Undoing thrush effects of steroid inhalers

Hallo Can anyone with Asthma please advise?After prescribing a Becanose Steroid Inhaler to attempt to clear my Eustachian tubes I used it for some 8 weeks.It was then I discovered that one possible side effect was oral thrush.So I discontinued use of the inhaler.However some 8 weeks later the thrush is still with me.This is possibly caused by a lowering on the immune system caused by the inhaler.Despite various anti thrush treatments its proving tricky to clear.Has anyone any experience of this?Ought the immune system to undo the thrush and how long can this be expeceted to take?Has anyone had a similiar experience?

26 Replies

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  • Try having natural bio yoghurt. It works wonders. You can also try cleaning round your maouth and tongue with toothpaste and a toothbrush. I have found both ways work well, but you have to be careful not to make yourself gagg when cleaning your mouth.

  • Thrush

    Well thanks for your tips Angela.Here are the things I have already tried:

    Citricide,Goldenseal,raw Garlic,Amphoceterin Lozenges,Nystatin in suspension,Yoghurt,Salt water,Daktarin Oral gel,Gentian tea,BOILING TOOTHBRUSHES,however the problem appears to be a result of a partially lowered immune system brought on by steroids and not dirt in the mouth.

  • hi,

    looking at your list yoyu have tried most anti thrush things, i can suggest you either buy the pre pro biotc drinks, or if you cant tollerat them you can get them in tablet form from health food shops. some have to be kept in the fridge, i take them every day now as have had so many anti bs, thrush in mouth is horrid, have you had your moyuth swabbed to make sure the diagnosis is correct. may be worth asking gp if symptoms persistant.

    good kuck george x

  • If you've tried so much stuff and it's not better - are you sure it's thrush?

  • Thrush

    Almost certainly thrush or hairy tongue(white).A white patchy coating on the tongue.Incidentally apparently from 1:8 to 1:20 people using the Benacose Inhaler experience this to varying degrees according to reports on The Net.It seems to be a particularly side effect inhaler and Im surprised that its now even easier to buy over the counter at £8.99.(it used to be prescription only).The Manufcaturer-Allen and Hanburys a division of Glaxo Smith Klein of West London offer a ""customer health care telephone number(s)on their website"".However on ringing this one just gets the general switchboard.After being kept hanging on for a long time One is then promised to be put through to a ""pharmacist member of staff""but one only gets a young girl who just wants to take your details and log your side effect and who is unable to help.Basically they just dont appear to want to know.Information on white coating is hard to come by some reports say it lasts a few days others months.Some say it cleared up with first line thrush medications,some say it goes naturally.So if anyone has actual experience of Asthma inhaler induced thrush perhaps they can describe their effects?

  • Have you had your tongue looked at by a doctor to confirm that it is thrush? Whilst the internet is all very well and good for suggesting diagnoses it can be quite misleading, and the fact that this problem with your tongue hasn't cleared with all these things you've tried should warrant a look from a health professional to ensure the diagnosis is correct.

    Additionally, you say that you can get this over the counter - are you referring to the beclomethasone nasal spray? I only ask because the beclomethasone *asthma* inhaler is a prescription-only medication, and cannot be purchased over the counter.

  • lazens wrote:

    ""Basically they just dont appear to want to know.""

    Well, what *exactly* would you expect them to do?! Oral thrush is a known side effect of all steroid inhalers, and will be listed on the patient information leaflet. GlaxoSmithKlein's customer services line is not there to provide you with medical information or a diagnosis... that's what your DOCTOR is for!

    You are asking the users of a message board to help you self-diagnose a possible case of oral thrush. This is an impossibility; go and see your GP.

    Steve

    (Moderator)

  • Inhaler

    Well actually I do not remember the words oral thrush being mentioned at all in the side effects section of the ""patient advice leaflet""for what its worth neither did the doctor warn me on handing the prescription.

    Second point is that there seems to be A)a lack of information generally about peoples' experience of these inhalers eg.none of your websiters have come forward with theirs though undoubtedly many 1000s use them.B)Denial that inhalers can cause long lasting thrush or similiar symptoms amongst inhaler users from pharamacists.The ones I have spoken to claim the few cases they've had back the thrush cleared up ""in a couple of days"".This is patently not the case.In fact there seems to be a lack of interest generally in this topic at least on this board apart from some amateur and somewhat useless suggestions of the much yoghurt kind.If you want to kill it by all means close the thread but given this increasing problem it may well surface again?

