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Man opening his mouth to show his oral thrush, depicted as large white spots

Side Effects: Dealing With Oral Thrush

Side effects to inhaled COPD medicines are generally considered negligible. Still, they do exist. And most of the time they can be prevented. Oral thrush is one of these side effects. Here’s what to know about oral thrush and how to deal with it.

What is it?

Candida albicans is a fungus. It normally resides in your mouth. It’s usually kept in check by your immune system.1 But, some of us inhale inhaled corticosteroids (ICS) every day. We do this to reduce airway inflammation. This helps to control asthma or COPD.

Inhalers allow for low doses of ICS to be inhaled. This is usually all that’s needed to control COPD. This is nice because the medicine is applied directly to airways where it’s needed. Only a tiny fraction gets into your system. This makes it so systemic side effects are minimized. Some consider systemic side effects to ICS as negligible.

But, studies show that only 10-20% of inhaled medicine makes it to your lungs where it’s needed.2 Researchers are aware of this and have adjusted dosing accordingly.

Other studies show that up to 50% of inhaled medicine impacts into your upper airway. This includes your oral cavity.3 When this happens, it can knock down your oral immune response. And this can cause a condition called oral thrush.1-4

What are symptoms?

As an asthmatic, I have used ICS for over 30 years. So, I know symptoms of thrush all too well. It starts with a cottonmouth. When you eat salty foods, the affected areas burn. I’m usually pretty certain I have it when I have it. So, the fungus can grow on your tongue or anywhere in your oral cavity.

It causes white ulcerations inside your mouth. These can develop on your tongue. These can be sore to the touch. They can give you a cottony mouth. They can also burn.1-6

It can even get down your throat. I think this is how it can sometimes cause dysphagia. That’s a medical term for difficulty swallowing. You can swallow, it’s just sore down there. I think this is how it may also cause a harsh voice, as thrush may impact your vocal cords. It may also cause a cough. I have never experienced these throat symptoms of thrush, but I have heard many who have experienced them.2,6

As a respiratory therapist, I take care of many people with COPD. Occasionally I get complaints from my patients about symptoms of thrush. Some of these patients tell me they don’t want to take their ICS inhaler anymore to prevent it. But, I assure them you do not have to quit taking your medicine as thrush is both treatable and preventable.

How is it treated?

If my doctor diagnosed me he’d prescribe Diflucan. It’s a pill you take for a few days. It usually works pretty fast. Some of my friends have been prescribed Nystatin. It’s a lozenge. I’m told it tastes nasty. They both work fine. And I think which one you are prescribed is physician preference.6-8

But, I have learned you can treat it on your own. The fungus hates salt. So, you can just rinse and gargle with salt water. You can do this 2-3 times daily. It does sting a bit when you do this. Where the infection is will sting. Once you spit, the stinging usually subsides. I like to think of the stinging as little fungus dying off. So, it feels awkward but it’s tolerable.

You may also use baking soda instead of salt. Whether you take medicine or rinse your mouth with salt water, the fungus usually dies off fast. My experience is this takes about 2-3 days and I’m back to normal.

As usual, you’ll definitely want to talk to your doctor if you suspect thrush. You’ll want to get a proper diagnosis. If your doctor agrees you have thrush, one of the above treatments may be prescribed. Your doctor may also have other ideas.

How can it be prevented?

In my case, the culprit is my failure to rinse and spit after using my ICS inhaler. Sure, I know better. But, still, I’m a normal person. I get busy. I get lazy. I forget. And these are the times I “sometimes” get oral thrush.

Preventing it is quite simple. The best, most proven way of preventing it is by rinsing, gargling, and spitting after each use of your ICS inhaler. You should also do this if inhaling ICS with a nebulizer. Rinsing and gargling removes any medicine particles  that impact in your upper airway. Spitting removes them from your body.

So, rinse, gargle, then spit! Do that and you’ll prevent thrush.

However, you may sometimes still get thrush despite your best efforts to prevent it. It’s rare, but it can still happen This is most likely if you are on the higher doses of ICS. Your risk may also be increased if you are taking systemic ICS, such as prednisone. So, always be sure to talk to your doctor if you experience symptoms. It is still treatable.

