Review Question - QID 100894

Inhaled corticosteroids, such as beclomethasone, are frequently used in the long-term management of asthma. Oral candidiasis, depicted in the image, is a potential side effect of inhaled corticosteroid use.

Corticosteroids work by binding to glucocorticoid receptors, thus inhibiting the transcription of inflammatory mediators such as phospholipase A2. Because inhaled corticosteroids contact the oral cavity directly, local immunosuppression can lead to oral candidiasis, secondary to Candida albicans infection. Rinsing following inhaled corticosteroid use is advocated to decrease the risk of candidiasis.

Elward et al. discuss the clinical efficacy of inhaled corticosteroids in the long-term treatment of asthma. The authors note that inhaled corticosteroids are often more beneficial than other treatment methods and lead to less exacerbations and symptoms.

Allen discusses the use of inhaled corticosteroids in children with asthma and addresses the possible complications of long-term use. According to the author growth may be affected as well changes in adrenal function. These changes are typically insignificant, however, caution should be used.

Figure A depicts a patient with oral candidiasis secondary to inhaled corticosteroid use. This is the most common presentation of oral candidiasis and is characterized by white plaques that can easily be scraped off the erythematous underlying mucosa.

Incorrect Answers:
Answers 1 & 2: Salmeterol and Albuterol, beta2-agonists, are not associated with oral candidiasis.
Answer 4: Ipratropium, an anticholinergic, is not associated with oral candidiasis.
Answer 5: Theophylline, a PDE inhibitor and adenosine receptor blocker, is not associated with oral candidiasis.