  • Lazens, you still haven't answered the questions I posed you: a) has your oral condition been diagnosed by your doctor and b)are you using a nasal spray or an inhaler?

    If you are using a *nasal spray* then I doubt very much you will find oral thrush listed as a side effect, because it's used nasally; on steroid inhalers, you will certainly find it listed, as it's a common side effect, particularly if you take high doses and don't use a spacer device.

    If you've been prescribed it to clear your eustacian tubes, then you must be using a nasal spray, not an inhaler. The doseage of steroids in nasal sprays really isn't anywhere near high enough to cause immunosuppression of any kind.

    ""The ones I have spoken to claim the few cases they've had back the thrush cleared up ""in a couple of days"". This is patently not the case.""

    Actually, most oral thrush really *should* clear up in a couple of days. All of these factors really add up to suggest that perhaps this really might not be oral thrush, and you should really be seeing your doctor to be properly diagnosed and treated.

    CathBear

    (moderator and doctor)

    P.S. If you could refrain from calling our message board users ""amateurish"", then I'd be most grateful - it doesn't go down very well and isn't likely to make people inclined to try to help you in future. Thanks.

  • Can we clear something up here, please. I assume that you have been prescribed Beconase, which is a nasal spray. Have you been taking in nasally (in other words, through the nose) and not orally (by mouth)? If you HAVE been taking it orally, it is no surprise that you have developed thrush, as this is not how it designed to be taken. As CathBear stated, when taken nasally the likelihood of developing ORAL thrush from it is very, very low - this is why it would not have been mentioned by your doctor.

    It is important to note that the side effects of an oral inhaler and a nasal spray - even when they dispense the same drug - will be different, and the two certainly cannot be compared.

    Nextly, you assume that our members are ignoring your request for information regarding their experiences. Not so; some have already responded. But more to the point, you say that the Beconase was prescribed to clear your eustachian tubes, and not for asthma. Although some asthmatics will be prescribed nasal steroids, far more will be prescribed oral steroids, and may not be responding because they have no experience of nasal steroid-related oral thrush.

  • Hi Lazens,

    Just adding my thoughts to this discussion as I too have had problems with thrush recently!

    I have been a nasal spray user for the past 7 years for my severe hayfever and have never experienced oral thrush. I have used both beclomethasone and fluticasone based sprays at the maximum recommended doses without significant problems. However last week (wednesday to be exact) I developed severe oral thrush from my Flixotide steriod inhaler, which didn't suprise me too much due to the high dosage I am on and the fact I had just finished anti biotics for a throat and ear infection. Due to various allergies I could not take the usual Nystatin pastilles and my asthma nurse felt Fluconazole could interact with some of my other medication. I was using Daktarin Gel until I reacted to it quite nastily and so my nurse suggested I tried yoghurt. It was great, the problem cleared up pretty quickly (its gone now!) and it was far more natural and a less intrusive on my body! I really would recommend it. However it sounds like maybe a trip to the GP would be an idea too to make sure it is definitely thrush. Do you have any other symptoms? I had a bit of a sore tongue and throat and also where patches of white peeled off it was very red.

    Anyway thats just my experience, hope it helps a little?

    With regards to amateur responses on this forum... although there are people with medical training amongst us, most of us are here just to share our experiences. We are not experts in curing other peoples asthma and related conditions and not everyone has experienced the same things. If people do not reply to your posts it may be that they don't have anything relevant to say, especially as more often than not thrush clears up quickly with the conventional treatments such as Nystatin, Daktarin or Fluconazole. Others here may be more used stuborn steriod side effects such as recurrent thrush but as you have listed pretty much everything that can be tried they don't know what else to suggest other than a visit to the GP.

    I really do hope you get this problem sorted soon because it is unpleasant and a nuisance.

    Take care,

    Sparkly Fairy :-)

  • Lazens,

    I can't speak for anyone else, but personally the reason why I did not respond to your query was because your initial question did not make enough sense to make a valid answer possible.

