[Background]: Fluticasone propinate (FP), an inhaled steroid agent, has greater clinical efficacy in bronchial asthma than Beclomethasone dipropionate (BDP), but it has been reported that the rate of oropharyngeal candidiasis becomes high. In this study, we evaluated the medium-term pharyngeal candidiasis rate in elderly patients after BDP was replaced with FP in maintenance therapy.
[Method]: A total of 53 elderly patients 65 and over, who had previously received stable maintenance therapy with BDP, were switched to treatment with half doses of FP, and they were taught to gargle again.
Eight weeks and six months later, pharyngeal swabs were taken for culture and assessment of candidiasis. These results were compared with those of 24 patients 64 and below. We also measured the inspiratory peak flow rate with inhaled FP.
[Results]: Eight weeks later, candidiasis appeared in 11 patients in the advanced age group (20.8%), which was significantly high compared with only one patient in the age group under 65 (4.2%). Although the pharyngeal candidiasis of 8/11 patients became negative by teaching them thoroughly how to gargle with povidone-iodine, candidiasis appeared in another seven patients six months later, bringing the total up to 10/53 (18.9%).
[Conclusion]: The appearance rate of pharyngeal candidiasis in the elderly patients, who changed for FP, was unexpectedly high. It was suggested that the frequncy of gargling after inhaling FP and the inspiratory peak flow rate when FP is inhaled could be big influential factors. When we use FP, it may be important to give medium and long term-persistent instructions to patients.