To decrease the likelihood of an opportunistic yeast or fungal infection associated with metered dose inhaler (MDI) steroids, what would you recommend that a patient does?
1. Cut in half the number of puffs or treatments.
2. Use a spacer or holding chamber.
3. Rinse the mouth after each treatment.
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. 1, 2, and 3
ANS: C
The high percentage of oropharyngeal drug deposition with use of steroid pressurized MDIs (pMDIs) can increase the incidence of opportunistic oral yeast infection (thrush) and changes in the voice (dysphonia). Rinsing the mouth after steroid use can help avoid this problem, but most pMDI steroid aerosol impaction occurs deep in the hypopharynx, which cannot be easily rinsed with gargling. For this reason, steroid pMDIs should not be used alone but always in combination with a spacer or valved holding chamber.
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