    You refer to a non-existent medication (you variously call it Beconose and Benacose), you do not make it clear whether it is an inhaler or a nasal spray (you refer to it as an inhaler but the reference to eustachian tubes would seem to suggest otherwise), you claim a side effect which is extremely rare with nasal sprays, and you claim it is available over the counter, whereas in fact all steroid nasal sprays and inhalers are prescription only.

    You complain of lack of interest and refer to the suggestions of those who have tried to help you as 'amateur and somewhat useless' - in fact using yoghurt for oral thrush is a perfectly reasonable (and medically validated) suggestion, and at the time that this was posted you had not stated that you had already tried it. You also appear fairly hostile to any attempt to suggest that your (self?) diagnosis is incorrect, which as far as I can see is about the only useful thing it is possible to say in response to your query. As for your complaints of lack of information about, and denial of, side effects of medication, I am not sure if you are referring to patients, pharmacists or doctors - but I can assure you that all three groups are usually only too well aware of the likely side effects of commonly used medications.

    This board is a community for asthma sufferers and those otherwise affected by asthma to provide mutual support and discussion of some of the issues that we face. It is not intended to be a source of instant diagnosis and medical advice - whilst there are medics on the site, they are here primarily as fellow asthma sufferers. Your complaint of lack of interest seems to imply some sense of entitlement and indignation that your question has not got more responses - in fact, since you posted it only just over 48 hours ago I think the response has been rather good. As Steve said of your similar indignation with GlaxoSmithKline's phone line - what do you expect us to do?

    Actually, you are right about one thing. I have certainly developed an extreme lack of interest in responding to any future queries you might have.

    Em H

  • I hesitate to reply, but as a mere amateur and humble board frequenter my oral thrush has always responded well to Daktarin oral gel. I mostly use nebulised steroids but have recently been given Symbicort to use alongside of my nebbed steroids to good effect but it does seem to give me oral thrush. That said it does go within a few days, maybe you should seek advice from a health care professional. We are humble amateurs but we do respect, support and care for each other in this AUK community, Lois

  • inhalers

    Well it seems this post has detiorated into anarchy.

    Let me clarify:The spray in question is called Beclometasone.It is a steroid.It is a cocortisoid.

    As the moderator of this board states these are notorious for causing thrush as is amoxillin which I was also given.

    I HAVE seen the doctor on several occassions already.

    Unless you have experience of beclometasone I would not comment.

    It is recently available over the counter in Boots as is 150mg fluocazole for womens vaginal thrush(1 oral capsule).It is also available on prescription.Its perfectly possible for a drug to be both.The beclometasone goes up your nose twice a day and the liquid dribbles down the back of the throat.After 2 weeks or so anti inflammatory steroid effects kick in with whatever else such as immunosuppression.It was given to clear my eustachian tubes to unblock them as an experiment.I do not have asthma.It did work to a degree.The alternative might have been years of blocked tubes or having ones ear drums cut open.people can have thrush for months.various other wierd effects were seen after the spray like if you got a cut it turned yellow and oozed pus then formed a big blister before healing-this obviously points to a immune supressed system caused by beclometasone.So to suummmarise I have one doctor,numerous commentators and the moderator of this board all stating that steroid/cotocoisoid sprays/inhalers whatever cause thrush.However Allen and Hanburys did not!

  • Actually, no-one has stated that corticosteroid NASAL SPRAYS cause oral thrush. In fact, several people have stated that they are very unlikely to, if used correctly, due to the dosage and route of administration. This is why Allen and Hanbury's do not list it as a side effect in their patient information leaflet. Oral thrush is not listed in the BNF as a potential side effect of corticosteroid nasal sprays. This, combined with the fact that your condition does not seem to have responded to any thrush treatment, is why people are quite rightly querying the diagnosis.

