An inhaler delivers medication directly to the lungs, making it an effective and targeted treatment for various respiratory conditions. However, the path the medicine takes means a portion of the dose inevitably settles in the mouth and throat rather than reaching the airways. For specific types of inhalers, particularly those containing long-term control medication, rinsing the mouth immediately after use is a necessary instruction. This simple aftercare step prevents potential localized side effects that can compromise oral health and the effectiveness of the treatment plan.
Why Corticosteroids Need Removal
The primary reason for post-inhaler rinsing concerns inhaled corticosteroids (ICS), which are preventative medications used to manage chronic inflammation in the airways. These drugs reduce swelling and mucus production within the lungs. Despite optimal inhaler technique, a significant amount of the drug, sometimes up to 80% of the dose, can deposit on the surfaces of the mouth and the back of the throat (the oropharynx).
This residual medication becomes problematic when it lingers in the upper respiratory tract. Corticosteroids work by suppressing local immune responses. When this immune suppression occurs in the mouth, it disrupts the natural microbial balance that keeps oral pathogens in check. The instruction to rinse is about clearing the inert or misplaced particles before they can cause localized adverse reactions.
Specific Oral Side Effects of Inhaler Use
The most common consequence of failing to remove residual inhaled corticosteroids is oropharyngeal candidiasis, often referred to as oral thrush. This fungal infection is caused by an overgrowth of Candida albicans, a yeast naturally present in the mouth. The immunosuppressive effect of the steroid residue allows the fungus to multiply rapidly, leading to characteristic white or yellowish patches on the tongue, cheeks, or roof of the mouth.
Clinical data shows that using inhaled corticosteroids increases the risk of this fungal infection compared to a placebo. In addition to thrush, the presence of medication residue can lead to irritation of the vocal cords and surrounding tissues. This localized irritation frequently causes dysphonia (hoarseness or a change in voice quality). Users may also experience throat irritation or pharyngitis, manifesting as a persistent sore or dry throat. Studies indicate that the risk of oral candidiasis and dysphonia can be five times greater when using certain inhaler types without rinsing afterward.
Step-by-Step Rinsing and Aftercare
The correct aftercare procedure is quick and simple, but it must be performed immediately after using the corticosteroid inhaler to be effective. The goal is to maximize the removal of the medication particles from both the mouth and the throat. Begin by taking a mouthful of plain water, approximately one to two tablespoons, immediately after the final puff of the dose.
The procedure involves two distinct actions: first, vigorously swish the water around the entire mouth, making sure to reach under the tongue and along the gums. Second, take a moment to gargle the water at the back of the throat, as this area is a common site of medication deposition and subsequent irritation. Gargling helps to dislodge particles that have settled near the vocal cords and pharynx.
After both swishing and gargling, it is essential to spit the water out; the water should never be swallowed. Swallowing the rinse water defeats the purpose by allowing the residual steroid particles to be absorbed through the digestive tract, potentially leading to unwanted systemic exposure. Research shows that delaying the rinse by even a single minute can reduce the effectiveness of drug removal by more than half.