Mouth and throat care

Hi guys! Hope you're all doing ok! Am currently captured and that's probably what's triggered this as not moved out of bed for a few days and so not brushed my teeth properly but my mouth is very sore and dry. I do have a bit of thrush but it feels more dry and sore than usual. I would assume that when I was taking care of my mouth properly again it'd sort itself out a bit, but as for the foreseeable future I'm nebulising my steroids, I know that's really rough on your mouth, I. Worried now it's started to get bad it might not improve properly. Apart for nystatin to treat the thrush, is there any 'symptomatic relief' you can have for the dryness and soreness? Would temporary use of artificial salvias be suitable for this.

Also, in terms of nebulised steroids - are they bad for your eyes? My family has a strong history of glaucoma so my cons has said to be careful when nebbing my ipatropium as that can increase risk of glaucoma (I neb my morning and evening doses so tend to do it while I'm still basically unconscious and so my eyes are closed anyways!) but he didn't mention anything about the steroid, I'll try to remember to ask tommoz but there have been so many changes recently I have a few questions and do have a tendency to forget things like that!!

Thanks for any advice guys :-)

11 Replies

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  • Hello Soph,

    Make sure you rinse your mouth and or clean your teeth after nebbing steroids, same advice as with inhaler/ spacer steroids.

    There is also a gel that is antifungal you could try called Dactarin, or a course of fluconazole will help clobber it, but then you need to keep on top of it.

    Drinking plenty too....

    With nebbed steroids you should be using a mouthpiece! Not a mask as it will affect the skin around your mouth and nose.

    Also use mouthpiece where you can for Atrovent too...

    Hope this helps

    Kate

  • When I couldn't get out of bed in hossie, I would brush my teeth in a bowl with a glass of water to rinse. Mouth are is really important, won't the nurses help you by providing this? They can give you nystatin drops for oral thrush. Like Kate said, I've always been told to use a mouthpiece for nebulised steroids rather than a face mask.

  • Am mobile now, so can wash my mouth out properly, was a little bit semi-conscious for a few days but probs could have been bruising teeth etc sooner than I did! Will make sure I use a mouthpiece from now on, hadn't even thought about my skin! Thanks guys :-) also, did either of you have issues with the ampules turning to foam if there is any salb/atrovent at all left in the pot? I'm using different pots now, but wondered how I would work it with omron which you can't change pots for!?! Thanks :-)

  • Just rinse the Omron med chamber out between nebs?

  • Definitely second the gargling after steroid nebs. If you can do with salt water rather than just plain water even better.

    I use a Pari Trek so can't help you there. Also seconding the importance of gargling after steroid nebs. Doctor had prescribed steroid nebs 3xday in lieu of upping systemic steroids (sadly didn't work - back up on 40mg again - grrr - even my very conservative pulmo - new one - though FEV1 42% predicted/34% PB was a little low). Had a mind fart a month ago and didn't connect the dots that I should treat a steroid neb the same way I do seretide'/flixotide - ended up with ucky thrush.

    Aside from protecting eyes - another advantage of mouth piece is that it give one a way to assess how well one is pulling in air - sometimes it goes very fast and sometimes it can take up to an hour unless I really really work at it, and even if I do, its much slower.

    I'm using flixotide nebs - turning to foam - with or without salb - my ampules foam up a bit - maybe its just part of things. I often though do a combined neb to help things get in deeper - 1ml (5mg) vento + 2mg flixotide ampule. That's not an uncommon combination so I think the salb and steroids are meant to go together .

    Hoping you feel better soon and can do heaps more than just making it out of bed.

  • the omron doesnt seem massivly keen on the budesonide whether or not I rince it - wonder it the mesh nebs dont get on as well with foamy nebs! It'd do for emergencies, or if im away for one night, but think im gonna have to stick to the respironics porta-neb for my main treatments, not the end of the world but its so noisy and slow!!

    Ive gotten into a habit of nebbing, then rincing, then eating, then brushing my teeth so hopefully mouth gets a good old rinse! Plus im currently using corsodyl mouth spray stuff so that rinses your mouth out a bit as well. Its all annoying me a little bit at the moment, my goal is always to make treatment take up as little time as possible so i can juts get on with my life, and its hard to accept that nebs twice a day no matter what are a thing now. I know its not really a big deal, just need to get used to a new minimum i guess. Could be worse, there was talk of me spending the next month or so on QDS nebs (0.5mg of budesonide, 5mg of salbutamol and 250mcg of ipatropium) and that would have really driven me mad - i sleep far too many hours to do things QDS properly so id deffo have to wake up especially and im a stroppy teenager and dont really do that! lol!

