Oral thrush with inhaler — GPhC CRA MCQ
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Correct answer: B — Treat candidiasis and review spacer technique rinsing and steroid dose
Treat candidiasis and review spacer technique rinsing and steroid dose: The active infection needs antifungal treatment while spacer use, technique, post-dose mouth-rinsing and the minimum effective inhaled-corticosteroid dose reduce recurrence without abandoning controller therapy. Treat candidiasis, pause corticosteroid, then restart with the same technique: Repeated unsupervised interruption risks asthma deterioration and fails to correct oropharyngeal deposition. Use long-term fluconazole and retain the current high-dose inhaler technique: Systemic prophylaxis adds interaction and toxicity risk and does not address preventable local deposition. Add spacer and rinsing while postponing antifungal treatment for one week: Prevention measures do not replace treatment of the current symptomatic infection. Change to another high-dose pMDI and reassess plaques after one week: A brand change alone neither treats candidiasis nor reliably reduces deposition.
Reference: BNF: beclometasone dipropionate inhaled: https://bnf.nice.org.uk/drugs/beclometasone-dipropionate/; BNF: nystatin: https://bnf.nice.org.uk/drugs/nystatin/; NICE NG245: asthma diagnosis, monitoring and chronic management: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations