Can inhalers cause thrush

The Asthma-Thrush Link

Inhaled steroids are an effective treatment for asthma.

Because the medication is delivered directly to your airways rather than traveling throughout the body like oral medications, there are fewer side effects, making inhaled steroids a better choice for the long-term treatment of chronic asthma.

Are you doing everything you can to manage your asthma? Find out with our interactive checkup.

But inhaled steroids can lead to thrush, a yeast infection of the mouth, tongue, and throat.

Thrush occurs when the corticosteroid inhalers that depress the immune system in the lungs to control your asthma have the same effect on the surface of the throat — with a typical inhaler, most of the drug winds up on your throat on its way to your lungs, explains Russell B. Leftwich, MD, a physician specializing in allergy and immunology in Nashville, Tenn., and a spokesperson for the American Academy of Allergy Asthma and Immunology.

So while the inhaled steroids do not get into the bloodstream the way oral medications do, says Dr. Leftwich, they can have a very powerful one on the surface of the mouth and throat, making thrush common in people who use inhaled steroids to treat asthma symptoms.

The Facts on Thrush

A type of yeast called Candida causes thrush, or oral candidiasis. “All of us have normally in our bodies, but it’s kept in check by our immune system so that we don’t know we have it,” says Leftwich. “Babies commonly get it because their immune systems are notfully developed.”

The most obvious sign of thrush are the spotty white blotches it creates on the tongue and throat.

“Usually, there are no symptoms,” says Leftwich, who often spots it on patients’ throats before they’re even aware that they have it.

Thrush Prevention Tips

Simple steps can help you avoid this nuisance infection. To prevent thrush, rinse out your mouth and gargle with water after using an inhaler, says Leftwich.

You can also reduce your risk of developing thrush by using a spacer with your inhaled steroids. “A spacer is a chamber — a tube — that spreads out the medication and slows it down,” explains Leftwich. By spraying the medication in one end of the tube and putting your nose and mouth over the other, you’re able to inhale slowly and draw the medication into your lungs.

“Everyone should use a spacer, regardless of whether they have thrush,” says Leftwich. Though spacers can cost between $20 and $40 and are usually not covered by health insurance, they are well worth it. “You get more medicine in your lungs, less in the mouth and throat, which can cause thrush, and the medicine lasts longer, which means you get more for your money,” he adds.

Bring up using a spacer with your physician, suggests Leftwich. “A lot of family doctors don’t know about spacers,” says Leftwich. “You need a prescription to get one.”

When Thrush Treatment Is Needed

Thrush usually goes away on its own. If it’s persistent, your doctor may prescribe an antifungal medication such as nystatin.

“These anti-microbials kill the yeast and almost always clear up the thrush,” says Leftwich. If not, your doctor will need to investigate further. “There are some situations where thrush may be a sign of other health problems such as diabetes or an immune system disease,” Leftwich points out. And those are conditions you’ll want to address as soon as possible.

Let’s Talk Oral Thrush

No, thrush is not the name of a band. It’s not the name of a WWE championship wrestler. In actuality, it’s a slang term for a fungus infection.

I did not plan on writing about this subject today. The reason I decided to write on this subject is that I ate a tomato with salt and it made my tongue sting. Then I realized that my mouth felt dry and cottony. I looked in the mirror, stuck out my tongue, and it had white patches on it. These are all classic symptoms and signs of thrush.

Oral thrush is not going to kill you. It’s not going to get you out of school or work. Rather, it’s more of an irritant than anything. If you had thrush around your vocal cord and lost your voice (dysphonia), then maybe you could get out of work. Lacking that, you just learn to deal with it.

What is oral thrush?

It’s caused by a fungus called candida albicans. It’s a fungus that normally lives in your mouth and throat, although it’s kept in check by bacteria that normally live in your mouth. When you use inhaled corticosteroids every day, some of the medicine deposits in your mouth, on your tongue, and the back of your throat.

Inhaled corticosteroids are meant to reduce the immune response in your airways to reduce airway inflammation. This is very helpful for controlling asthma. However, it may also reduce the inflammatory response in your mouth, wipe out normal bacteria, allowing candida albicans to spread. This is called an infection often referred to as Thrush. The scientific name is oral candidiasis.

How do you get thrush?

It’s the most common side effect of taking inhaled corticosteroids every day to control your asthma. I have had it many times. In fact, I usually get it at least once a year. So, I am pretty well-acclimated to it. I usually don’t like to self-diagnose myself, but I’m pretty good at knowing when I have thrush.

Okay, you might be thinking? How did a person who has had asthma for 47 years, is a respiratory therapist, an asthma writer, and has been taking inhaled corticosteroids for over 30 years get thrush? How could someone well acclimated to thrush let himself get it?

