A man with his mouth open wide to show white spots on his tongue, uvula. Adult, male, POC, mustache, oral thrush, say ah.

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 fungal 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.1

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.1 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.

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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.1 When you use inhaled corticosteroids every day, some of the medicine deposits in your mouth, on your tongue, and the back of your throat.1

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.2

Getting oral thrush from an asthma inhaler

It is one of the most common side effects of taking inhaled corticosteroids every day to control your asthma.3 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. 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.2

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

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.23

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.2

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.2,4

Treating thrush without losing the asthma inhaler

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.2 However, these are all options you can discuss with your doctor. I do know of some people who keep getting thrush from one type of asthma inhaler, 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.

In conclusion

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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