    Of course it is possible for a medication to be available on prescription as well as over the counter, no-one is disputing that - all medications that are available over the counter are also available on prescription. In fact, beclomethasone nasal spray is designated a prescription only medication - with the dispensation that it 'can be sold to the public for nasal administration (other than by aerosol) if supplied for the prevention and treatment of allergic rhinitis in adults over 18 years subject to max. single dose of 100 micrograms per nostril, max. daily dose of 200 micrograms per nostril for max. 3 months, and a pack size of 20 mg' (direct quote from the BNF). At these sorts of doses, there would be NO SIGNIFICANT SYSTEMIC IMMUNE DEPRESSION. Even at the sorts of doses that doctors may prescribe (upto a maximum of 800mcg per day, occasionally higher in extreme cases) there is very unlikely to be any systemic immunosuppressive effect. Certainly it would not cause infection of skin wounds as you are describing - I am not sure where you have got that information from, but such a phenomenon would be relatively rare even in someone on high dose oral steroids.

    I am not sure that you can blame Allen and Hanburys or beclomethasone for your mouth problem. It may be that mucosal swabs or scrapings of the mouth lesions are required to reach a diagnosis, which will also provide information on sensitivities to anti-fungal agents, if it does turn out to be thrush. Since none of us have the power to perform swabs remotely, I can only reiterate the advice of several other people, including the moderators of the board - to go back and see your own doctor. I am not sure what else you expect of us.

    Em H

  • Em H is spot on; you can't lump all the possible methods of dispensing beclomethasone into one big pot and expect the exact side effects to be the same for all of them!

    Oral thrush is NOT a common side effect of NASAL beclomethasone. End of. Sorry if that disagrees with your self-diagnosis.

    Oh, and the dictionary describes ""anarchy"" as, ""absence of any cohesive principle, such as a common standard or purpose.""

    It's not anarchy when everyone else agrees with each other but disagrees with you.

    Furthermore, please refrain from telling members of the board whether they have a right to reply to your post or not. It doesn't exactly promote good feeling towards you.

    Now, please, go and see your GP and get this sorted. There is really nothing more we can do for you here.

    Steve

    (moderator)

  • OK, it really *really* irritates me when people mis-quote me and then claim that I've supported their argument.

    Lazens said: ""Let me clarify:The spray in question is called Beclometasone.It is a steroid.It is a cocortisoid. As the moderator of this board states these are notorious for causing thrush as is amoxillin which I was also given.""

    No. What I said was this: ""If you are using a *nasal spray* then I DOUBT VERY MUCH YOU WILL FIND ORAL THRUSH LISTED AS A SIDE EFFECT, because it's used nasally; on steroid INHALERS, you will certainly find it listed, as it's a common side effect, particularly if you take high doses and don't use a spacer device.""

    Amoxicillin can cause thrush, but it RARELY causes ORAL thrush, it is far more likely to cause thrush of the vulva in women.

    Lazens said: ""After 2 weeks or so anti inflammatory steroid effects kick in with whatever else such as immunosuppression""

    And I re-iterate what I already said: ""The doseage of steroids in nasal sprays really isn't anywhere near high enough to cause immunosuppression of any kind.""

    Beconase contains 50mcg per actuation. If you're taking 2 puffs into each nostril twice a day, then that gives you a daily dose of 400mcg. Even if you used this for years, it wouldn't cause immunosuppression. You certainly cannot get immunosuppression from using it for two WEEKS.

    Lazens said: ""So to suummmarise I have one doctor,numerous commentators and the moderator of this board all stating that steroid/cotocoisoid sprays/inhalers whatever cause thrush.""

    No. You don't. You have TWO doctors, a FEW other board members and TWO moderators saying that steroid INHALERS can cause oral thrush. Most of us have already told you several times that NASAL SPRAYS don't!

    So please, Lazens, read what is actually written in the messages and not what you want to read to support you own ideation.

  • Oral thrush

    Well there are points there,however what else can you call a white tongue coating that looks like thrush,behaves like thrush and even has the furry bits down the centre with no other symptoms?There do exist 6 different strains of thrush-the main one being Candida Albigans.Have you heard of ""resistant thrush""?I can find no other bacterial infection that this could be on its own.As to whether the spray brought it on or the Amoxcillin brought it on several people are very insistent that it ""couldnt"".I wonder if they work for or have shares in Glaxo Smith Klein or something?For to admit that a spray does might upset their apple cart?Just a thought.I understand the point you are making about inhalers and sprays,BUT dont forget with a spray some liquid goes down the throat and into the body just as inhaler mist must do.the whole system is linked(Also if you search the Net long enough you will definetly find umpteen references to specifically SPRAYS in fact the very spray in question causing thrush,period..Also the Doctor seems quite happy with the spray being responsible-he prescribed it.Also various medical sources state that thrush can be ""a long haul""and that ""every spore""has to be eradicated.Lets leave the jury open on what caused this shall we it seems to be open to debate.Yes they have taken a swab.The anti fungals inhibit and diminish the thrush.It took 4 months to get the ears clear.In the old days it could take 10 months or more for patients to recover from Infections and viruses before penicillin!You also have to take into account a patients age,the state of their immune system and hormonal balance.I know this is unpopular in todays pop a pill fast drug society but its a fact.I would not go on funcazole as reports of side effects are legion-in 25% of takers but that is a different story.......

