Don’t Forget This One Crucial Step if you are using a STEROID inhaler.

Many asthmatics use long-term steroid inhalers - either daily or as needed, but are unaware of how important it is to rinse and gargle after every dose. In this post, I’ll explain why this simple step matters and the risks of ignoring your doctor’s advice.

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Why you should ALWAYS rinse and gargle your mouth after using a steroid inhaler.

Steroid inhalers (like budesonide, fluticasone, beclomethasone) leave a thin layer of medicine in the mouth and throat and this steroid layer can be a medium for fungal growth.

If not rinsed, this can lead to:

• Oral thrush (fungal infection)

• Hoarseness / voice change

• Sore throat

• Cough or irritation

To prevent side effects like oral thrush and hoarseness, it is important to IMMEDIATELY rinse and gargle with water after using a steroid inhaler and spit out the water. 

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Step-by-Step Technique

1. Immediately after inhalation, take a sip of plain water into your mouth.

2. Swish the water vigorously around your mouth, making sure it reaches all areas, including under the tongue and around the cheeks.

3. Gargle the water in the back of your throat for a few seconds to clear any residue from the oropharynx.

4. Spit out the water. Do not swallow the rinse water.

5. Repeat the entire process at least one more time with a fresh sip of water to ensure maximum removal of medication residue. 

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MDI vs DPI vs Nebuliser - Which causes more throat problems?

1️⃣ MDI (Metered Dose Inhaler)

Since it uses a propellant, it pushes the steroid particles into the mouth at high speed. as a result of which, more drug gets deposited in the mouth & throat.

→ Higher risk of:

• Oral thrush

• Hoarseness / voice change

• Sore throat

⭐ Rinsing is VERY important

⭐ Using a spacer reduces mouth deposition by ~60–80% and makes inhalation smoother and safer.

Inhaler with a Spacer

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2️⃣ DPI (Dry Powder Inhaler)

(e.g., Rotacaps)

The inhale powdered medicine is directly taken inside with the breath - no propellant.

Thus, less deposition in the mouth compared to MDI

But still significant enough to cause fungal infections if not rinsed.

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3️⃣ Nebulisation

Delivery: Mist inhaled over 5–10 minutes

• Best lung penetration in patients who are sick, elderly, or breathless

• Does not require technique or effort

• Useful in acute exacerbations, children, elderly, severe asthma/COPD

Longest exposure time, so drug stays in mouth longer and can cause significant thrush.

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Throat Deposition & Thrush Risk (Highest → Lowest)

1. MDI without Spacer (worst)

2. Nebulisation

3. MDI with Spacer

4. DPI (best, but still needs rinsing)

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Good inhaler technique doesn’t end with the puff- it ends with a rinse.

Use your inhaler right, and let the medicine help your lungs - not harm your mouth.