Can asthma inhalers cause a sore throat?

Yes, some asthma inhalers can cause a sore throat, irritation and hoarseness due to the active ingredient, like a corticosteroid, depositing on the back of your throat. Using a spacer device, rinsing your mouth with water after your dose and improving your inhaler technique can help reduce the chance for a sore throat.

Not everyone who uses an asthma inhaler will get a sore throat. Factors such as the type of inhaler device and medicine, the frequency of use and user technique can all affect the incidence of a sore throat. Inhaled corticosteroids are more likely to cause these side effects.

Related : View a list of common asthma inhalers

Why do asthma inhalers cause a sore throat?

Asthma inhalers may cause a sore throat due to:

• Local irritation or drying effect from the medicine depositing in the back of the throat.
• Poor inhaler technique (may improve with use of a spacer device).
• A fungal infection (oral thrush) in the mouth and throat due to immunosuppressive effects when using corticosteroid inhalers.
• Corticosteroids leading to structural changes in the vocal folds causing voice changes like hoarseness.
• Frequent use or high doses may increase the risk of a sore throat.

FDA package inserts for many asthma inhalers list "sore throat" or "throat irritation" as a possible side effect. Active ingredients found in asthma inhalers, like corticosteroids or beta₂ agonists, can cause throat irritation or mouth dryness. Using combination inhalers with more than one medicine might worsen the side effect.

Other reasons you may have a sore throat from using an asthma inhaler include a poor inhaler technique. Use of a spacer device, when possible, may help with inhaler technique and get more medicine to your lungs. Review your inhaler technique with your healthcare provider and discuss the possible use of spacers.

Oral thrush (oral candidiasis) is a fungal infection that causes white plaques in your mouth. This can occur due to corticosteroid inhaler use, and lead to throat soreness or irritation. Always rinse your mouth with water (without swallowing) after use of a corticosteroid inhaler to help prevent this side effect.

Beta₂ Agonist Bronchodilators

Bronchodilators like beta₂ receptor agonists are used in asthma to dilate the airways and relax the muscles surrounding the airways to improve airflow and lessen symptoms, like tightening of the airways, wheezing, cough, and shortness of breath.

• Short-acting beta₂ agonist (SABA) agents (for example: albuterol, levalbuterol ) are used as needed to help control flare-up symptoms or for exercise-induced bronchoconstriction (formerly called exercise-induced asthma). SABAs are not used for long-term, maintenance treatment of asthma.
• Airsupra is a newer combination asthma rescue inhaler that combines the SABA albuterol and the corticosteroid budesonide. Current albuterol rescue inhalers work to alleviate acute asthma symptoms, but do not treat the underlying inflammation, leaving patients at risk of further exacerbations. Airsupra is an asthma rescue inhaler and is not used for maintenance (long-term) treatment.
• Long-acting beta₂ agonist (LABA) agents like formoterol or salmeterol may be used as add-on therapy in people whose asthma is poorly controlled only by inhaled corticosteroids. LABAs, when used alone, increase the risk of serious asthma-related events, including asthma-related death and should always be used with a corticosteroid.

Corticosteroids

Inhaled corticosteroids are commonly used to help to prevent flare-ups and improve lung function in people with asthma.

• Inhaled corticosteroids include medicines like beclomethasone, budensonide, ciclesonide, fluticasone or mometasone and are the backbone of asthma treatment.
• Inhaled corticosteroids act directly in the lungs to slow down inflammation that can lead to asthma symptoms. They are often used in combination with long-acting beta₂ agonists (LABAs) for long-term asthma maintenance treatment.

How can I prevent a sore throat from my inhaler?

Rinse after your inhalation

To help avoid a sore throat, rinse your mouth and gargle with water (without swallowing) after using an inhaler, especially for any product that contains a corticosteroid. Corticosteroids like fluticasone or ciclesonide are more likely to be associated with a sore throat than beta-agonists like albuterol, but both classes have been shown to cause irritation.

Also be sure you are practicing good oral hygiene, such as brushing with a fluoride toothpaste twice a day and flossing regularly. Brushing after your inhalation may help to lessen the chances for a sore throat or oral thrush.

Inhalation technique

Also review your asthma inhaler technique with your healthcare provider to be sure you are using it correctly. The use of a spacer device with a metered dose inhaler (MDI) can decrease the amount of drug deposited in your throat which can help to lower side effects.

A spacer is a tube that attaches to the mouthpiece of your MDI. Spacers have a chamber that receives the aerosol before it is inhaled. This helps to eases the inhalation technique that can be hard for some people to master.

Using a spacer with your inhaler will also help more of the medicine to reach your lungs and improve your breathing symptoms. This may be especially helpful for children, although one study found a higher rate of voice changes with use of spacer devices in children.

Rescue (fast-acting) inhalers like albuterol, and some long-term controller medications can be used with a spacer. Spacers are not used with dry powder inhalers (DPIs), like the Diskus or Flexhaler devices.

Learn more: How do I use a spacer device?

Frequency of use

If you use your inhaler two times per day (or more often), ask your doctor if there is a product you could use with only requires once per day dosing. Studies have shown more frequent dosing with an inhaler can worsen throat symptoms. Do not stop your medicine or change your dosing schedule without first talking to your doctor.

