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The standard treatment for asthma and COPD often involves inhaled corticosteroid drugs like beclomethasone (Qvar), budesonide (Pulmicort, Symbicort) and fluticasone (Advair, Flovent). One side effect that patients may not be warned about is hoarseness or laryngitis. We fear it is considered a minor complication of therapy. Ear, nose and throat specialists (otolaryngologists) recognize that it can be a serious problem for many patients. They even have a name for this condition. SIL, also known as Steroid Inhaler Laryngitis (JAMA Otolaryngology-Head & Neck Surgery, June, 2002) may be far more common than most other health professionals realize.
How Common is Steroid Inhaler Laryngitis (SIL)?
When you search the official prescribing information for an inhaled HFA drug like Advair (fluticasone plus salmeterol) you will discover that throat irritation is listed at around 7 to 9 percent. Hoarseness and dysphonia (difficulty speaking) is 1 to 3 percent. We suspect it is substantially higher.
That is not just our opinion. Here is a comment by Dr, John DelGaudio, an ENT-otolaryngologist in Atlanta, Georgia affiliated with Emory University Hospital:
“The Physicians’ Desk Reference reports the incidence of hoarseness for the various steroid inhaler preparations to range from 1% to 9%, compared with 0 to 3% for nonsteroid inhalers. Clinical studies show the incidence of hoarseness to be much higher, occurring in as many as 55% of patients who use steroid inhalers. Of the inhaled steroids, fluticasone has a greater topical potency and greater tissue retention and half-life. Clinical reports of the incidence of dysphonia with fluticasone are limited, and clinical studies report an incidence that ranges from only 2% to 6%…
“The physical changes that are seen in the larynx of patients using inhaled fluticasone range from minimal to severe. Mild physical findings include edema [swelling] and erythema [redness]. Moderate changes include mucosal thickening and vocal cord bowing. The most dramatic changes include leukoplakia [thickened white patches], granulation, and laryngeal candidiasis [yeast infection].”
What Is It Like to Have Steroid Inhaler Laryngitis?
Q. I work as a public address announcer, so my voice is essential for my job. My asthma inhaler, Advair, makes me so hoarse that it is a real problem. My doctor hasn’t offered anything helpful. Do you have any suggestions?
A. You are not the only person to develop hoarseness (laryngitis) as a side effect of an inhaled corticosteroid. Doctors sometimes tell their patients to gargle after using the inhaler. One reader didn’t get any relief with this tactic:
“Gargling isn’t going to reach the vocal chords. I am a singer and have had to lower the key of all my songs to match my ‘frog-like’ voice.”
Can Mylanta Ease Steroid Inhaler Laryngitis?
Another reader had this suggestion:
“I have COPD and use the same inhaled medication. Initially it made me hoarse. Then I was told by a throat specialist to take some Mylanta after using it. Boy does it help.”
We could find no studies documenting the value of swallowing liquid antacid to avoid laryngitis from a steroid inhaler. That said, it might be worth a try. Check with your doctor to make sure Mylanta won’t interact with any of your other medications.
Other Reports of Steroid Inhaler Laryngitis:
Visitors to this website do not think this is a minor side effect. Here are just a few comments from readers:
“Advair definitely causes hoarseness, and it’s so bad I sounded like I was 100 years old. It was really hard to talk at all. And no, my Doc didn’t seem to care one whit, so why should anyone else?
“Rinsing and gargling didn’t ever help. I have COPD. And no, my Doc doesn’t care about this either. I want to thank The Peoples Pharmacy for ‘outing’ Advair for its abominable side effect of hoarseness. It was hell the whole time I was on it.”
Another readers is caught between a rock and a hard place:
“I used Advair for several years before I started getting hoarse. It got so bad that people were constantly asking me to repeat myself and no one could understand me over the phone. I stopped using the Advair, and the hoarseness went away, but my breathing got worse.
“My doctor told me voice hoarseness from fluticasone is rare. It might be rare, but I have it, and it is a bummer. I sound like I am straining to talk all the time. In fact, I sound like I am 90 years old, but I am 53. Talking is uncomfortable, so I say less, which my wife probably likes.”
This singer came up with an alternative therapeutic approach thanks to a pulmonologist.
“I am a singer and an asthmatic with allergies. Everything this bleepin allergist gave me made me more hoarse with coughing. He switched every time I complained loudly.
“Finally, I went to a pulmonary doctor and told him I wanted nothing with steroids Lo, and behold…I started to get better with Spiriva and montelukast for the allergies. I am now singing everything from Santa Baby to I Dreamed a Dream and counting my blessings every day.”
