Snapshot A 25-year-old man presents to the clinic for complaints of "white patches" on his tongue for the past 2 weeks. He reports that the patches can be scraped off and does not bleed or cause pain. His medical history is significant for chronic asthma for which he was started on inhaled corticosteroids 3 weeks ago. introduction One of 7 medications used for asthma aimed to reduce inflammation and obstruction corticosteroids β-agonists Muscarinic antagonists Methylxanthines Cromolyn Antileukotrienes Omalizumab Inhaled Corticosteroids Mechanism of action inactivates NF-kB, the transcription factor that induces production of TNF-α and other inflammatory agents subsequently inhibits the synthesis of most cytokines examples mometasone, fluticasone, budesonide, beclomethasone, triamcinolone, and flunisolide Clinical use chronic asthma 1st line therapy chronic obstructive pulmonary disease (COPD) Adverse effects topical candidiasis/thrush can be prevented with spacers or water rinse following usage of ICS dysphonia (e.g., hoarse voice) lung infections (e.g., pneumonia)