Hoarseness is a common experience for many individuals who rely on inhaled steroids to manage respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD). While inhaled steroids are highly effective in controlling inflammation and improving breathing, this voice change can be a side effect. This article aims to provide practical strategies to help prevent hoarseness associated with the use of these necessary medications.
Why Inhaled Steroids Cause Hoarseness
Inhaled steroids can lead to hoarseness when medication particles deposit in the mouth and throat, including on the vocal cords. This local deposition can cause direct irritation or inflammation of the vocal cords, altering their ability to vibrate properly and produce clear sound.
Another contributing factor is oral thrush, a fungal infection caused by an overgrowth of Candida yeast. Steroids can suppress the local immune response in the mouth and throat, creating an environment where this fungus can thrive. Oral thrush can manifest as white patches and cause discomfort, impacting voice quality. Less commonly, inhaled steroids might also induce a myopathy, or weakness, in the vocal cord muscles, leading to changes in voice.
Practical Prevention Methods
Rinsing the mouth and gargling with water immediately after each use of the inhaler helps to wash away any residual medication from the throat and vocal cords, minimizing direct irritation and reducing the risk of fungal growth. It is important to spit out the water after rinsing, rather than swallowing it.
Using a spacer device with metered-dose inhalers (MDIs) can also improve medication delivery to the lungs and decrease deposition in the throat. A spacer is a chamber that attaches to the inhaler, holding the medicine so it can be inhaled more slowly and effectively. This allows more of the medication to reach the airways where it is needed, rather than settling on the vocal cords.
Proper inhaler technique is important for ensuring the medication reaches the lungs and not the throat. For MDIs, this typically involves a slow and deep inhalation as the medication is discharged, followed by holding the breath for about 10 seconds. For dry powder inhalers (DPIs), a strong and deep breath is usually required to effectively draw the powder into the lungs. Regularly reviewing and practicing the correct technique with a healthcare professional is beneficial.
Maintaining good oral hygiene is also important. Brushing teeth and flossing regularly helps to keep the mouth clean and can reduce the risk of oral infections like thrush. Staying hydrated by drinking plenty of water throughout the day can also help keep the throat and vocal cords moist, easing irritation.
While dose adjustments or changes in the timing of doses might be considered, these decisions should only be made in consultation with a doctor. A healthcare provider can assess whether a lower effective dose or a different inhaler type might be suitable without compromising respiratory control. They can also discuss whether rotating different inhalers could be beneficial in some cases.
When to Consult a Doctor
While hoarseness from inhaled steroids is often a manageable side effect, there are instances when medical consultation becomes important. If hoarseness persists despite consistent use of prevention methods, or if it worsens, a doctor should be consulted. This is especially true if the hoarseness is accompanied by other concerning symptoms, such as pain, difficulty swallowing, or a persistent cough.
A medical professional can rule out other potential causes of voice changes, which might include infections, vocal cord nodules, or other conditions. They can also evaluate for signs of oral thrush, which may require specific antifungal treatment. This information is not a substitute for professional medical advice; always discuss medication changes or concerns about side effects with a healthcare provider.