A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?
A. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”
B. “You are using your inhaler too much and it has irritated your mouth.”
C. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”
D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”
Correct Answer: C. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”
Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush, a fungal infection. Oral candidiasis (thrush) is another common complaint among users of inhaled corticosteroids. This risk increases in elderly patients and patients who are also taking oral steroids, high dose ICS, or antibiotics.
Option A: Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own. It is advisable to have the patient rinse their mouth out after ICS use to prevent oral candidiasis. Treatments for candidiasis include clotrimazole, miconazole, and nystatin.
Option B: Fungal infections can develop even without overuse of the Corticosteroid inhaler. 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.
Option D: Although good oral hygiene can help prevent the development of a fungal infection, it cannot be used alone to treat the problem. Most cases of oral thrush will clear up in a couple of weeks. In general, a single dose of antifungal medication may be enough to cure the infection.
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