Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Inhaled steroids and oral candidiasis
Inhaled steroids are widely used for the management of asthma and chronic obstructive pulmonary disease. These medications are effective and are generally regarded as having far less potential to cause serious side effects than corticosteroids administered systemically (e.g. prednisolone). Examples of inhaled steroids include products such as beclomethasone (Qvar), budesonide (Pulmicort), ciclesonide (Alvesco) and others. Inhaled steroids are also included in combination products such as Seretide.
- Candida albicans is a yeast is normally found in small amounts in the mouth. Under normal conditions the balance of microbes present in the mouth prevents the overgrowth of Candida (if there is an overgrowth this is called oral candidiasis, or thrush).
- With the use of some medications (such as chemotherapy or steroids) or in situations where there is a compromised immune system (e.g. with diabetes or with HIV/AIDS), oral candidiasis may develop rapidly and cause symptoms such as painful white patches, often set on a red base within the mouth or on the sides of the tongue. Candidiasis can also cause difficulty swallowing (which may indicate that candidiasis is also present in the oesophagus). Another manifestation is cracking at the sides of their lips, a condition called angular cheilitis.
- Oral candidiasis is more common when inhaled steroids are higher dosages, or when inhaler technique is sub-optimal. Regular rinsing of the mouth after inhaler and careful tooth brushing after the use of inhaled steroids may reduce the risk.
- If thrush develops and is persistent, local treatment (e.g. nystatin mouthwash, miconazole gel) or oral antifungals such as fluconazole may be needed. It is important to be aware that even locally administered treatments can have adverse drug reactions and interactions – for example, miconazole can potentiate the anticoagulant effects of warfarin.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.