empty

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

Recommended

Benzodiazepines prescribed more in deprived areas, study confirms

Antidepressants may cut stroke risk




This website is for healthcare professionals, people who work in pharmacy and pharmacy students. By clicking into any content, you confirm this describes you and that you agree to Pharmacy Magazine's Terms of Use and Privacy Policy.

We use essential, performance, functional and advertising cookies to give you a better web experience. Find out how to manage these cookies here. We also use Interest Based Advertising Cookies to display relevant advertisements on this and other websites based on your viewing behaviour. By clicking "Accept" you agree to the use of these Cookies and our Cookie Policy.