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Abstract
Inhaled corticosteroids are increasingly recommended at all stages of asthma in all age groups as a first-line treatment for controlling symptoms and minimizing oral corticosteroid dependence in chronic asthma owing to their anti-inflammatory and immunosuppressive effects. Despite the fact that they are highly effective, their use can be accompanied by systemic and local adverse effects. Systemic adverse effects are infrequent, but oral candidiasis, the most common oral fungal infection, is a frequently observed local adverse effect of inhaled corticosteroid use. This adverse effect may lead to discomfort and cause reduced patient compliance. In this review, clinical findings of oral candidiasis, potential pathogenity mechanisms following such therapy along with the specific prophylactic measures that should be undertaken to minimize this adverse effect are discussed extensively. Understanding the factors leading to increased risk can give the opportunity of focusing on the patients who need timely intervention.
Highlights
Corticosteroids are the most effective and decent agents among anti-inflammatory drugs and play a crucial role in the effective management of asthma since they are able to interfere with several pathways implicated in the process of inflammation (Derendorf et al, 2006; Rachelefsky et al, 2007; Ullah et al, 2016; Ming et al, 2019)
For the old chlorofluorocarbon (CFC)-driven Pressurised metered-dose inhalers (pMDIs) devices which have the active drug included as a micronized suspension, the lack of shaking the device prior to use or between consecutive doses might cause the suspension to disperse inconveniently in the propellant and result in up to 50% reduction in the delivery of β2-agonists and corticosteroids
Among the reasons for the development of oral candidiasis as a relatively common disease are the emergence of Human Immunodeficiency Virus (HIV) infection, the increase in the prevalence of compromised patient groups in the public, common endocrine disorders such as diabetes mellitus, and the presence of nutritional deficiencies
Summary
Corticosteroids are the most effective and decent agents among anti-inflammatory drugs and play a crucial role in the effective management of asthma since they are able to interfere with several pathways implicated in the process of inflammation (Derendorf et al, 2006; Rachelefsky et al, 2007; Ullah et al, 2016; Ming et al, 2019). Potential adverse effects associated with IC therapy may be systemic as a result of entrance of the drug into the circulation across the lungs and the gastrointestinal tract, or local due to the deposition of the drug which is actively inhaled during administration in the oral cavity and oropharynx (Toogood et al, 1980; Maxwell, 1990; Selroos et al, 1994; Hanania et al, 1995; Roland et al, 2004; Buhl, 2006; Dahl, 2006; Derendorf et al, 2006; Irwin and Richardson, 2006; Rachelefsky et al, 2007; Godara et al, 2011; van Boven et al, 2013; Hejazi et al, 2016; Patil et al, 2016; Ullah et al, 2016; Erdoğan et al, 2019; Ming et al, 2019). MDIs combined with holding chambers and masks, as well as DPIs, are suitable for use in older children and adolescents that are cooperative (Cates et al, 2006; Baptist and Reddy, 2009; Hossny et al, 2016)
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