What’s your Experience?
If you have used an inhaled corticosteroid, have you experienced steroid inhaler laryngitis? Has one been better or worse than another? Please share your story in the comment section below.
Carol
I had childhood asthma, outgrew it in my 20’s until I caught covid in 2023. Then it triggered the asthma to return. My pulmonologist put me on Advair. Although I rinse after, I eventually developed the hoarse, raspy, laryngitis voice – once I stopped using Advair it went away within 2 days. So now I try limiting my use of Advair: only take 1-2 times per week after my Albuterol MDI when my breathing gets heavy & rinse afterwards… so far so good. It seems to be helping me to manage my symptoms and avoid the laryngitis voice side effect.
Vin
I’m an RRT (Registered Respiratory Therapipst). My uncle was started on Pulmicort, and after a few days called me to say his voice was a mess. I asked him about rinsing and spitting, and he was. I suggested he rinse and spit, then gargle and spit, then drink something. My theory was that after rinsing and gargling if there was still steroid “crumbs” in an area of the larynx, drinking might take care of that. Whatever is left is ending up in your stomach anyway. Two days later his voice came back. Rinse, repeat and drink.
Amy
I’ve been taking Symbicort for three years. I missed serving on the worship team at church, so I joined the team at my new church even though I’d been diagnosed with asthma a year earlier. I thought it was just the asthma making it hard for me to sing as I used to and thought the practice would strengthen my vocals. Instead, it’s just gotten steadily worse, and I started getting a gravelly voice. It was only in my much lower register at first and has gradually worsened until I can only sing mezzo Soprano without any hoarseness.
I also teach Adult Sunday School, and speaking has gotten worse and worse, so that I’m constantly trying to clear the hoarseness to no avail. Drinking water helps sometimes, but in general, the more I speak, the worse it gets.
I started researching, and after awhile, I came across my likely culprit–the Symbicort. I’d been told to rinse my throat out after taking it, but no one told me to drink some water right after so the steroid doesn’t stay in my larynx.
I went to my doctor. She’s sending me to an ENT, but I can’t see him for almost a month, still. I’m needed on my worship team, as we’re in transition, and I’m the only one that knows our older songs and arrangements.
Thankfully, the ENT specializes in helping vocalists.
Ann
Went to hospital with pneumonia. I am an asthmatic. Respiratory specialist told me while I was in hospital that the Seretide I was taking for asthma was ‘old school’ and that I needed to change to Symbicort. That was 7 weeks ago, and I have had bad laryngitis since. Have been 3 times since to my GP complaining about laryngitis. Today I asked my GP for a repeat script for Symbicort as I am running low, and she told me that my laryngitis could be from the Symbicort. Why don’t doctors know this? I am stopping the Symbicort right away. She wanted me to see an ENT specialist to see if I have nodules on my vocal cords. Duh???
Lana
Trelegy caused hoarseness within a week of using it. More recently it caused me to completely lose my voice. This is unacceptable because I teach and need to speak all day. I have brought it to the attention of my doctor, and she just said I must be using the inhaler wrong. I do not believe this is the case. I believe I have SIL and possibly laryngpharygeal reflux caused by the inhaler. I can’t seem to get my provider to take it seriously. Perhaps medically it’s not considered serious but functionally it’s very serious to me.
Teresa
My daughter was early elementary age when she was put on a beclomethasone inhaler. Her voice changed from sweet and smooth to sharper, louder, and a bit quavery, as though it took her more effort to speak. It made her harder to understand, when she used to speak quite clearly. We had to stop the inhaler after a year due to two other, very serious, side effects – that’s another story. She’s been off it for years now, yet her voice still hasn’t returned to normal.
Lorraine
I have been on Advair for years. I worked speaking on the phone. The otolaryrangologist found yeast on my vocal cords. Treatment with Diflucan for 2 months took care of the yeast. Vocal rest helped with the hoarseness. As soon as I went back to working and Advair the hoarseness returned. My doctor and I have been trying Nystatin Oral suspension daily. It has worked well enough. I still get a cough and hoarseness on and off. Haven’t found anything that works better.
Brendan
Love the inhaler (I can sleep through the night now); hate the hoarseness. Try Throat Coat Tea after your inhaler.
Jennifer
Back in the 80s, I was on a steroid maintenance inhaler that wrecked my singing voice, but didn’t truly affect my speaking voice. Later I went off of it.
