Original article
Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 μg/day versus 200 μg/day

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ABSTRACT

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler.

We selected four groups of patients: 62 asthmatic patients who were taking 200 μg/d FP, 122 asthmatics who were taking 500 μg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects.

The frequency of positive swabs for Candida colonization was higher in 500 g/d FP group than asthmatics without ICS use (χ2 = 6.8, p < 0.05) and normal controls (χ2 = 4.9, p < 0.05), whereas it wasn’t different in the 200 g/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05).

The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months.

Section snippets

INTRODUCTION

Inhaled corticosteroids (ICS) have the properties of low systemic potency coupled with a high topical antiinflammatory activity. Among the local side effects, hoarseness and oropharyngeal candidiasis are the most common and clinically limiting factors. These side effects occur due to the deposition of the drug in the oropharynx. The incidence of oral candidiasis has varied from 1 % to 77 % with ICS treatment probably because of the method which is used to detect it1., 2.. It is well known that

METHODS

Two hundred thirty four asthmatic patients (58 male, 176 female) who were examined in our outpatient department were recruited to the study. 62 patients were taking 200 μg/d dry powdered FP and 122 patients were taking 500 μg/d dry powdered FP to control symptoms for at least three months. ICSs were delivered twice daily in all patients. 50 asthmatic patients who were seen as a first follow up and diagnosed as asthma were selected as asthmatic controls. They were not taking ICSs at least within

RESULTS

Demographic characteristics of the four study groups are shown in table I. Mean ages of subjects in each group were not statistically different (p > 0.05).

Table I also shows the frequencies and percentages of positive throat swabs for Candida in the four groups of subjects. Candida colonization was higher in those asthmatics who used 500 μg/d FP than controls (table I). Frequency of positive throat swabs for the patients with use of 200 μg/d FP was not different from asthmatics without ICS use (x2

DISCUSSION

The present study showed that ICSs increase oropharyngeal Candida colonization in higher doses of the drug. Although our 200 μg/d FP group had a higher frequency of Candida colonization than control groups, it did not reach statistical significance.

Local side effects are mainly seen in patients who use high doses of ICSs. Previous studies confirmed that the incidence of oral candidiasis is related to daily dose of inhaled steroid1,4. Our patients with 500 μg FP also showed higher frequency of

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