The Efficacy of Immediate Diet for Reducing Local Adverse Events of Inhaled Corticosteroid: A Pilot Study

Abstract

BackgroundLocal adverse events associated with inhaled corticosteroid use, including dysphonia, pharyngitis and oral candidiasis, can affect adherence for treatment. 'Mouth rinsing method' has been used for reducing local adverse events, but it cannot ensure complete prevention. The goal of this pilot study was to identify whether the 'immediate diet method' can reduce local adverse events in a limited number of patients.MethodsThe study was conducted in a total of 98 patients, who had been prescribed a medium-dose fluticasone propionate for the first time, from January to October in 2010. One training nurse had performed the education on how to use the inhaler, including the mouth rinsing method. And with follow-ups at one month intervals, any patient who experienced such adverse events were educated on the immediate diet method, having a meal within 5 minutes after using an inhaler and they were checked on any incurrence of adverse events with one month intervals for 2 months.ResultsThe mean age of patients was 65.9 years old. The local adverse events had incurred from 18.4% of the study subjects. When performed the follow-up observation in 18 patients with local adverse events after education on the immediate diet method, 14 patients (77.8%) had shown symptomatic improvements. Three of 4 patients did not show any improvement, in spite of implementing the immediate diet method. The other 1 patient did not practice the immediate diet method properly.ConclusionThe immediate diet method may be useful in reducing the local adverse events, caused by the use of inhaled corticosteroid.

Randomised, multicentre, prospective interventional study to evaluate the efficacy of immediate diet in addition to standard mouth rinsing in reducing local adverse events of inhaled corticosteroid among asthmatic patients: a pilot study

“…Approximately 70% of participants who suffered from LAEs showed improvement after the application of an immediate diet for more than two months. 12 This result was consistent with a previous study that showed no residue remaining in the oesophagus after changing FP-DPI inhalation time to before meals, and hence an improvement of oesophageal candidiasis was observed. 16 The study explained that FP residue deposited in the oesophagus was removed by the passage of food.…”

“…The result from Lee et al showed that the symptoms of LAEs in 14 out of 18 patients (77.8%) were alleviated after applying the immediate diet method. 12 There is no doubt that neither the standard method (mouth rinsing with water) nor immediate diet alone can completely prevent LAEs. So, a new intervention is needed to maximise the efficacy of removing deposited ICS particles in order to minimise the occurrence of its LAEs.…”

Measurement of the Raman spectra and hygroscopicity of four pharmaceutical aerosols as they travel from pressurised metered dose inhalers (pMDI) to a model lung

“…This lends a time-critical aspect to 36 drug delivery since solid particles in the lungs are removed over time by ejection via the mucociliary 37 escalator in the ciliated regions of the lungs or partition into macrophages in the alveoli (Hardy & 38 Chadwick, 2000) and dissolution appears to be the rate-limiting step for the uptake of inhalable drugs 39 (Bur, et al, 2010). If more of a given drug is removed in these manners before itis fully dissolved, a 40 greater dose must be administered and the resultant side effects such as immunosuppression with 1 corticosteroids (Lee, et al, 2012) and hypoalkaemia with salbutamol (Hung, et al, 1999) will have 2 greater impacts on patient health. 3…”