A 38-year-old woman with persistent asthma has been using inhaled fluticasone propionate 250 µg twice daily for 6 months. She reports a white patch on her palate and mild difficulty swallowing. What is the most common local adverse effect of inhaled corticosteroids responsible for her symptoms?

Explanation

## Most Common Local Adverse Effect of Inhaled Corticosteroids **Key Point:** Oropharyngeal candidiasis is the most frequent local adverse effect of inhaled corticosteroids, occurring in 5–10% of patients depending on dose and duration. ### Mechanism Inhaled corticosteroids deposit directly on the oropharyngeal mucosa, suppressing local immune function and allowing overgrowth of *Candida albicans*. The risk is dose- and duration-dependent. ### Clinical Presentation - White patches (pseudomembrane) on palate, tongue, or buccal mucosa - Mild dysphagia or throat irritation - Erythema and soreness - Usually asymptomatic in mild cases ### Prevention & Management | Strategy | Details | |----------|----------| | **Rinsing** | Rinse mouth with water immediately after each inhalation (most effective) | | **Spacer use** | Reduces oropharyngeal deposition | | **Antifungal therapy** | Topical clotrimazole or nystatin for established infection | | **Dose reduction** | Not usually necessary if preventive measures used | **High-Yield:** The incidence of oropharyngeal candidiasis is significantly reduced (by >50%) with simple post-inhalation mouth rinsing — this is a key counselling point for all ICS users. **Clinical Pearl:** Candidiasis typically appears after 3–6 months of ICS use and resolves within 2–3 weeks of topical antifungal therapy combined with preventive measures. ### Why Other Local Effects Are Rare - **Laryngeal stenosis, tracheal ulceration, esophageal stricture:** These are extremely rare complications and are NOT typical local adverse effects of ICS. They may occur with very high doses or in susceptible individuals but are not the "most common" local effect. [cite:KD Tripathi 8e Ch 34]