  • HI Lazens

    Havun used a nasal spray for as long as i can remmeber if you use it properly it shouldnt go down the back of your throat you should tilt your head slightly forward and just puff it up your nose and not actually sniff it up because the action of squeezing it up your nose should be enough atherwise you just sniff it up hard and straight down the back of your nose to your throat so doesnt sit where its supposed to in the nose to be any benifit to you and ive never heard of a nasal spray causeing thrush and i used several different types over the years

  • ‘what else can you call a white tongue coating that looks like thrush, behaves like thrush and even has the furry bits down the centre with no other symptoms?’

    - there are many potential causes of a white coated tongue - dehydration, smoking, leucoplakia, lichen planus and keratosis pharyngitis to name just a few

    - clearly it does not behave like thrush, as it is not responding to anti-thrush treatments

    ‘There do exist 6 different strains of thrush-the main one being Candida Albigans [sic].’

    - actually, there are hundreds of strains of Candida. However, there is no such thing as Candida ‘Albigans’

    ‘Have you heard of ""resistant thrush""?I’

    - yes – that is why I suggested swabbing for cultures and sensitivities

    ‘I can find no other bacterial infection that this could be on its own.’

    - thrush is not a bacterial infection. Since you are obviously not a doctor, maybe it would be better to leave the diagnosis to someone who is, as everyone has been suggesting?

    ‘I wonder if they work for or have shares in Glaxo Smith Klein or something?’

    - no, actually. And in general, drug companies have nothing to gain from not listing a side effect, especially if it as common as you seem to insist. The British National Formulary (an *independent* publication of all the drugs available to prescribe in this country) certainly have nothing to gain from not listing a side effect. If they don’t list it, that is because it is not a significant side effect.

    ‘the whole system is linked’

    - I am not sure what you mean by this – if you are trying to imply that there is significant systemic absorption with normal doses of nasal corticosteroid, then sorry, it’s just not true.

    ‘Also if you search the Net long enough you will definetly [sic] find umpteen references to specifically SPRAYS’

    - oh, the Net. What a convenient catch-all non-specific reference that is. If I search the net for long enough, I can find many references to theta DNA healing as the practical application of applied quantum mechanics in curing disease. I’m not sure I’ll be rushing to the bank just yet.

    ‘various medical sources state that thrush can be ""a long haul"" and that ""every spore"" has to be eradicated’

    - ah, ‘various medical sources’. Indeed. It is simply not true that ‘every spore has to be eradicated’ – 50% of the population carry candida spores in their mouths as a completely asymptomatic colonisation, causing no disease – including virtually every denture wearer.

    ‘In the old days it could take 10 months or more for patients to recover from Infections and viruses before penicillin!’

    - actually, in ‘the old days’ the majority of people with a significant bacterial infection died. I am not sure how this is at all relevant to your argument, though.

    ‘I would not go on funcazole [sic] as reports of side effects are legion-in 25% of takers but that is a different story...’

    - assuming you mean fluconazole, the side effect profile is actually pretty benign – as you pointed out yourself, millions of women take it every year for vulval or vaginal candidiasis. Every drug has side effects.

    - are we to gather from this comment that you are refusing to take the advice of your own doctor? Suddenly the problems you are having, as well as your attitude to the answers which we have tried to supply, become a lot clearer…

    I am really not sure what your motivation is. You ask for advice, you complain that there have not been enough responses to your request, and you then proceed to systematically ignore and try (not very successfully, I might add) to ‘debunk’ every single suggestion that is made to you. I wonder what motivated you to seek advice from the site in the first place, since you are so obviously incapable of accepting any answer that does not fit in with your narrow (and incorrect) world view.

