CASE 5 — What is the main oral/pharyngeal risk posed by the patient's inhaler therapy?

Correct answer: D. Oropharyngeal candidiasis

• A. Metaplastic transformation is not a recognized complication of inhaled beta-2 agonists or ICS.
• B. While some inhalers have low pH propellants, oropharyngeal candidiasis is the clinically dominant concern.
• C. Inhaled corticosteroids (often combined with salmeterol) can mildly affect blood glucose, but this is not the primary oral concern.
• D. Inhaled corticosteroids (ICS) — which salmeterol is commonly combined with (e.g., Advair = salmeterol + fluticasone) — cause OROPHARYNGEAL CANDIDIASIS due to local immunosuppression. This is the primary oral complication. Patients should rinse their mouth with water after each use to reduce risk.