Hoarseness (dysphonia) is a frequent side effect experienced by people who use inhalers, particularly those containing inhaled corticosteroids (ICS). This voice change can range from a mild, temporary roughness to a significant alteration in pitch and quality. Although it is a common concern, it is often manageable with simple adjustments. Understanding the cause and taking preventative steps can significantly reduce the likelihood of this side effect.
Why Inhalers Affect the Voice
The primary cause of voice changes from inhaler use is the localized effect of the medication on the vocal cords (larynx). Inhaled Corticosteroids (ICS), which are used daily for the long-term control of conditions like asthma, are the main culprits in causing this dysphonia. When the medication is inhaled, some of the aerosolized or powdered drug inevitably deposits in the back of the throat and on the vocal cords instead of reaching the lungs.
This local deposition can lead to two main issues: irritation and muscle weakness. The corticosteroids can cause mild irritation or inflammation of the vocal cord lining, which is a form of laryngitis. The medication can also induce a localized muscle weakness (myopathy) in the tiny adductor muscles of the vocal cords. This myopathy prevents the vocal cords from coming together properly, leading to a breathy, hoarse, or croaking voice.
Poor inhaler technique is a significant factor that increases the amount of medication deposited in the throat, exacerbating the problem. If the inhalation is not performed correctly—such as breathing in too quickly for a metered-dose inhaler (MDI) or not forcefully enough for a dry-powder inhaler (DPI)—more of the active drug settles in the upper airway. This residue left behind on the vocal cords has the potential to cause irritation and change the voice.
Steps to Prevent Vocal Side Effects
Preventing hoarseness relies heavily on minimizing medication contact with the vocal cords and the back of the throat. The most effective strategy involves rinsing the mouth and gargling with water immediately after every use of a corticosteroid inhaler. Swish the water around the mouth and then gargle for several seconds, ensuring the residual medication is cleared before spitting the water out. This simple action washes away the majority of drug particles that could cause irritation or muscle effects.
Using a spacer device with a metered-dose inhaler (MDI) can dramatically reduce local deposition. A spacer is a tube that attaches to the inhaler and holds the medicine in a chamber, allowing the user to inhale the aerosol slowly and deeply. This creates a finer mist and reduces the velocity of the medication, which helps a higher proportion of the drug bypass the throat and reach the lungs. Since the medication is delivered more efficiently, less of it remains to cause a side effect like dysphonia.
Proper technique is essential for every type of inhaler, whether you are using a spacer or not. For MDIs, the technique requires a slow, deep breath, followed by holding the breath for up to ten seconds to allow the drug to settle in the lungs. In contrast, dry-powder inhalers (DPIs) require a strong, powerful, and deep breath to effectively draw the powder into the lungs. Patients should regularly review their technique with a healthcare professional to ensure maximum benefit and minimal local side effects.
When Hoarseness Becomes a Medical Concern
Inhaler-induced hoarseness is generally considered a temporary and reversible side effect that often improves once preventative measures are in place. If the voice changes are mild, implementing the correct rinsing and technique steps should lead to improvement within a few days or weeks.
You should consult a doctor if the hoarseness becomes severe or persists for an extended period despite consistently using proper technique and rinsing. Seeking medical advice is also necessary if the dysphonia is accompanied by concerning symptoms such as difficulty swallowing, significant throat pain, or bleeding.
Another sign of complication is the development of white patches in the mouth or throat, which can signal a fungal infection called oral candidiasis (thrush)—a known side effect of inhaled corticosteroids. Never stop using the prescribed inhaler without first speaking to your healthcare provider, as this could worsen the underlying respiratory condition.