Inhaled Steroid Candidiasis Prevention — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsInhaled Steroid Candidiasis PreventionORE Part 1

A 45-year-old woman uses a pressurised metered-dose inhaler containing beclometasone for asthma. She has erythematous candidiasis of the hard palate and oropharynx, which has been treated. Which advice best reduces the risk of recurrence?

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Reveal the answer and explanation

Correct answer: E — Rinse and spit after use, and use a spacer

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

A is correct. Rinsing the mouth with water and spitting after each dose reduces residual inhaled corticosteroid in the mouth and pharynx, lowering the risk of candidiasis. For a pressurised metered-dose inhaler, a spacer also reduces oropharyngeal deposition. Increasing the corticosteroid dose would tend to increase local adverse effects. Inhaled corticosteroid treatment should not be stopped abruptly solely because thrush has occurred; candidiasis can be treated while asthma treatment is maintained. Chlorhexidine is not standard prophylaxis for inhaled-steroid candidiasis, and routine long-term topical antifungal prophylaxis is unnecessary when local preventive measures can be used.

Reference: Electronic Medicines Compendium. Qvar MDI 100 micrograms Summary of Product Characteristics, section on candidiasis/hoarseness, updated 2026. https://www.medicines.org.uk/emc/product/605/smpc