Inhaled Corticosteroids — Adverse Effects
Oral candidiasis from an inhaler isn't a sign of infection spreading — it's a preventable nursing failure. The intervention takes 30 seconds and changes everything.
Core Concept
Inhaled corticosteroids (ICS) like fluticasone, budesonide, and beclomethasone deposit medication in the oropharynx, suppressing local immune defenses. The most common adverse effect is oropharyngeal candidiasis (thrush) — white patches on the tongue and buccal mucosa. Prevention is straightforward: rinse the mouth and spit after every dose. Using a spacer with a metered-dose inhaler reduces oropharyngeal deposition and lowers thrush risk. Dysphonia (hoarseness) is the second most common local effect, caused by direct steroid deposition on the larynx leading to mucosal irritation and vocal cord changes. Systemically, ICS at standard doses carry minimal risk, but long-term high-dose use can cause adrenal suppression, decreased bone mineral density, growth suppression in children (monitor height), and easy bruising. The nurse monitors for signs of systemic absorption: round face, weight gain, hyperglycemia. Patients must understand that ICS are not rescue inhalers and stopping abruptly after prolonged high-dose use risks adrenal crisis.
Watch Out For
Don't confuse ICS-induced thrush (white patches, preventable with rinsing) with oral infection requiring antibiotics — thrush from ICS is treated with antifungals like nystatin. Students mix up local side effects (thrush, hoarseness) with systemic effects (adrenal suppression, osteoporosis), which only emerge at high doses over months. Rinsing and spitting is for ICS specifically — students incorrectly generalize this to all inhalers including bronchodilators.
Clinical Pearl
Rinse, gargle, spit — never swallow. If the patient skips this step after every ICS dose, expect to see white patches within weeks.
Test Your Knowledge
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