    I cant tellif its coincidence, but my breathing has been a bit better, the pack says you can notice the effects in as little as three days, but that seems very short given that steroid inhalers take like 2 weeks, but im an optimist so im going to hold out hope that it is the nebs doing something magic :-) 2mg of budesonide a day does seem like an awful lot - i mean, i know its nothing to the pred doses we take, but still! Although i guess when you neb you spend some of the time breathing out, so lose some?? i dont know! far too complicated for my little brain to handle before midday!

    Beth - i was specifically told not to put anything in with the steroids - although it was by a nurse on MAU so perhaps she wouldnt come into contact with nebulised steroids *that* often??

    I'm starting to feel quite a bit better, sleeping much better having a neb before bed, and when you've slept everything is a little easier. Just quite stressed with all the stuff i have to do for uni at the moment, but it'll all be over soon :-)

  • the omron doesnt seem massivly keen on the budesonide whether or not I rince it

    I think it may have to do with power rating - before I bought my portable neb, I spent sometime examining specs - some nebs simply don't have the power to properly deliver steroids which are larger particles. Since I knew I would be prescribed steroid nebs from time to time, making sure I had a portable neb that could handle them was a priority. The pari trek fit the bill for me - it is still very light weight and compact - power cord, battery, nebulizer, mouth piece, tubing all fit in a bag the size of a small camera case, but does what i need it to do. They only problem I've had with it is that I had to replace the power cord with a more durable one about 7 months after I bought it - the place where the wiring jointed the plug wore thin and began to fray.

    far too complicated for my little brain to handle before midday!

    one thing your brain is not is little, tired maybe but not little :-)

    Beth - i was specifically told not to put anything in with the steroids - although it was by a nurse on MAU so perhaps she wouldnt come into contact with nebulised steroids *that* often??

    Interesting that both you and Nursefurby have been given the same advice. I wonder if it has to do with the way your salb nebs are packaged? I know some people are prescribed salb pre-diluted with saline. My salb is a nebulizer solution that i dilute myself when I'm doing a pure salb neb (sometimes feel like I'm doing chem lab). When I do a mixed steroid/vento neb I skip the dilution because the total volume is alredy 3ml. Since I've been both prescribed mixed nebs and given them in hospital and/or clinic, I don't think its a case of misunderstanding my doctor's instructions.. Whatever the reason, this is a good example of why one should never recommend treatments without the caveat of check with your doctor/asthma nurse/etc.

    I'm starting to feel quite a bit better, sleeping much better having a neb before bed, and when you've slept everything is a little easier. Just quite stressed with all the stuff i have to do for uni at the moment, but it'll all be over soon :-)

    Glad to hear things are beginning to improve. It really does make a difference when one gets a good night sleep, doesn't it?

  • Steroid nebs should not be mixed with bronchodilators as far as I am aware (and have been told). I have the bronchodilator first, and then the steroid. This is what the respiratory specialists advise. Like Beth, I would also second not just rinsing, but gargling after the steroid.

    Glad you're feeling a bit better Soph. I sleep much better with a neb before bed, its just the getting to sleep bit which is pants, as Im shaky and my heart rate is through the roof after the neb!

  • Im on enough heart meds that im surprised mine doesnt actually just stop!! It barely goes up at all in response to salbutamol now! lol! i do the salb first working on the theory itll get the steroids in further!

    Im shockingly bad at gargling, i have a tendancy to drink it before it even gets near the back of my mouth! lol! means ill probs never choke on anything but does make gargling tricky!!

  • Beth my salbutamol nebs are just that - non diluted, no saline. I've never seen, nor heard of ready diluted with saline ones..

  • I asked the nurse who gave me a combined flixotide/ventolin neb this AM (yes, I'm captured) about mixed nebs. She confirmed that they do it all the time - so it isn't just my pulmonologist or the local urgent care facilities or my GP that does this. I told her about the discussion we've been having - she found the difference in practice interesting and said she would ask one of the doctors about it.

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