Absence of gargling affects topical adverse symptoms caused by inhaled corticosteroids in females

Abstract

Objective: Topical adverse events caused by inhaled corticosteroids (ICS) are suspected to be more common in females. Although gargling or mouth washing after inhalation is recommended as the gold standard for preventing adverse events due to ICS, the preventive effects of this method have not been confirmed in real-world studies. This study aimed to examine the association between gargling or mouth washing and the incidence of topical adverse symptoms in males and females in daily practice. Methods: We analyzed a subpopulation of participants in the Drug Event Monitoring (DEM) project of the Japan Pharmaceutical Association. An anonymous survey was performed in February 2010, to assess the self-perception of topical adverse symptoms during ICS use by conducting interviews of pharmacists using structured questionnaires. Results: A total of 412 males and 480 females were included. The patients used a dry-powder inhaler (DPI) (71.2%), pressurized meter-dose inhaler (pMDI) with (7.5%) or without (16.6%) a spacer or inhalation solution (4.7%) as the delivery device. Topical adverse symptoms occurring after previous prescriptions were reported by 41 (4.6%) subjects. The common symptoms were hoarseness, stomatitis and dry mouth (1.3%, 1.1% and 1.1%, respectively). In the multiple regression model, the presence of symptoms was found to be significantly associated with the absence of gargling or mouth washing after inhalation [adjusted odds ratio (OR): 3.75, 95% confidence interval (95%CI): 1.33-10.59, p ¼ 0.012]. When stratified by gender, the absence of gargling or mouth washing was identified to be a risk factor in females only (OR: 4.32, 95%CI: 1.11-16.87, p ¼ 0.035) and not in males (OR: 3.26, 95%CI: 0.65-16.33, p ¼ 0.151). Furthermore, the association between the absence of gargling or mouth washing and the incidence of topical adverse symptoms was significant in the patients using DPI (OR: 4.85, 95%CI: 1.66-14.14, p ¼ 0.004), but not in those using the other devices. Conclusions: In this study, the absence of gargling or mouth washing after ICS use was associated with topical adverse symptoms, especially in females. To achieve good adherence to treatment and improve the quality of life, female patients with asthma should strictly practice the gargling or mouth washing method.

Rinsing of oropharynx and storage place of respiratory medicine inhaler: A cross‐sectional audit

“…Ruffin et al reported that 56% of the emitted aerosol dose was deposited in the oropharynx, and this might persist in situ for up to 3 hours, and that a prompt mouthwash could remove 60% of this residue from the oropharynx. There were two previous studies on local adverse effects caused by inhaled drugs . In a study by Kajiwara et al with 892 patients with bronchial asthma, the absence of RMOG after ICS was associated with topical adverse symptoms.…”

“…There were two previous studies on local adverse effects caused by inhaled drugs . In a study by Kajiwara et al with 892 patients with bronchial asthma, the absence of RMOG after ICS was associated with topical adverse symptoms. They reported that the absence of gargling or mouth washing was identified to be a risk factor in females only and not in males, when stratified by gender in the multiple regression model .…”

Dry mouth as a novel indicator of hoarseness caused by inhalation therapy

“…However, some local side effects such as oral candidiasis, coughing at the time of inhalation, and hoarseness have been reported [2]. Some of these local adverse reactions can be managed by gargling after inhalation, which washes away the orally deposited drug [3]. The most difficult local side effect to manage is hoarseness [4], which is caused by drug deposition on the vocal cords.…”

“…Hoarseness is a severe subjective symptom and may sometimes cause the self-interruption of inhalation therapy. Previous studies demonstrated that many factors, including age, gender, drug, and the dosage form, caused hoarseness [3,[5][6][7]. Furthermore, a higher risk of dysphonia has been associated with the administration of fluticasone propionate than other corticosteroids [5,8].…”

The Clinical Pharmacology of Past, Present, and Future Glucocorticoids

“…In order to decrease local adverse effects (dysphonia, stomatitis, and dry mouth), it is recommended to administer medication with a spacer, gargling, rinsing the mouth, and washing the face after inhalation (if nebulizers are used), as well as washing the spacer [ 25 ]. However, no scientifi c evidence for such procedures is available with the exception of gargling, which was shown to be protective for female patients using DPIs [ 35 ]. In children aged 2-5 years, synchronization of breathing with drug delivery is not suffi cient to allow proper administration.…”