Although throat cultures are frequently positive for Candida after use of orally inhaled corticosteroids, clinical thrush is reported in only 4% to 13% of patients. The incidence is less in children. The prevalence of thrush is related to the total daily dose and dosing frequency. Use of concomitant nasal steroids, systemic steroids, or antibiotics also increases the risk of thrush. Oropharyngeal thrush may be decreased by using an add-on spacer device, rinsing the mouth after use of the inhaler, or increasing the dosing interval. Candida overgrowth results from inhibition of normal host defenses. Most cases of thrush are self-limited and require only a reduction in the dose of the inhaled steroid; however, if additional therapy is needed, nystatin is effective