Is mouth rinse necessary after using a metered-dose inhaler (MDI)?

Mouth Rinse After Using a Metered-Dose Inhaler (MDI)

Yes, mouth rinsing is necessary after using a metered-dose inhaler (MDI), especially when using inhaled corticosteroids (ICS), to reduce the risk of local side effects such as oral thrush and hoarseness.

Why Mouth Rinsing is Important

Mouth rinsing after using an MDI serves several important purposes:

1. Prevention of local adverse effects:

   • Reduces risk of oropharyngeal candidiasis (oral thrush) 1
   • Decreases incidence of hoarseness 2
   • Minimizes sore throat and other local side effects 3

2. Reduction of systemic absorption:

   • Decreases the amount of medication that may be swallowed and absorbed systemically 4
   • May reduce potential systemic side effects of inhaled corticosteroids 4

Optimal Mouth Rinsing Technique

The most effective mouth rinsing technique includes:

• Timing: Rinse immediately after inhalation - effectiveness decreases significantly with delays 5

  • A delay of just 1 minute can reduce drug removal by 51-65% 5
  • After 10 minutes, only 5.6-7.7% of the drug can be removed 5

• Method: Use a combination of gargling and rinsing 5

  • Gargle AND rinse (rather than just one method) removes more medication residue 5
  • Repeat the process at least twice 6

• Duration: Even brief rinsing (2-3 seconds each of gargling and rinsing) is effective 5

Special Considerations

For Different Inhaler Types

• MDIs with spacers/VHCs: Still require mouth rinsing, though spacers already reduce oropharyngeal deposition 1
• Dry powder inhalers: Mouth rinsing is equally important 4, 2

For Different Patient Groups

• Patients using inhaled corticosteroids: Particularly important to rinse to prevent local side effects 1, 7
• Elderly patients: May need additional consideration for proper technique 1

Common Pitfalls and Solutions

1. Poor patient adherence: Nearly one-third of patients report suboptimal mouth rinsing technique 3

   • Solution: Healthcare professionals should provide clear instructions about proper technique and rationale 3

2. Delayed rinsing: Waiting too long after inhalation significantly reduces effectiveness 5

   • Solution: Emphasize immediate rinsing after inhalation

3. Inadequate technique: Many patients only perform partial rinsing 6

   • Solution: Teach combined gargling and rinsing, repeated at least twice

Implementation in Practice

1. Immediately after using the MDI:

   • Gargle with water for 2-5 seconds
   • Rinse mouth with water for 2-5 seconds
   • Repeat at least once more
   • Spit out the water (do not swallow) 4

2. For patients using multiple inhalers:

   • Always use bronchodilators first
   • Use corticosteroid inhalers last
   • Rinse mouth after completing all inhalations

By following these guidelines, patients can significantly reduce their risk of developing local side effects while using metered-dose inhalers, particularly those containing corticosteroids.