    You accuse us as a community of variously being ‘amateur’, ‘useless’ and having a financial bias. If you are so convinced of these things, I would suggest that you might like to seek your advice from elsewhere in future. I am sure that you will find a web forum somewhere who will agree with your ideas about medication, doctors and drug companies. I am not sure that that forum will provide you with a great deal of help with your mouth problems, though.

    Em H

  • Lazens it seems we have exhausted all ideas and suggestions of help for you and it is obvious that you will only value a response which meets your requirements - ie someone else who has had exactly the same persistent problem with exactly the same medication. It does not appear that any of us here have a response good enough for you.

    You say that you would never take fluconazole due to the side effects, but how do you know that you would definitely be affected? Perhaps you would like to consider the decisions many of the members of this forum have to make on a regular basis. Lots of us have to take medication and then take additional medication to control side effects in order to be able to breathe and try to lead a normal life. There are also people with allergies who would be grateful to be able to take what ever they are offered to relieve conditions such as thrush but are unable to do so and have to resort to other methods. If I was suffering with such a persistent problem as yours I would try anything. Then again I am not you.

    I was wondering, if you don't have asthma what made you choose an asthma forum to ask this question as opposed to a forum for hayfever or allergic rhinitis where you would be more likely to come across people who are currently using a beclomethasone nasal spray. My suggestion would be to try else where because we are running out of ideas here!

    Best wishes

    Sparkly Fairy

  • Lazens, please give it up. You are currently trying to argue medically with EmilyH and CathBear - both of whom are doctors.

    You will not win, primarily because you are wrong.

    I do, however, object strongly to the tone you have been taking for most of this discussion. When you start to accuse random message board members of somehow being in a position to gain financially from ""lying"" to you about the side effects of medications, I draw the line.

    I can't PM you, so I will have to give you your first warning here in thread. It is for breaking the T&Cs of this message board with regard to keeping all messages ""civil"".

    Other than that, I can add little to what EmilyH and Sparkly Fairy have posted below.

    But - and now I'm not asking you, I'm telling you as a moderator - as far as you are concerned, you should give up on your fruitless quest for justification for ignoring the advice your doctor appears to have given you, admit that you are both wrong and clutching at straws, and allow this thread to die while you still have a grain of dignity.

    Steve

    (Moderator)

  • Wot EmH said... nicely put.

  • Beconase

    (abusive post removed by passing moderator)

  • Lazens,

    None of the posts have been abusive, or bullying. Just because someone disagrees with you, or wishes to correct you, does not mean it is ""bullying"".

    You had already insulted members of our message boards before your final post - which I will be removing, because quite frankly no-one deserves to read such rudeness - but I won't delete your account; you're banned.

    When you have a medical degree, then you may feel free to slander those who also hold one; until then, I don't think you're in any position to decide whether we are good doctors or not.

    As for people with agendas - well, you seem to have come to this board merely to air your own, for you certainly haven't engaged in any discussion which doesn't agree with your own viewpoint. All we have done is pointed out that your assumptions may be wrong and that you should see a doctor. I don't think that has an agenda. Oh, apart from making sure that you're safe and healthy. Ooops, I forgot that one. Silly me.

    If you don't want to engage in sensible discussion, and if all you want to do is find someone who agrees with you, then a discussion forum really isn't the place for you.

  • Thank you, Cathy, for removing that last post - unlike the others, which were just frustrating and slightly annoying, that one did make me feel quite angry.

    Bullying other people, being in the pay of the drug companies, and having an 'agenda' are so far from being what doctors (and in fact decent human beings of all types) aspire to - and certainly not why I went to Med School or the way I tried to practice medicine. To make accusations like that goes to the heart of what it means to be a doctor, and makes a mockery of it. It also makes a mockery of what this site, and the many good people on it, are all about.

    Several of us have tried in good faith to help this person based on the sketchy information that he gave us, to no avail. It is clear that this community will not make him happy, and he certainly will not make us happy, so I am glad he will not be returning.

    Thanks again Cathy and Steve for being our tireless moderators as usual and protecting us from these trolls.

    Em

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