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Implementation of mouth rinsing after use of inhaled corticosteroids in Australia


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.

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

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


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

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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).

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  • Asthma
  • Chronic obstructive pulmonary disease
  • Inhaled corticosteroid
  • Mouth rinse