Posterior Pharyngeal Candidiasis in the Absence of Clinically Overt Oral Involvement: A Cross-Sectional Study



Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy.


We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy.


Median age was 54.7 (27–84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5–19.2), particularly fluticasone usage 6.8 (2.62–17.9) and the presence of dysphonia 3.2 (1.3–8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage.


This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.

This is a preview of subscription content, access via your institution.


  1. 1.

    Odds FC (1998) Candida and candidosis: a review and bibliography. Bailliere Tindale, London

    Google Scholar 

  2. 2.

    Scully C, el-Kabir M, Samaranayake LP (1994) Candida and oral candidosis: a review. Crit Rev Oral Biol Med 5(2):125–157

    CAS  PubMed  Google Scholar 

  3. 3.

    Dubus JC, Marguet C, Deschildre A, Mely L, Le Roux P, Brouard J, Huiart L (2001) Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device. Allergy 56(10):944–948

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Toogood JH (1990) Complications of topical steroid therapy for asthma. Am Rev Respir Dis 141(2 Pt 2):S89–S96

    CAS  PubMed  Google Scholar 

  5. 5.

    Knight L, Fletcher J (1971) Growth of Candida albicans in saliva: stimulation by glucose associated with antibiotics, corticosteroids, and diabetes mellitus. J Infect Dis 123(4):371–377

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Buhl R (2006) Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma. Allergy 61(5):518–526. doi:10.1111/j.1398-9995.2006.01090.x

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Rachelefsky GS, Liao Y, Faruqi R (2007) Impact of inhaled corticosteroid-induced oropharyngeal adverse events: results from a meta-analysis. Ann Allergy Asthma Immunol 98(3):225–238. doi:10.1016/S1081-1206(10)60711-9

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Roland NJ, Bhalla RK, Earis J (2004) The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest 126(1):213–219. doi:10.1378/chest.126.1.213126/1/213

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Adams N, Bestall JM, Lasserson TJ, Jones PW (2004) Inhaled fluticasone versus inhaled beclomethasone or inhaled budesonide for chronic asthma. Cochrane Database Syst Rev 2:CD002310. doi:10.1002/14651858.CD002310.pub2

    PubMed  Google Scholar 

  10. 10.

    Williamson IJ, Matusiewicz SP, Brown PH, Greening AP, Crompton GK (1995) Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations. Eur Respir J 8(4):590–592

    CAS  PubMed  Google Scholar 

  11. 11.

    Hanania NA, Chapman KR, Kesten S (1995) Adverse effects of inhaled corticosteroids. Am J Med 98(2):196–208. doi:10.1016/S0002-9343(99)80404-5

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Irwin RS, Richardson ND (2006) Side effects with inhaled corticosteroids: the physician’s perception. Chest 130(1):41S–53S. doi:10.1378/chest.130.1_suppl.41S

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Spencer CM, Jarvis B (1999) Salmeterol/fluticasone propionate combination. Drugs 57(6):933–940 (discussion 941–933)

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Barnes PJ, Pedersen S, Busse WW (1998) Efficacy and safety of inhaled corticosteroids. New developments. Am J Respir Crit Care Med 157(3 Pt 2):S1–53

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Program NAEaP (2007) Expert panel report 3: guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services, National Institute of Health, National Heart, Lung and Blood Institute, Bethesda

  16. 16.

    Milne LJ, Crompton GK (1974) Beclomethasone dipropionate and oropharyngeal candidiasis. Br Med J 3(5934):797–798

    PubMed Central  CAS  Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that there are no conflicts of interest in the conduct of this study.


There were no sources of funding affiliated with this project. The authors declare that this study complies with the current laws and research ethics of the country of Ireland.

Author information



Corresponding author

Correspondence to Siobhan V. Glavey.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Glavey, S.V., Keane, N., Power, M. et al. Posterior Pharyngeal Candidiasis in the Absence of Clinically Overt Oral Involvement: A Cross-Sectional Study. Lung 191, 663–668 (2013).

Download citation


  • Bronchoscopy
  • Inhaled corticosteroids
  • Candidiasis