Inhaled corticosteroid mouth care — GPhC CRA MCQ
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Correct answer: D — Assess cumulative exposure and provide steroid-card and adrenal-risk advice
Assess cumulative exposure and provide steroid-card and adrenal-risk advice: High-dose inhaled corticosteroid plus repeated systemic courses increases adrenal-suppression risk; emergency information and a specialist treatment review are required. Continue treatment because inhaled corticosteroids do not suppress adrenal function: High inhaled doses and cumulative systemic exposure can produce clinically important suppression. Stop beclometasone before travel and continue reliever treatment alone: Abrupt withdrawal can destabilise asthma and does not instantly reverse adrenal suppression. Carry salbutamol information but omit the previous systemic-steroid courses: Clinicians may need the steroid exposure history when assessing illness, surgery or adrenal crisis risk. Increase every beclometasone dose during illness under a standard rule: Unstructured dose escalation is not a substitute for appropriate sick-day and asthma action advice.
Reference: BNF: beclometasone dipropionate inhaled: https://bnf.nice.org.uk/drugs/beclometasone-dipropionate/; NICE NG245: asthma diagnosis, monitoring and chronic management: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations