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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.

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 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 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.

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 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.

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

Comments

  • alinnepb
    4 months ago

    Hello, recently I don’t have much money to purchase a fluticasone and salmeterol inhaler, since here in Mexico are very expensive and if you are a young asmathic usually your health insurance will make you perform several tests and paperwork before giving you an expensive medicine, which is something very debilitating. So, I turned to the old salbutamol which I can afford, but I for sure know that I have more than a 70% resistance to it, it takes more than 8 shots a day and today I was washing my tongue and it is very white, I got really scared and that’s how I found this website. I felt a lot better after reading your messages, I will try the baking soda method, but also I think I am dehydrated because my lips and skin are very, very dry and I feel extremely tired all the time. I am glad I found this post, thank you for sharing your advices.

  • Leon Lebowitz, RRT moderator
    4 months ago

    Hi alinnepb, and thanks for your post. We’re glad you found this site, too. Thanks for letting us know how the information you’re reading here helps you to manage your condition. If there is anything we can do to assist you, please let us know. All the best, Leon (site moderator)

  • TracyLee
    6 months ago

    John, you wrote “you may want to rinse, gargle, swish, and spit”. I have been swishing and spitting, then with fresh water gargling and spitting again. So it is OK to gargle with the water from the swish? Swish, immediately gargle, and then spit once? You can probably tell I haven’t had any guidance on this other than from websites.

  • John Bottrell, RRT moderator author
    6 months ago

    Great question. To be honest, I don’t think it really matters what order you do them in. I really don’t think it would matter since the goal of swishing and gargling and spitting is to remove medicine particles from your mouth and throat and get rid of them from your body. Bottom line, it’s just something very simple you can do to reduce your risk for side effects. Does this answer your question? Thoughts? John. Site Moderator.

  • John Bottrell, RRT moderator author
    5 months ago

    You are welcome!

  • TracyLee
    5 months ago

    John, thanks for the clarification.

  • Madeleine
    6 months ago

    I am on Advair. I used to get thrush despite gargling and rinsing several times after my Advair use. The solution that works for me…our shower hose has a focused, forceful setting. After using my Advair I hold the shower head to my mouth, close my throat and turn the water on for a couple of seconds. Takes a little practice and the right king of shower hose but no more thrush infections. They’re so annoying!

  • John Bottrell, RRT moderator author
    6 months ago

    As Lyn said, I’m also impressed with that idea. John. Site Moderator.

  • Lyn Harper, RRT moderator
    6 months ago

    How creative, Madeleine! I’m always so impressed with the innovation of people when they need to solve a problem. Good for you! Mouth thrush is no fun so whatever you can do to avoid is fabulous.

    Thanks for sharing that idea.

    Regards,
    Lyn (site moderator)

  • Leon Lebowitz, RRT moderator
    6 months ago

    Hi Madeleine and thanks for your post. I’m so glad you found something that works so well for you to help prevent ‘mouth thrush’. For me, that would be a little frightening to direct the water full force into my mouth while keeping my throat closed. Fortunately, rinsing has never let me down. All the best, Leon (site moderator)

  • Kats
    2 years ago

    I agree Janet ,after being on antibiotics I use to get thrush. Now I use a spacer. I also rinse my mouth and sinuses with Alkalol.
    Haven’t had thrush again. Twice was enough!!

  • Leon Lebowitz, RRT moderator
    2 years ago

    Rinsing is the way to go Kats – keep up the good work!
    All the best,
    Leon (site moderator)

  • Mahod
    2 years ago

    You are right, Thrush is not the name of a band or battle bot!! 2 months on nebulizer meds. Budesonide followed by perforomist. Ibupropium bromide as rescue when home.
    Had thrust larynx and airways. Difficult to breathe and laryngitis. I use coconut oil pulling follow by salt water. Both as rinse, swish, gargle, spit.
    Laryngitis and infections have hung on now for 7 weeks. Had asthma attacks 3 times this week. I am new to this and trying to get a handle on it. I have hypogammaglobulinemia, on ivig infusions for 7 months. I understand the connection with frequent pneumonias and bronchitis. I am stunned that I can be doing pretty well and wham! Upper back pain, tight chest, can’t talk.. you know the rest. I relax, use rescue inhaler and breathing/ relaxation exercises. When does this get better??? How or where can I learn what I may be doing that triggers the episodes?

  • JanetH
    2 years ago

    I’ve had thrush a handful of times. An additional factor is if you have been sick and on antibiotics, as well as using your inhalers, it seems to make it easier for thrush to make a foot-hold. I am not on a dry inhaler, use a spacer most of the time, and am religious about rinsing my mouth, yet I still seem to get thrush.

    There are also clotrimazole troches that are prescribed for thrush, but you have to remember to suck on one every few hours. Also, a time or two when I’ve had a very mild case, my allergist said just to gargle with something like Listerine a few times/day, and that seemed to nip it in the bud. I’ve not tried gargling with salt or baking soda, so I might try that next time I suspect I have it.

  • John Bottrell, RRT moderator author
    2 years ago

    Hey, thanks for sharing. I never heard of using Listerine, so that’s another alternative worth trying if the need arises. That’s one of the neat things about this community is sharing ideas like that.

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