recurrent oral thrush

[HC26]

Hi all,

I’m looking for some advice around inhaled steroids and constant oral thrush.

I was moved to flixotide 125 last year after my asthma worsened. I take 1 puff morning and night. Since summer last year I have had oral thrush on and off constantly. I never had this on my previous inhaler which was clenil 100. My doctor has recommended that I go back to the clenil inhaler since it didn’t cause thrush issues before, taking 1 puff morning and night.

Is this not quite a bit jump in inhaled steroid? I’m worried my asthma flares up.

Also has anyone has long term issues with oral thrush?

Thank you!

[Homely2 Administrator]

I use a spacer and gargle after using my inhaler. I do not know if this is stopping it, or I am just lucky.

[Lysistrata Administrator Community Ambassador]

I'm on a high dose of inhaled steroid and don't have problems with thrush. I rinse my mouth out and gargle with plain water after taking it morning and evening, then spit it out - no problems! If it's for any reason hard to do that (in hospital, ironically!) then I do start to notice I'm becoming hoarse so I think it does make a difference.

I can't use a spacer with mine as it's a dry powder version, but if yours is the spray (metered dose inhaler, MDI) then using a spacer would also be a good idea - more goes in your lungs and less in your mouth that way. If you're on the dry powder then it could be an idea to switch to the MDI version if there is one and use a spacer with it.

While I realise some people may have problems with thrush even if they do rinse, I really feel like your GP hasn't considered all angles here - you needed the increase before for your asthma, and I feel like they should have suggested ways to deal with thrush (like the ideas above and from other replies), rather than putting you back on something that wasn't controlling your asthma.

You might like to have a chat to the asthma nurses and see what they suggest: 0300 2225800 or WhatsApp [phone] Monday-Friday 0915-5pm

[risabel59]

Hi, this a problem for lots of people. Always use a spacer assuming that you are using an MDI. And rinse well after using. But a useful tip my dentist gave me was to give up using alcohol based mouthwash. Instead rinse out with warm salted water. (not too much salt). This tip really helped me. Although I do get the Thrush back from time to time particularly after Anti biotic.

R

[Spikedog66]

Hi I've constant thrush despite spacer, brushing teeth gargling etc. Fluconazole is the only treatment that takes it away but can only take it periodically. Im trying luvbiotic toothpaste mouthwash and pastilles not doing much after a week but will see. Not much I haven't tried had oral thrush for years and had various inhalers.Its the steroids in the inhalers I dont think I will ever get rid of it.

[Emaych61]

I’ve never had oral thrush but I have had oesophageal thrush which was blamed on my asthma inhaler of the time (flixotide 250) even though I’d been on it for over ten years with no problems at all.

I gargle and rinse out with water, clean my teeth (and it is a very thorough cleaning routine, involving interdentals as well as a small headed tooth brush and - in the evening - dental floss) and then gargle and rinse out with water again after using my preventer inhaler. One resp cons also told me that I should rinse out after using a ventolin inhaler if it was possible to do so (obviously if you’re out and about and need to use it that’s harder to do). I also make sure that I eat something within half an hour of taking a preventer inhaler in an effort to dislodge any steroid medication which has adhered to the walls of the oesophagus.

[Frowler]

I find using a tongue scrapper, brushing teeth after using my inhaler followed by rinsing my mouth with water and reducing sugar intake all really help, although its a constant battle!

[DaveW27]

I was told to use steroid inhaler just before cleaning my teeth morning/evening so as the mouth gets washed out thoroughly.

[HC26]

thank you all for your comments!

I have always used mouthwash after taking my inhaler but looks like I will ditch that for now and try water or salter water instead!

I am really good with my oral hygiene in the hope that this would help but unfortunately that has not been the case so far!

I have a spacer and try smaller breathing so I’m not having a big intake of steroid at once.

I’m still debating about switching to clenil inhaler as this did not cause me issues before.

Thanks again!

[Hil101]

hi, I have similar problems and had taken fluconazole a few times including a 1-week course but the thrush would still come back. I take Fostair 200 and sometimes another inhaler as well. I rinse out, clean teeth, use a spacer etc. as others have suggested. More recently, when I feel thrush starting (voice affected, lump in throat etc), I use a small blob of over-the- counter Daktarin near my tonsils and let it sink down my throat. I generally find that the thrush goes away after a couple of days of doing this. I hope it works for you. There’s also prescription Nystatin but I haven’t had this

[Jaffa_Cat]

I had this problem while I was on Fostair (the dry powder one). I just kept getting oral thrush - as soon as I got rid of it, it seemed to come back again. I was doing all the things they tell you do it (rinsing my mouth out, gargling etc) and my GP had prescribed me a medicated mouthwash, but nothing was helping. In the end I spoke to my respiratory specialist and they changed me onto a different inhaler (it was the equivalent strength of what I was taking, just a different brand where I only have to take one puff a day, rather than using the Fostair numerous times a day on the MART regime). Since being on this different inhaler I *touch wood* haven't had oral thrush in a few months. So if you're concerned about moving back to your old inhaler, it's worth having a chat to your Doctor about your concerns, as there may be another inhaler that's the equivalent dosage to what you're already on that you could try instead