From the Guidelines
Rinsing your mouth with water after using corticosteroid inhalers is a crucial step in preventing local side effects, such as oral thrush, hoarseness, and sore throat, as recommended by the most recent and highest quality study 1. To minimize the risk of these side effects, it is essential to rinse your mouth thoroughly with water after each use of corticosteroid inhalers, such as fluticasone (Flovent), budesonide (Pulmicort), beclomethasone (QVAR), or mometasone (Asmanex), and then spit out the water without swallowing it. Some healthcare providers also suggest brushing your teeth afterward. The importance of rinsing your mouth after using corticosteroid inhalers is highlighted in several studies, including one published in the Journal of Allergy and Clinical Immunology 1, which emphasizes the need to reduce local side effects, such as oral thrush (candidiasis), cough, and dysphonia. Using a spacer device with your metered-dose inhaler can also help reduce medication deposition in your mouth and throat, further decreasing the risk of these side effects while improving medication delivery to your lungs, as noted in another study 1. Key points to consider:
- Rinse your mouth with water after each use of corticosteroid inhalers
- Spit out the water without swallowing it
- Brush your teeth afterward, if recommended by your healthcare provider
- Use a spacer device with your metered-dose inhaler to reduce medication deposition in your mouth and throat By following these steps, you can minimize the risk of local side effects associated with corticosteroid inhalers and ensure the safe and effective management of your asthma or chronic obstructive pulmonary disease (COPD) symptoms.
From the FDA Drug Label
If oropharyngeal candidiasis develops, it should be treated with appropriate local or systemic (i. e. oral) antifungal therapy while still continuing therapy with budesonide inhalation suspension, but at times therapy with budesonide inhalation suspension may need to be temporarily interrupted under close medical supervision. Rinsing the mouth after inhalation is advised [see Warnings and Precautions (5.1)] . Patients should rinse the mouth after inhalation of budesonide inhalation suspension.
Rinsing the mouth after inhalation of Corticosteroid Inhalers is advised to prevent oropharyngeal candidiasis. This is a recommended practice when using budesonide inhalation suspension, as stated in the drug label 2 and 2. The same advice is also given in 2.
From the Research
Importance of Rinsing Mouth after Corticosteroid Inhalers
- Rinsing the mouth after using corticosteroid inhalers is effective in preventing local adverse effects such as hoarseness and oropharyngeal candidiasis 3.
- A study found that immediate gargling and rinsing after inhalation is most useful for the removal of drugs following inhalation of corticosteroids 3.
- The amount of drugs removed by mouth washing is significantly associated with the time lag between inhalation and mouth washing 3.
Implementation of Mouth Rinsing
- A study found that almost one-third of patients reported a suboptimal mouth rinsing procedure after using an inhaled corticosteroid 4.
- Receiving advice on mouth rinsing from a healthcare professional increased the likelihood of correct implementation and improved patient understanding of the rationale 4.
- Patients were more likely to report their rinsing procedure had a positive impact if they had experienced oral candidiasis or sore mouth/throat 4.
Risk of Oral Candidiasis
- Inhaled corticosteroids increase the risk of oral candidiasis, with the relative risk being highest in the first 3 months after therapy initiation 5.
- A study found that the amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not 6.
- The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone 6.