Inhaled steroids in COPD increase oral thrush risk

Using inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD) appears to double the risk of developing oral thrush compared to long-acting bronchodilators alone, a study using UK data reports.

The study, sponsored by Teva, included 8,255 matched pairs of patients. Patients prescribed fixed-dose combinations of ICS and long-acting beta-agonists (LABA) were more than twice as likely to experience oral thrush as those prescribed long-acting bronchodilators alone (5.5 and 2.7 per cent respectively).

The risk of oral thrush was 23 per cent lower with budesonide plus formoterol (5.7 per cent) than with fluticasone plus salmeterol (7.0 per cent), delivered using dry powder inhalers (DPIs). However, most patients using budesonide plus formoterol used low ICS doses. Patients taking fluticasone plus salmeterol therapy usually used higher ICS doses. After dose-adjustment, there was no significant difference in oral thrush incidence.

The risk of developing oral thrush was 33 per cent lower with fluticasone plus salmeterol delivered with a pressurised metered dose inhaler (pMDI; 5.5 per cent) than with a DPI (7.3 per cent). This may reflect higher ICS deposition in the throat with DPIs.

The risk of oral thrush was 26 per cent lower in patients who used a spacer for fluticasone plus salmeterol delivered with a pMDI than those who did not (4.2 and 5.8 per cent respectively).

High doses (at least 1,000mcg/day fluticasone equivalent units) of fluticasone plus salmeterol delivered by DPI and pMDI almost doubled (OR 1.97) oral thrush risk compared to a low daily dose (<500mcg/day; 7.2 and 4.7 per cent respectively).

Respiratory Medicine 2016; 120:54-63

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