The Asthma-Thrush Link

Inhaled steroids are an effective treatment for asthma.

Because the medication is delivered directly to your airways rather than traveling throughout the body like oral medications, there are fewer side effects, making inhaled steroids a better choice for the long-term treatment of chronic asthma.

Are you doing everything you can to manage your asthma? Find out with our interactive checkup.

But inhaled steroids can lead to thrush, a yeast infection of the mouth, tongue, and throat.

Thrush occurs when the corticosteroid inhalers that depress the immune system in the lungs to control your asthma have the same effect on the surface of the throat — with a typical inhaler, most of the drug winds up on your throat on its way to your lungs, explains Russell B. Leftwich, MD, a physician specializing in allergy and immunology in Nashville, Tenn., and a spokesperson for the American Academy of Allergy Asthma and Immunology.

So while the inhaled steroids do not get into the bloodstream the way oral medications do, says Dr. Leftwich, they can have a very powerful one on the surface of the mouth and throat, making thrush common in people who use inhaled steroids to treat asthma symptoms.

The Facts on Thrush

A type of yeast called Candida causes thrush, or oral candidiasis. “All of us have [Candida] normally in our bodies, but it’s kept in check by our immune system so that we don’t know we have it,” says Leftwich. “Babies commonly get it because their immune systems are notfully developed.”

The most obvious sign of thrush are the spotty white blotches it creates on the tongue and throat.

“Usually, there are no symptoms,” says Leftwich, who often spots it on patients’ throats before they’re even aware that they have it.

Thrush Prevention Tips

Simple steps can help you avoid this nuisance infection. To prevent thrush, rinse out your mouth and gargle with water after using an inhaler, says Leftwich.

You can also reduce your risk of developing thrush by using a spacer with your inhaled steroids. “A spacer is a chamber — a tube — that spreads out the medication and slows it down,” explains Leftwich. By spraying the medication in one end of the tube and putting your nose and mouth over the other, you’re able to inhale slowly and draw the medication into your lungs.

“Everyone should use a spacer, regardless of whether they have thrush,” says Leftwich. Though spacers can cost between $20 and $40 and are usually not covered by health insurance, they are well worth it. “You get more medicine in your lungs, less in the mouth and throat, which can cause thrush, and the medicine lasts longer, which means you get more for your money,” he adds.

Bring up using a spacer with your physician, suggests Leftwich. “A lot of family doctors don’t know about spacers,” says Leftwich. “You need a prescription to get one.”

When Thrush Treatment Is Needed

Thrush usually goes away on its own. If it’s persistent, your doctor may prescribe an antifungal medication such as nystatin.

“These anti-microbials kill the yeast and almost always clear up the thrush,” says Leftwich. If not, your doctor will need to investigate further. “There are some situations where thrush may be a sign of other health problems such as diabetes or an immune system disease,” Leftwich points out. And those are conditions you’ll want to address as soon as possible.

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