To prevent thrush when using an inhaled corticosteroid, what practice should be followed?

• A. Gargle with alcohol
• B. Rinse mouth with water after inhalation
• C. Inhale deeply and hold breath
• D. Take with a meal

Answer: (B)

Inhaled corticosteroids can cause oral thrush because some of the medication deposits in the mouth and throat, suppressing local defenses and allowing Candida to grow. Rinsing the mouth with water after inhalation is the best way to prevent this because it physically removes residual steroid from oral surfaces, reducing the local exposure that promotes fungal overgrowth. Be sure to spit out the rinse rather than swallow. Using a spacer with a metered-dose inhaler can further reduce oropharyngeal deposition, but the key preventive step here is rinsing the mouth.

Gargling with alcohol isn’t protective and can irritate the mucosa, while inhaling deeply and holding the breath or taking the inhaled dose with a meal don’t address the risk of mouth/throat exposure to the steroid.