What to make of this?

This is something I teach all of my patients. Every time you use your ICS inhaler: Rinse, Gargle, Spit! This is the best way of preventing oral thrush.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Kennard, Jerry, “Causes and risk factors of thrush,” verywell health, 2018, August 13, https://www.verywellhealth.com/thrush-causes-risk-factors-2328817, accessed 12/31/18
  2. Godara, Navneet, Ramya Godara, Megha Khullar, “Impact of inhalation therapy on oral health,” Lung India, 2011, Oct. to Dec., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213714/, accessed 12/31/18
  3. Gardenhire, Douglas S., Dave Burnett, Shawna Strickland, Timothy R. Myers, "A Guide To Aerosol Delivery Devices for Respiratory Therapists," 4th Edition, 2017, pages 2-3
  4. “Oral Thrush,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533, accessed 12/31/18
  5. Sulica, L., “Oral Thrush,” Annuls of Otology, Rhinology, & Laryngology, 2005, May, https://www.ncbi.nlm.nih.gov/pubmed/15966523, accessed 12/31/18
  6. Nordqvist, Christian, "Oral Thrush: All You Need To Know," Medical News Today, 2017, December, https://www.medicalnewstoday.com/articles/178864.php, accessed 12/31/18
  7. "Nystatin (Oral Route), Mayo Clinic, https://www.mayoclinic.org/drugs-supplements/nystatin-oral-route/proper-use/drg-20065146, accessed 12/31/18
  8. "Diflucan," Rx List, https://www.rxlist.com/diflucan-drug.htm#description, accessed 12/31/18

Comments

  • beartrostle
    4 months ago

    I have used hydrogen peroxide as a gargle when i have developed Thrush. Works well and usually its gone in 3 days.

  • Leon Lebowitz, BA, RRT moderator
    4 months ago

    Hi beartrostle and thanks for your post. Thanks for sharing what works for you, ‘thrush’, and hydrogen peroxide. We generally advise our members to run anything they are using (prescription medications, OTC medications, or home remedies), past their physicians prior to taking them. It would be considered a prudent approach to treatment. What do you think? Leon (site moderator)

  • mschafer
    4 months ago

    I have always rinsed my mouth out, but on several occasions I have gotten thrush, but it was not in my mouth it was in my throat, which effected my swallowing & speech.
    Every time the only thing that would clear this up was a prescription of Nystatin (sp) Swish & Swallow. This would clear it up in about 10 days, but like I said the first symptom that I had was my voice became real hoarse, no signs of it in my mouth.
    So what i try to do is not swallow at all until I get my mouth rinsed out & this seems to help keep it out of my throat.
    My doctors kept insisting I didn’t have thrush because they could see none in my mouth, but I kept insisting that I thought it was & then they went had an prescribed the medicine.

  • Leon Lebowitz, BA, RRT moderator
    4 months ago

    Hi mschafer and thanks for sharing your own experiences with inhalers and thrush. It’s always best when you can advocate for yourself. As John’s article points out (and as you have been affected yourself), the infection can be located in the mouth and also the throat. Glad to see this article resonated so clearly with you. Keep up the good work! Leon (site moderator)

  • Sashabear
    4 months ago

    Might I suggest getting minced garlic from your store, drop a smidge, maybe 1/4 tea., in a small glass and chug it with juice. Also, Oregano oil in some juice and chug it down, maybe 2X daily. That tastes strong, so have something to drink near you. Both kill the fungus and if you have it in your mouth, odds are it is elsewhere.

  • Leon Lebowitz, BA, RRT moderator
    4 months ago

    Hi Sashabear and thanks for your post. Remember that the side effect we are discussing is a fungal infection caused by yeasts, and is commonly known as ‘thrush’ or oral Candidiasis. While your suggestion may work well for you, we always advise our members to first check with their own physician before ingesting anything.
    We appreciate your input and suggestion.
    Leon (site moderator)

  • Leon Lebowitz, BA, RRT moderator
    4 months ago

    This is an excellent article John. It really provides everything we all need to know about this side effect of using inhaled corticosteroids.
    I, personally, appreciate this concise and comprehensive presentation.
    Warmly,
    Leon (site moderator)

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