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I keep getting thrush from my inhaled steroids. What can I do to prevent this?


Updated May 21, 2014

Inhaled Steroids
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Question: I keep getting thrush from my inhaled steroids. What can I do to prevent this?
Answer: The use of inhaled steroids for the treatment of asthma can sometimes increase the risk of developing thrush. Thrush, also called oral candidiasis, is caused by an overgrowth of yeast in the mouth due to a decrease in the infection-fighting ability of the immune system in the mouth as a result of using inhaled steroids. Thrush can normally be prevented with mouth rinsing and tooth brushing after the use of inhaled steroids, but some people still tend to get thrush despite following these measures.

For people with more severe asthma, higher dosages of inhaled steroids or the frequent use of oral steroids can also predispose to the development of thrush. Once thrush has developed, a person may need treatment with nystatin mouthwash or oral Diflucan (fluconazole). Some people require periodic rinsing (once daily to a few times per week) with nystatin in order to keep thrush from coming back.

The use of a spacer device with a steroid metered dose inhaler can be helpful in reducing or preventing thrush. This device acts to reduce the amount of medication delivered to the mouth, and helps more medication get to the lungs, where it’s needed most. Unfortunately, many new inhaled steroids utilize dry powder inhalers (such as Advair, Pulmicort and Asmanex) that don’t utilize a spacer.

Dry powder inhalers seem to especially predispose people to getting thrush. The powder from these inhalers doesn’t dissolve well in water, so some people find that rinsing their mouths and brushing their teeth doesn’t help to keep the thrush away. For these people, rinsing with an alcohol-based mouthwash, such as Listerine, may be more helpful in preventing thrush.

Want to learn more? Find out about the side effects of inhaled steroids.


Schleimer RP, Spahn JD, Covar R, Szefler SJ. Glucocorticoids. In: Adkinson NF, Yunginger JW, Busse WW, et al, eds. Middleton’s Allergy Principles and Practice. 6th edition. Philadelphia: Mosby Publishing; 2003:870-914.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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