Ten days ago I began the Advair generic, and it has now totally wrecked my speaking voice. Very hoarse and croaky. Since I do public speaking, this is a concern of mine. The original steroid inhaler had a long spacer, which may have damped some of the bad effects. But the “diskus” has no spacer at all, and it’s a dry powder. I’m not sure I will continue if this doesn’t improve.
Susan
I have been diagnosed with leukoplakia on my vocal chord and have to have surgery to remove it. I have COPD and have used Advair for years. I’ve just discovered that Advair likely caused the problem. I don’t know what I’m going to do. I know I need a steroid inhaler, but I don’t want to have this problem again. I feel like I’m between a rock and a hard place.
Lynn
I have had a history of inhaled medications for asthma for the past 7 or 8 years. I started with montelukast only then added Advair 150/50. My next PCP decided that (since I really don’t have severe symptoms) to change that to Flovent. One severe respiratory infection, and she switched me to Advair 250/50. A visit to the pulmonologist last week has landed me on Advair 500/50.
I’ve lost my voice almost entirely since then. It is a strain to talk at all; I sound like I’m 150 years old.
I’m going to try to antacid thing to see if that works. And I’m going to talk with my PCP in a couple of weeks.
I may need Advair, but I also need my voice!
Mary Ellen
NY
I used Symbicort 160 for 5 days and stopped because my throat became extremely sore, and I had practically lost my voice. In addition, I had a couple of laryngeal spasms (felt like I was suffocating). Almost 3 weeks have passed since I used the Symbicort inhaler yet my symptoms persist. I have laryngitis, a sore-feeling throat, and swallowing issues. I had NONE of these symptoms before starting the Symbicort, just a tight chest.
I was referred to an ENT who diagnosed me with LPR. She prescribed Prilosec and Zantac and is sending me for speech therapy to deal with my voice issues. I REPEAT, I HAD ABSOLUTELY NONE OF THESE SYMPTOMS PRIOR TO USING SYMBICORT FOR 5 DAYS. Symbicort is poison and should be taken off the market. Big Pharma is making billions off this harmful drug. I just hope my condition improves, and I can get back to baseline. I also will NOT be taking the Prilosec or the Zantac, as I was misdiagnoised because I had zero throat, voice issues before using the Symbicort.
David
Chapel Hill
Great input here. I am a professional singer but absolutely need a corristeroud inhaler, im having the same problem with the laryngitis. Is there anything I can do besides not use it, which is not an option?
Don
Chapel Hill
It’s not clear to me that if cessation of the inhaler would bring the voice back to normal?
Jenny
Minneapolis
I’m a singer and Advair is not my friend. I’m taking less than I should, so can’t breathe as well, and still having some issues with the hoarseness and vocal dropouts. Doc doesn’t want to take me off of Advair because my asthma is moderate and said the pills only work for people with mild asthma. I don’t want this to end my career!
Bev
I have been using Adair 500/50 for 3 years. I’ve been very hoarse for the past couple months. I need to be able to talk. So I stopped Advair 5 days ag. Still very hoarse, and now breathing is not so good. How long till voice comes back? I’m gonna have to go back on advair to breathe. I just wanted to be sure it was the advair causing the hoarseness.
Abby
Fresno
Yeast infection!!
Fluconozole 100 mg. Once a day for 3 weeks, cured me as long as I don’t come into contact with any of those inhalers. I take Combivent, albuterol as a rescue and take singulair. Had almost no voice for 2 years and it was extremely painful. Anyway that’s what I had and that is what fixed it but cannot touch a steroid inhaler!
Jean
WHAT ABOUT VENTOLIN? I have never had any problems with this inhaler and it is one of the few brands that has any real medication in it so says my pulmonary doctor.
Gayle
SC
I am a 72 year-old with well controlled asthma thanks to Advair. 150/50. Never made me hoarse but I only use it once per day. A miracle for me!
Val
Calif.
I’ve been using Advair since it first came out. My doctor gave me a free trial and taught me how to use it. Stand up straight, head held up, breathe in deeply, and hold for 5 seconds. Breathe out, and wash mouth out well, then gargle for a few seconds as deeply as possible, some times twice. He was a user also and knew how to do it. I have never had voice problems of any kind and often someone will comment how young my voice sounds. I am 80 years old.
Megan Schlick
Cleveland, Ohio
My pulmonary doc prescribed Advair for my asthma. He could have cared less that I am a singer, and that the other musicians are not inclined to change the key of an aria just because the doc didn’t warn me that my vocal range might go lower by 2 whole steps! I now Sing Mezzo or Alto Arias.
