Oral Thrush and COPD

Symptoms, Prevention, and Treatment

Chronic Obstructive Pulmonary Disease (COPD) is a condition that affects millions of people worldwide, making it difficult to breathe and manage many everyday activities. Alongside the more well-known symptoms of COPD, many individuals with the condition experience a decreased appetite and report that food tastes different. This change in taste is often due to a familiar but lesser-known issue: oral thrush.

Lesley Williams, a Registered Respiratory Therapist at Apria with 35 years of experience, states, “Effectively managing COPD requires more than just treating the lungs; it involves understanding and mitigating side effects like oral thrush, which can arise from essential inhaler use. By taking proactive steps and working closely with healthcare providers, patients can maintain both their respiratory and oral health, ensuring comprehensive well-being.”

What is Oral Thrush?

Oral thrush is a fungal infection caused by the overgrowth of Candida, a type of yeast that naturally exists in small amounts in the mouth. In healthy individuals, the body's immune system keeps Candida under control. However, when the balance is disrupted, Candida can multiply, leading to a condition known as thrush. This infection leaves a white, sometimes creamy, film in the mouth and can significantly impact food taste, often leaving a persistent bad taste.

For most people, oral thrush is a temporary issue that resolves quickly with proper treatment. However, for those with COPD, the situation can be more complicated due to a weakened immune system, making it harder to fight off infections like thrush.

Signs of Oral Thrush

Oral thrush can present with several noticeable symptoms, including:

White patches on the tongue, inner cheeks, roof of the mouth, and throat
Redness or soreness in the mouth
Difficulty swallowing
A cottony feeling in the mouth
Loss of taste or a bad taste in the mouth

If you notice any of these symptoms, particularly if you have COPD, it’s essential to take them seriously and seek medical advice.

The Link Between Inhalers, Medications, and Thrush

Inhalers, especially those containing corticosteroids, are a cornerstone of COPD treatment. These medications help reduce inflammation in the lungs, making it easier to breathe. However, corticosteroids also weaken the immune system. When you use an inhaler, some of the medication can linger in your mouth and throat, creating an environment where Candida can thrive.

This increased risk of oral thrush is a common side effect of corticosteroid inhalers. While the medication is crucial for managing COPD, it's important to be aware of this potential side effect and take steps to minimize the risk.

How to Prevent Oral Thrush if You Have COPD

Fortunately, there are several strategies you can employ to reduce the likelihood of developing oral thrush while managing COPD:

Rinse Your Mouth After Using Your Inhaler: Rinse your mouth thoroughly with water and spit it out after each use. You can also use a mixture of water and hydrogen peroxide or a non-alcohol-based mouthwash. Avoid using mouthwashes that contain alcohol, such as Listerine, as they can irritate the mouth and potentially exacerbate the problem.
Use a Spacer with Your Inhaler: Ask your doctor about adding a spacer to your inhaler. A spacer is a device attached to the mouthpiece of your inhaler that creates a space between your mouth and the medicine. This helps break the medicine into smaller droplets, allowing more of it to reach your lungs and reducing the amount in your mouth.
Consider Non-Steroid Medications: Discuss with your doctor the possibility of using non-steroid medications or minimizing the dosage of corticosteroids if possible. Your doctor can help determine the best course of action to manage your COPD while reducing the risk of oral thrush.

What to Do if You Are Experiencing Thrush

If you suspect that you have developed oral thrush, it’s essential to contact your doctor promptly. Since COPD weakens your immune system, thrush can become more challenging to treat if not addressed early. Typically, your doctor will prescribe antifungal medication to clear the infection. Early intervention is critical, so don’t hesitate to seek medical help if you notice symptoms of thrush.

Managing COPD involves balancing the use of essential medications with potential side effects like oral thrush. By understanding the connection between your inhaler use and the risk of thrush, you can take proactive steps to prevent it. Always consult your healthcare provider for the best strategies to keep your COPD and oral health in check, ensuring that your treatment plan supports your overall well-being.

References
Batsiou, Maria, Richard Dekhuijzen, Leif Bjermer, Sinthia Nosnic-Anticevich, Henry Chrystyn, Alberto Papi, Roberto Rodríuez-Roisin, et al. “Incidence of Oral Thrush in Patients with COPD Prescribed Inhaled Corticosteroids: Effect of Drug, Dose, and Device.” PubMed, September 22, 2016.
Khijmatgar, Shahnawaz, Giridhar Belur, Rajesh Venkataram, Mohmed Isaqali Karobari, Anand Marya, Veena Shetty, Avidyuti Chowdhury, et al. “Oral Candidal Load and Oral Health Status in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Case-Cohort Study.” BioMed research international, September 11, 2021.
“Overview: Oral Thrush.” InformedHealth.org [Internet]., December 13, 2022.
“Thrush: What Is It and How to Get Rid of It.” Cleveland Clinic, May 1, 2024.

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