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ICS Oral Candidiasis — RACP Adult Medicine MCQ

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HardRespiratoryICS Oral CandidiasisRACP Adult Medicine

A patient using inhaled corticosteroid develops recurrent oral candidiasis despite an appropriate indication for the medicine. Which prevention strategy is most appropriate?

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Correct answer: D — Check inhaler technique, use a spacer when indicated, rinse and spit after dosing, and optimise corticosteroid dose

The best answer is “Check inhaler technique, use a spacer when indicated, rinse and spit after dosing, and optimise corticosteroid dose”. Oropharyngeal deposition of inhaled corticosteroid predisposes to candidiasis. Technique correction, a spacer where relevant, mouth rinsing and dose optimisation reduce exposure while preserving asthma or COPD control. Infection is treated when present, but indefinite systemic antifungal therapy and abrupt controller withdrawal create avoidable harm.

Reference: Australian Asthma Handbook: Selecting inhalers for adults and adolescents: https://www.asthmahandbook.org.au/management/adults-and-adolescents/principles-of-management/selecting-inhalers-for-adults-and-adolescents