How to treat and prevent oral thrush when using an inhaler

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Inhaled corticosteroids reduce inflammation in the airways and suppress the immune response.

While this is beneficial for managing respiratory symptoms, it can also weaken the immune system in the throat and mouth.

Typically, the mouth contains a balance of different microorganisms, including bacteria and yeast. With a weakened immune system, there can be disruptions in this balance, allowing the Candida fungus to overgrow.

Learn more about oral thrush.

Antifungal medications are the primary treatment for oral thrush.

A healthcare professional can prescribe these medications, which work to eliminate the Candida fungus responsible for the infection.

It is important that people always follow their treatment regimen for the entire duration a doctor prescribes, even if symptoms improve before completing the course. Stopping treatment prematurely can allow the infection to return.

Mild infections

For mild infections, a doctor may prescribe the following antifungal medications:

• clotrimazole
• nystatin
• miconazole

A person will apply these to the inside of the mouth daily for 7–14 days.

Severe infections

For more severe infections, a doctor will usually prescribe fluconazole as a tablet or through a vein.

With long-term inhaler use

For people who use corticosteroid inhalers long-term, doctors may recommend periodic check-ups to monitor oral health and adjust the treatment plan if needed.

Home remedies

Some people find that probiotics can help restore the balance of beneficial bacteria in the mouth and reduce the risk of thrush.

People may consume probiotic-rich foods, such as yogurt, or consider taking probiotic supplements. However, it is best for people to consult a healthcare professional before starting any new supplements.

To help prevent oral thrush, a person can try the following:

• Rinsing: After using an inhaler, a person can rinse their mouth thoroughly with water or brush their teeth to help remove any medication residue that might promote oral thrush.
• Using spacer devices: For people using a corticosteroid inhaler, using a spacer device can help reduce the amount of medication that settles in the mouth and throat. This can minimize the risk of thrush.
• Avoiding smoking and alcohol: It is best for people who smoke or consume alcohol to try to stop or reduce their intake, as these substances can exacerbate oral thrush.

Oral thrush can produce a variety of symptoms in the mouth and throat.

White patches

The most common sign of oral thrush is the appearance of white patches in the following areas:

• the tongue
• the roof of the mouth
• the inner cheeks

These may sometimes also appear on the:

• gums
• tonsils
• back of the throat

These patches may look “curd-like,” similar to cottage cheese. They may scrape off easily, revealing red or bleeding tissue underneath.

Other symptoms

Other common signs and symptoms of oral thrush include:

• Pain: People may experience pain or discomfort in the mouth, particularly when eating, drinking, or swallowing. Some individuals may experience a burning sensation.
• Redness: The affected areas can appear red and inflamed.
• Loss of taste: Some people may notice changes in their sense of taste or lose this sense temporarily.
• Cracking and splitting: In severe cases, the corners of the mouth may become cracked and painful.

The outlook for people with inhaler-related oral thrush is generally good with appropriate treatment and preventive measures.

To maintain oral health and prevent recurrences, it is important that people:

• follow the guidance of a healthcare professional
• practice good oral hygiene
• reduce risk factors associated with thrush

It is best for people who experience recurrent oral thrush associated with inhalers to discuss this with a doctor, preferably the one who prescribed the inhalers.

A healthcare professional may recommend switching to a different type of inhaler or inhaler device. Some inhalers have a lower risk of causing oral thrush compared with others.

Doctors can help select an inhaler less likely to contribute to thrush that will still effectively manage the underlying respiratory condition.

Some other potential causes or risk factors for oral thrush include:

• Age: Infants and older adults are more susceptible to oral thrush.
• Antibiotics: Antibiotics can disrupt the balance of microorganisms in the mouth, including beneficial bacteria that help keep Candida in check.
• Dentures: Ill-fitting or improperly cleaned dentures can create an environment where Candida can thrive. Denture-related stomatitis is an oral thrush that affects the tissues beneath dentures.
• Diabetes: High blood sugar levels associated with unmanaged diabetes can promote the growth of Candida.
• Dry mouth: Conditions or medications that cause dry mouth can reduce saliva production. Saliva usually helps control the growth of Candida in the mouth.
• Hormonal changes: Hormonal fluctuations, such as those that occur during menopause or pregnancy, can affect the balance of microorganisms in the mouth.
• Difficulties with oral hygiene: A lack of oral hygiene, including infrequent brushing, infrequent flossing, or not cleaning the tongue, can cause an accumulation of yeast and bacteria in the mouth.
• A weakened immune system: Having a compromised immune system can reduce the body’s ability to control the growth of Candida.

Inhaled corticosteroids to treat asthma can increase the risk of developing oral thrush. This can result in creamy-white patches and redness in the mouth, pain, and a loss of taste.

Treatment typically involves antifungal medications that a person applies directly in the mouth. To help prevent oral thrush, it is best for a person to rinse their mouth with water or brush their teeth after using an inhaler.

If someone uses corticosteroid inhalers long-term, a doctor may recommend regular check-ups to monitor their oral health. This can help catch and address any signs of thrush early.