Due to this delayed therapeutic response, it is absolutely essential that patients who are prescribed corticosteroids for respiratory disease are adherent to their medication regimen. In the ISOLDE trial, fluticasone therapy decreased the frequency of COPD exacerbations and the rate of health decline in patients with moderate-to-severe COPD; however, had little effect in decreasing the rate of FEV1 decline.[4] Patients should be counseled to wash their mouth following use of inhaled corticosteroids to decrease the risk of developing oral thrush, a common side effect of these medications. Muscarinic antagonists (anti-cholinergics): Blocking the muscarinic acetylcholine receptors in pulmonary smooth muscle tissue results in a decrease in smooth muscle tone and bronchodilation.