Oral thrush

Oral thrush (oral candidiasis) is a fungal infection that occurs in your mouth due to an overgrowth of a yeast called Candida. Oral thrush can occur with use of inhaled corticosteroids like fluticasone or ciclesonide that deposit on the back of throat. Rinsing your mouth with water (without swallowing) after inhaling your corticosteroid asthma medicine can help to lower the risk of this fungal infection.

Candidiasis of the mouth or throat is diagnosed by a doctor during an examination or by testing a sample from the infected area.

Oral thrush symptoms include:

• White patches found on the tongue, inner cheeks, throat and roof of the mouth
• Mouth or throat inflammation, redness and soreness
• Dry mouth or cottony feeling
• Loss of taste or abnormal taste
• Swallowing trouble
• Skin breaks or redness at the corners of the mouth

Treatments will vary but often include local antifungal medicines (oral gel, lozenge, suspension or mouthwash) used inside the mouth for 7 to 14 days. Types of antifungals used include clotrimazole , miconazole (Oravig) or nystatin. In more serious cases, an oral or injected antifungal medicine may be needed.

If you notice white spots, or continue to have a sore throat, irritation or other side effects due to your inhaler, speak with your healthcare provider right away.

Related questions

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• What does Symbicort do to the lungs?
• Symbicort vs. Advair: How do they compare?

List of Common Asthma Inhalers

There are many effective long-term medications available to manage asthma and improve your breathing and quality of life. Some asthma medicines, like corticosteroids, may be more likely to cause a sore throat.

Quick-relief asthma medications

Short-acting beta₂ agonist (SABA) bronchodilators, also called fast-acting or rescue inhalers, are used in asthma to open the airways quickly to ease attacks and worsening symptoms. Rescue inhalers work by quickly widening the breathing passages and relaxing airway muscles.

• ProAir HFA , ProAir RespiClick , Proventil HFA, Ventolin HFA (albuterol)
• Xopenex , Xopenex HFA (levoalbuterol)
• AirSupra (albuterol and budesonide)

These are used on an as-needed basis as rescue inhalers to control sudden breathing symptoms in asthma, as well as for prevention of exercise-induced bronchospasm. Asthma patients should always have access to a rescue inhaler for sudden breathing problems.

In some countries outside the US, albuterol is known by the generic name salbutamol.

Long-term control asthma medications

There are many options and drug classes used for long-term control of asthma. These medicines are used on a regular basis to help control asthma symptoms and lessen the need for rescue inhalers.

Some can be used alone in asthma, like corticosteroids, but others are used in combination. These product are NOT used as rescue inhalers for sudden breathing problems

Inhaled corticosteroids reduce swelling and tightness in the airways and are used on a regular basis to prevent asthma attacks.

• Alvesco (ciclesonide)
• Asmanex HFA, Asmanex Twisthaler (mometasone)
• Arnuity Ellipta, Flovent, Flovent Diskus, Flovent HFA (fluticasone)
• Pulmicort Flexhaler, Pulmicort Respules (budesonide)
• QVar Redihaler (beclomethasone)

Long-acting beta₂-agonist (LABA) bronchodilators can be used in addition to inhaled corticosteroids in patients whose asthma is poorly controlled by inhaled corticosteroids alone.

LABAs help the muscles around the airways to stay relaxed to prevent symptoms like wheezing, coughing, chest tightness, and shortness of breath and help to open the airways for 12 hours or longer. In asthma, they act as bronchodilators to prevent asthma attacks or exercise-induced bronchoconstriction.

LABAs are always combined with an inhaled corticosteroid in asthma treatment. LABAs, when used alone, increase the risk of serious asthma-related events, including asthma-related death.

• Serevent Diskus (salmeterol)
• Perforomist, Foradil (formoterol)

Long-acting muscarinic antagonists (LAMAs), also called anticholinergic bronchodilator inhalers can be used in addition to corticosteroids to help relax the airway muscles and improving the ability to breath. They are used in asthma, but are more frequently used in chronic obstructive pulmonary disease (COPD).

• Atrovent, Atrovent HFA (ipratropium)
• Spiriva, Spiriva Respimat (tiotropium)

Ipratropium (Atrovent HFA) is a short-acting anticholinergic bronchodilator, but it works differently than albuterol and is NOT used as a rescue inhaler.

Tiotropium (Spiriva) is a long-acting anticholinergic bronchodilator that helps to control airway inflammation asthma.

These products are NOT used as rescue inhalers for sudden breathing problems. Use a short-acting beta₂ agonist like an albuterol inhaler or Airsupra for breathing emergencies.

Combination asthma inhalers for maintenance

Combination inhalers for asthma usually contain a corticosteroid and a beta₂ agonist bronchodilator. Some products, like Trelegy Ellipta, may also contain an anticholinergic bronchodilator.

• Advair Diskus, Advair HFA, AirDuo RespiClick, Wixela Inhub (fluticasone and salmeterol)
• Breo Ellipta (fluticasone and vilanterol)
• Dulera (formoterol and mometasone )
• Symbicort (budesonide and formoterol)
• Trelegy Ellipta (fluticasone, umeclidinium, and vilanterol)

The corticosteroid works in asthma by preventing the release of substances in the body that cause inflammation. Anticholinergics and long-acting bronchodilators work by relaxing muscles in the airways to improve breathing. These agents are not used as a rescue inhaler for an asthma attack or bronchospasm attack.

Note: This is not a complete list of all asthma inhalers or medications. In addition, this is not all the information you need to know about asthma, asthma inhalers or other treatments for safe and effective use and does not take the place of your doctor's directions.

Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.