deposition.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.