Gina
I used Qvar for less than six months because of the hoarseness it caused. My voice returned to normal once I stopped.
jean
CA
Thanks for all the ideas. No laryngitis yet. I plan to do the triple gargle and water swallow to reduce the likelihood of it occurring. .
Joyce
Missouri
I have hoarseness too from Breo and all the other inhalers I have used. I’m wondering if a nebulizer would have the same side effect?
Kathy
Ohio
I have used Advair Diskus for several months and began experiencing hoarseness intermittently. My CNP suggested I inhale deeper (I am a shallow breather) and gargle/rinse thoroughly. I am using the inhaler only once daily (not the recommended twice daily) and that combination seems to be working. I developed a rash around my mouth two months ago, and medication clears it, and then it comes back.
Carole
Virginia
I used dulera inhaler with a spacer for allergic asthma for 4 years in which I became increasing hoarse. I always gargled. I thought it was due to sicca syndrome, a dryness condition that I have, until I read that the inhaler propellant could cause hoarseness. I read the drug insert and hoarseness is not listed. My pulmonologist confirmed that dulera caused it. Put me on Alvesco which has a different propellant. Only been using it about 2 weeks, so I hope it works. With my insurance it costs almost 4 times as much as dulera, but it will be worth it if it cures the hoarsness.
Carl
IN
I’ve used Advair for several years and I have not experienced any hoarseness; however, I follow the instructions that say to rinse your mouth and gargle with water after each use. I never omit doing this. Maybe this helps to prevent the hoarseness.
Joyce
CO
I have COPD and asthma and have used Dulera ( mometasone furoate) for 5 years and have never experienced hoarseness. I love this inhaler, so much, that when I am almost forced (by doctor, insurance, etc) to use a different product, I refuse. The stuff really works and is gentle.
What I find that gives me discomfort is ipritropium bromide. Either in the form of Spiriva or nebulized liquid. The stuff is just like inhaling razor blades sometimes and leaves me with that awful gravelly voice and irritated bronchi. But, it works so well! I have discovered that nebulizing albuterol sulfate after wards makes thus problem go away.
I hope this helps! Thankyou for allowing me to share.
Monica
OH
Advair and Qvar created terrible voice hoarseness. I’ve been on Singular for years and switched to use of Xopenex via a nebulizer for those times when my asthma flares–the best combo I’ve been able to come up with.
Julia
Chapel Hill, NC
I have had a chronic cough for 25 years. I’ve seen MANY doctors over the years, taken every OTC antihistamine, nasal spray, anti-acids, nasal rinses, numerous prescription antihistamines and nasal sprays; you name it, I’ve tired it. Most don’t work forth a fig.
In 2013 my primary care physician prescribed Flovent. While I’ve never been diagnosed with asthma, he thought it was worth a shot. It seemed to work better than anything else at controlling the cough. About 2 years ago I noticed that my voice seemed to be getting weaker. I remember my Dr. telling me that it’s important to rinse my mouth out after using the inhaler in order to avoid thrush in my mouth. I began to think that perhaps if this medication can cause problems in the mouth, it might also cause problems in the throat, and rinsing won’t help there.
I asked my Dr. about this theory, but he discounted it.
My voice has continued to get weaker and I continue to get very frustrated with the whole thing. My husband and I are in our 70’s. He is hard of hearing and I can barely speak above a whisper. This is not a good combination! I am glad that this article has brought out some evidence that perhaps I was correct in the first place. I will pursue this further, thank you!
Patty
Illinois
Spiriva gave me horrid laryngitis to the point that people thought I was sick and would back away from me for fear they would catch my “bug”. I did OK on Advair but am now on Serevent with no problems.
Bill
New Mexico
Unfortunately all the doctors in new Mexico lump everything into one basket and call it copd and just keep switching inhalers on us
Demian
Colorado
My doctor, a lung specialist at National Jewish Hospital, advertised as the best respiratory hospital in the country, prescribed fluticasone (100 mcg). It definitely causes hoarseness, and I will discontinue it as soon as I can get his permission. I teach university classes, and am straining to speak after a half hour; also, sometimes the straining causes a sore throat and an almost complete loss of voice (which disturbs my wife greatly). I don’t feel that it helps anything anyway.
Betty
Texas
I have used these since the 1980’s…the secret it gargle deeply 3 times, then drink LOTS of water to wash vocal cords and deeper. I have never had a problem.
