Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone.
BACKGROUND
Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur.


OBJECTIVE
To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis.


METHODS
The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter.


RESULTS
The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids.


CONCLUSIONS
Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.
Fukushima
Chizu
C
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. chizu-f@ngs2.cncm.ne.jp
Matsuse
Hiroto
H
Tomari
Shinya
S
Obase
Yasushi
Y
Miyazaki
Yoshitsugu
Y
Shimoda
Terufumi
T
Kohno
Shigeru
S
D000280:Administration, Inhalation; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects; D002180:Candidiasis, Oral / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013223:Statistics as Topic; D017211:Treatment Failure
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D005938:Glucocorticoids; D000666:Amphotericin B; D000068298:Fluticasone; D001507:Beclomethasone