The reason is that I’m a normal person. Like most people, I’m prone to forgetting. I’m prone to making errors. Plus there are times when I take the higher doses of inhaled corticosteroids, and studies show that higher doses increase your risk for developing thrush.

I take 250/50 dose of Advair. That’s 250 mcg of the corticosteroid fluticasone. Sometimes I take the 500/50 dose. When I take that higher dose, I’m most likely to get thrush. I usually don’t get thrush using the lower dose unless I don’t rinse and spit after each use, which brings me to how to prevent it.

Preventing oral thrush from an asthma inhaler

Many studies have been conducted regarding inhaled corticosteroids and thrush. Based on these studies, most experts agree that, when you use a dry powder inhaler like I do, you should rinse and spit after each use. This removes most of the medicine that deposits in your mouth. To be more precise, you may want to rinse, gargle, swish, and spit. This should make your risk of getting thrush negligible.

If you use an inhaler, like Symbicort or Flovent, the best way to prevent side effects is to use a spacer with your inhaler. The spacer collects the large particles, the ones that are most likely to impact in your mouth, making it so only the smallest particles to be inhaled. These smaller particles then have a direct path to your lungs.

Some researchers say that you do not need to rinse and spit if you use a spacer. However, some researchers say that you should always rinse and spit after each use regardless of what inhaled corticosteroid you use.

Treating thrush

If you get thrush, it doesn’t mean you have to quit taking inhaled corticosteroids. It does not mean you have to switch to a different product. However, these are all options you can discuss with your doctor. I do know of some people who keep getting thrush with one product, and so they switch to another and they’re fine.

If you want to take that route, that’s fine. But Advair works so great for me, I’d hate to stop taking it due to a little thrush. So, what I do is call my doctor. I’ve had thrush enough that I know when I have it. So, it’s possible he will just call me in a prescription for Diflucan. It’s a pill taken once a day for 3-4 days. It also comes as a swish. Some people prefer that. There’s also a swish called Nistatin. Which medicinal option you use is up to you and your doctor.

Now, there’s one other option I’d like to mention. This is the one I opt for most of the time. I basically mix a teaspoon or two of Nistatin in a cup of water and rinse my mouth out with that. You can also use baking soda. The idea here is that the fungus hates salty environments. I usually do this 2-3 times a day for 3-4 days. It usually does the trick, avoiding a need to call my doctor.

What to make of this?

Thrush is an annoyance more than anything. Plus, it’s relatively easy to treat. Still, by using a spacer if you have an inhaler, and by rinsing your mouth after using a dry powder inhaler, it can just as easily be prevented.

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Going to Battle With Thrush

We all know that our inhaled corticosteroid inhalers come with their fair share of potential side effects. While not everyone gets the side effects, some seem to be plagued with them more often than not. One of the most unpleasant side effects of inhaled corticosteroid maintenance inhalers is thrush.

Oral thrush is officially called oral candidiasis

Essentially, it’s a yeast/fungus that develops on the mucous membranes in the mouth & throat. It can happen to anyone, but is more commonly found in the elderly, babies and those who are immunocompromised. Certain medications can cause an overgrowth of the candida fungus, thus causing a thrush infection.

Symptoms of thrush include a thick white film covering the tongue and possibly throat and on occasion the gums. You might have a sore throat as well. If the infection is pretty bad, and the white spots on the tongue are scraped, they might bleed. In minor cases, the tongue might not be very white at all, and just sore and red.

Your best battle against oral thrush is prevention.

There are several steps you can take to help prevent thrush from happening. First, be sure to rinse your mouth out (and spit it out!) every time you take your steroid inhalers. Really be diligent about doing this. Make it a habit. You can even take it a step further and brush your teeth afterwards to be extra cautious especially if you find that you are prone to thrush infections as some are more than others.

Another simple tip is to use a spacer with your metered dose inhalers. (Spacers aren’t meant to be used with the dry powder inhalers or the Respimat versions of inhalers.) A spacer prevents the medication from hitting the back of your throat and holds it in the chamber long enough for you to inhale it down into your lungs. This makes a huge difference not only in thrush prevention but also in your lungs getting more of the medication and you getting the maximum benefit. Spacers are inexpensive and some times your doctors office might be able to give you one or a prescription for one to pick up at your local pharmacy or you can purchase one online.

If you find yourself with a case of thrush, it can usually be taken care of pretty easily.

Give your doctor a call. He or she will prescribe an anti fungal medication (generally it’s a prescription mouthwash) that you will use for a period of time that they will decide on depending on the severity of your case. Rinsing your mouth with saltwater may feel soothing especially if it’s really sore. You will also want to make sure to clean your mouthpieces of your inhalers really well while recovering from thrush to prevent any reinfections from occurring. Also be sure to replace your toothbrush.

While thrush can be unpleasant, there are steps you can take to prevent it and also steps you can take to get rid of it generally pretty easily with a trip to the doctor.

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