Daniel
California
Last year, my nose doctor prescribed fluticasone propionate, 50mg, for my stuffed sinus. I barely took a few sniffs for a few days when I developed a large cyst inside of my right cheek. I stopped taking it immediately, and the cyst slowly disappeared. I also went to my dentist for a cleaning, and he indicated that it would eventually subside. I won’t be taking this again. It may be okay for some people, but not for me. It did cause me pain whenever I brushed my teeth, so I had to be careful when brushing my right cheek.
Marilynn
Chicago suburbs
Fluticasone made me terribly hoarse, worst in the norming. When I read it could do this, I stopped using it, and the hoarseness became minimal. But my runny nose and eyes got so bad that I went back to it, although trying to minimize usage. So far, it’s doing ok.
Susan
Buffalo, NY
Had the same experience with many of these inhalers, although they work extremely well for my asthma. My allergist prescribed a spacer to use with the Symbacort, suggesting that the larger particles that irritate, drop down into the spacer chamber and only the smaller particles get into your throat. My doctor said the larger particles are more irritating and only serve the purpose of propelling the powder. This has worked tremendously and my voice is 90% better
Joanne
I’ve used Pulmicort for years for asthma. Yes, my throat is hoarse. Will discuss with my allergist. Thanks for bringing this to our attention
margaret
Minneapolis, Mn.
I have had the hoarseness reaction to all of the steroid inhalers; my pulmonologist kept switching my prescription and it did not improve. Finally I went back to Advair and I take half the dosage and the hoarseness disappeared. I am not sure it is the right choice for my asthma, but the hoarseness was quite extreme and i knew that could not be good. I will appreciate hearing solutions to this.
Jane
I believe the horseness happens in probably 98% of users of inhaled steroids. I quit the Advair because of it but now I’m on Trelegy and although that causes horseness too, I’ve learned to rinse out my throat and to drink just a few sips of water after inhalations and that sure helps. I think Pulmonary docs are pretty worthless overall for helping with this or anything else. My allergist is the one who knows how to manage my COPD. My recommendation would be to rinse out your throat well…hold water at the throat level and move the throat up and down quickly to rinse, then just swallow a few sips of water. Good luck! It’s not fun to sound like you’re 100 years old and to struggle so hard just to talk.
Carol N,
Salem Oregon
Advair, tho wonderful for asthma, gave me voice hoarseness and dysphonia. I can NOT deal with my daily business unable to speak!
I tried Qvar and broke out in pimples in my mouth, down my throat and a red swollen tongue after first use!
Insurance insisted I use a dry powder inhaler next. (forgot its name) I cannot breathe in dry powder inhalers. They actually CAUSE a worse asthma attack.
After nearly begging on hands and knees, then simply refusal to take it, my Dr agreed to Flovent. Ive had that drug most of my life. Its never bothered me at all!
He agreed, to one inhalation twice a day (Advair was 2 inhalations twice a day). It took about a month on just FLovent to stop the hoarseness. That was a yr ago, and I’ve not had a single day of hoarseness since. I also take Singulair, the Zenopex for rescue. (age 65)
Jane
Wisconsin
Many years ago, I had tried a number of inhaled cortico-steroids for asthma, all of which caused hoarseness. My pulmonologist put me on Serevent, which I have used with no problems ever since.
Nancy
South Carolina
Yes, I have COPD and have been on steroid inhalers for several years, including Advair. My voice is very hoarse, at times very bad like laryngitis.
Mary
Wisconsin
Hi. I too use the steroid Symbicort for mild COPD. I too have a change in my voice and lately a metal taste in my mouth! I don’t even sound like myself when I’m talking. My doctor also said to gargle but it does not make a difference!
S.
Houston, Tx.
In September 2017 became hoarse and feeling ill. Went to ENT Dr and she did the Scope through the nose and discovered Fungal infection ( Thrush) on vocal cords. I use Symbicort and always rinse 3/4 times after using, but can not rinse deep down in vocal cords. Had to use a liquid solution Nystatin, to swish and swallow. Took 2 weeks to clear up.
Steriods cause upper respiratory infections and I ended up with bronchitis and 4 days in the hospital in January; another side effect. Need to try Singular. Xopenex is my rescue inhaler which never had issues with. I am allergic to pure Albuterol. Makes my breathing worse. I brought COPD on myself from many years of smoking cigarettes.
Chris
Andrew, IA
I tried Spiriva and it made my voice worse and gave me a sore throat! But Advair is just a little easier on my throat, but still get hoarse and cough a lot. I have Asthma and COPD. I like breathing, but sure wish there was some other inhaler!!