Skip to main content
SpringerLink
Log in

Implementation of mouth rinsing after use of inhaled corticosteroids in Australia

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background: Clinical guidelines recommend that patients using inhaled corticosteroids should rinse their mouth following inhalation. There is however, a paucity of research regarding patient implementation of this recommendation and the impact it has on the occurrence of adverse effects. Objective: The aim of this study was to determine how well patients implement mouth rinsing after using inhaled corticosteroids in practice and their understanding of the rationale, information sources and the impact of mouth rinsing on adverse effects. Setting: Australians aged 18 years and over with a diagnosis of asthma and/or chronic obstructive pulmonary disease who were currently using an inhaled corticosteroid. Method: Participants were recruited via Facebook to complete an online survey. Main outcome measure: Implementation of a mouth rinse which aligned to current guideline recommendations. Results: Of 380 eligible responses, 30.5% of patients reported suboptimal mouth rinsing after using inhaled corticosteroids. Receiving advice on mouth rinsing from a healthcare professional increased the likelihood of correct implementation (P < 0.001) and improved patient understanding of the rationale (P = 0.01). Whilst most (90.0%) patients were aware rinsing may reduce oropharyngeal adverse effects, few (5.5%) were aware of its potential to reduce systemic adverse effects. Patients were more likely to report their rinsing procedure had a positive impact if they had experienced oral candidiasis (P < 0.001) or sore mouth/throat (P = 0.01), compared to cough or hoarse voice. Conclusion: Almost one-third of patients reported a suboptimal mouth rinsing procedure after using an inhaled corticosteroid. Interventions are required to improve awareness and correct implementation of mouth rinsing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. National Asthma Council Australia. Australian Asthma Handbook. Melbourne: National Asthma Council Australia 2018. http://www.asthmahandbook.org.au/. Accessed 5 July 2018.

  2. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343(5):332–6.

    Article  CAS  Google Scholar 

  3. Lung Foundation Australia. Stepwise Management of Stable COPD. Milton, Queensland: Lung Foundation Australia; 2017. https://lungfoundation.com.au/wp-content/uploads/2017/10/LFA-Stepwise-Management-of-COPD_0817_WEB.pdf. Accessed 21 Sept 2018.

  4. Buhl R. Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma. Allergy. 2006;61(5):518–26.

    Article  CAS  Google Scholar 

  5. Horita N, To M, Araki K, Haruki K, To Y. Risk factors of local oropharyngeal and laryngeal adverse effects from use of single inhaled corticosteroids and long-acting beta-agonists. Allergol Int. 2012;61(4):583–8.

    Article  CAS  Google Scholar 

  6. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest. 2004;126(1):213–9.

    Article  CAS  Google Scholar 

  7. Foster JM, van Sonderen E, Lee AJ, Sanderman R, Dijkstra A, Postma DS, et al. A self-rating scale for patient-perceived side effects of inhaled corticosteroids. Respir Res. 2006;7:131.

    Article  Google Scholar 

  8. Fitzgerald JM, Chan CK, Holroyde MC, Boulet LP. The CASE survey: patient and physician perceptions regarding asthma medication use and associated oropharyngeal symptoms. Can Respir J. 2008;15(1):27–32.

    Article  CAS  Google Scholar 

  9. Pinto CR, Almeida NR, Marques TS, Yamamura LL, Costa LA, Souza-Machado A. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma. J Bras Pneumol. 2013;39(4):409–17.

    Article  Google Scholar 

  10. Kajiwara A, Kita A, Saruwatari J, Morita K, Oniki K, Yamamura M, et al. Absence of gargling affects topical adverse symptoms caused by inhaled corticosteroids in females. J Asthma. 2014;51(2):221–4.

    Article  CAS  Google Scholar 

  11. Sansom LN. Australian pharmaceutical formulary and handbook. 24th ed. Canberra: Pharmaceutical Society of Australia; 2019.

    Google Scholar 

  12. Selroos O, Halme M. Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from a metered dose inhaler and dry powder inhaler. Thorax. 1991;46(12):891–4.

    Article  CAS  Google Scholar 

  13. Yokoyama H, Yamamura Y, Ozeki T, Iga T, Yamada Y. Influence of mouth washing procedures on the removal of drug residues following inhalation of corticosteroids. Biol Pharm Bull. 2006;29(9):1923–5.

    Article  CAS  Google Scholar 

  14. MIMs Australia. Medicines Information. MIMs Australia 2019. https://www.emims.com.au/Australia/drug/search. Accessed 2 Apr 2019.

  15. Global Institute for Asthma. Global Strategy for Asthma Management and Prevention. Fontana, United States of America; Global Institute for Asthma 2020. https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf. Accessed 1 Sept 2020.

  16. Yokoyama H, Yamamura Y, Ozeki T, Iga T, Yamada Y. Effects of mouth washing procedures on removal of budesonide inhaled by using Turbuhaler. Yakugaku Zasshi. 2007;127(8):1245–9.

    Article  CAS  Google Scholar 

  17. Capanoglu M, Dibek Misirlioglu E, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers. J Asthma. 2015;52(8):838–45.

    Article  Google Scholar 

  18. Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394–406.

    Article  Google Scholar 

  19. Driesenaar JA, De Smet P, van Hulten R, Hu L, van Dulmen S. Communication during counseling sessions about inhaled corticosteroids at the community pharmacy. Patient Prefer Adherence. 2016;10(1):2239–54.

    Article  Google Scholar 

  20. Australian Institute of Health and Welfare. Chronic respiratory conditions. Canberra, Australia: Australian Government 2018. https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-respiratory-conditions/overview. Accessed 26 Sept 2018.

  21. Survey Monkey. Survey Sample Size. Survey Mokey, 2017. https://www.surveymonkey.com/mp/sample-size/. Accessed 26 Sept 2017.

  22. Cooper V, Metcalf L, Versnel J, Upton J, Walker S, Horne R. Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalence: a UK-wide, cross-sectional study. NPJ Prim Care Respir Med. 2015;25:15026.

    Article  Google Scholar 

  23. Australian Medicines Handbook. Adelaide. South Australia: Australian Medicines Handbook; 2019.

    Google Scholar 

  24. Foster JM, Aucott L, van der Werf RH, van der Meijden MJ, Schraa G, Postma DS, et al. Higher patient perceived side effects related to higher daily doses of inhaled corticosteroids in the community: a cross-sectional analysis. Respir Med. 2006;100(8):1318–36.

    Article  Google Scholar 

  25. Souza ML, Meneghini AC, Ferraz E, Vianna EO, Borges MC. Knowledge of and technique for using inhalation devices among asthma patients and COPD patients. J Bras Pneumol. 2009;35(9):824–31.

    Article  Google Scholar 

  26. Bosnic-Anticevich SZ, Sinha H, So S, Reddel HK. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47(3):251–6.

    Article  CAS  Google Scholar 

  27. Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns. 2008;72(1):26–33.

    Article  Google Scholar 

  28. Purohit AN, Patel PP, Gandhi AM, Desai MK. An evaluation of impact of educational interventions on the technique of use of metered-dose inhaler by patients. Indian J Pharmacol. 2017;49(2):194–200.

    PubMed  PubMed Central  Google Scholar 

  29. Foland AP, Stern T, Ramacciotti T, Martin J, Gilbert I, Cohn RC. Improvement of metered-dose inhaler administration technique: the effect of training sessions at a specialized pediatric asthma compliance and technique clinic. Curr Ther Res. 2002;63(2):142–7.

    Article  Google Scholar 

  30. van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL, Seydel ER. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Patient Educ Couns. 1997;32(1):87–95.

    Article  Google Scholar 

  31. Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med. 2010;123(11):1001–6.

    Article  CAS  Google Scholar 

  32. Gonzalez AV, Coulombe J, Ernst P, Suissa S. Long-term use of inhaled corticosteroids in COPD and the risk of fracture. Chest. 2018;153(2):321–8.

    Article  Google Scholar 

  33. Dreizen S. Oral candidiasis. Am J Med. 1984;77(4):28–33.

    CAS  PubMed  Google Scholar 

  34. Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371(9621):1364–74.

    Article  Google Scholar 

  35. Toogood JH, Jennings B, Greenway RW, Chuang L. Candidiasis and dysphonia complicating beclomethasone treatment of asthma. J Allergy Clin Immunol. 1980;65(2):145–53.

    Article  CAS  Google Scholar 

  36. Williamson I, Matusiewicz S, Brown P, Greening A, Crompton G. Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations. Eur Respir J. 1995;8(4):590–2.

    CAS  PubMed  Google Scholar 

  37. Gallivan GJ, Gallivan KH, Gallivan HK. Inhaled corticosteroids: hazardous effects on voice-an update. J Voice. 2007;21(1):101–11.

    Article  Google Scholar 

Download references

Acknowledgements

Peter Gee, University of Tasmania for assistance with survey development. National Asthma Council and Asthma Australia for assistance in raising awareness of the survey.

Funding

The study was funded by the School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia, 7001.

Author information

Authors and Affiliations

  1. Pharmacy Department, Royal Hobart Hospital, Hobart, Australia

    Laura Kate Johnstone

  2. Tasmanian School of Medicine, University of Tasmania, Hobart, Australia

    Bonnie Jayne Bereznicki

  3. School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, 7001, Australia

    Glenn Jacobson & Angus John Thompson

Authors
  1. Laura Kate Johnstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bonnie Jayne Bereznicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glenn Jacobson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angus John Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angus John Thompson.

Ethics declarations

Conflicts of interest

None.

Consent to participate

By submitting the survey participants provided their consent.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 102 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnstone, L.K., Bereznicki, B.J., Jacobson, G. et al. Implementation of mouth rinsing after use of inhaled corticosteroids in Australia. Int J Clin Pharm 43, 549–555 (2021). https://doi.org/10.1007/s11096-020-01161-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01161-7

Keywords

Search

Navigation