Advair Left Asthma Patient Too Hoarse to Talk (Dysphonia)

The mainstay of modern asthma treatment involves inhaled corticosteroid (ICS) drugs. These medications are less likely to cause systemic side effects than oral steroids. But that does not mean they are free of side effects. One that is not often mentioned to patients ahead of time is dysphonia. That’s doctor talk for too hoarse to talk. In fact, dysphonia is any problem with speaking. It is estimated that inhaled corticosteroid trigger dysphonia in “5% to 58% of patients” (Mayo Clinic Proceedings, Sept. 2012). Here is one story from a reader of our syndicated newspaper column:

Q. I used Advair to treat my asthma for several years. Bit by bit, 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. Do you know of a solution?

A. Inhaled corticosteroids and bronchodilators are a cornerstone for treating breathing problems like asthma or COPD (chronic obstructive pulmonary disease). Drugs like Advair (fluticasone + salmeterol), Breo (fluticasone + vilanterol) and Symbicort (budesonide + formoterol) have become very popular. They are a convenient way to relieve airway inflammation and make breathing easier.

Inhaled steroids are less likely to cause systemic side effects such as osteoporosis, diabetes and low potassium than oral drugs like prednisone. However, many people report hoarseness or other voice problems as a side effect (Journal of Voice, May 2017).  Unfortunately, researchers have made little if any progress on understanding and treating this problem.

Patients are often advised to gargle after inhaling their medicine. It is not clear, though, that this is particularly effective. As one People’s Pharmacy reader noted:

“Your vocal chords are not washed by anything you gargle or drink. They are deeper than that. I am, or was, a singer and I am devastated by having to choose between breathing and singing.”

Other Stories from Readers Too Hoarse to Talk:

Giorgio in California shared this experience:

“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. The good news is that I can eat without trips to the ER as a result of my eosinophilic esophagitis.”

Linda is also too hoarse to talk:

“I have used many different inhalers. Right now Advair HFA…1 puff twice a day (instead of 2) and Incruse. I am too hoarse to talk. It is very embarrassing! I use a spacer with the Advair and gargle and rinse. I do a lot of phone consults with docs… so tired of this!”

Mary also read our newspaper column and reports:

“I read your article about Advair. I stopped taking it probably three or four years ago since it caused me not to be able to sing. My pharmacist suggested Qvar and Spiriva.

“I was a nurse when I was younger. I have asthma only. He said Qvar has a different propellant.

“I still have to gargle after I use it. I eat a apple each day and walk two miles half up hill with our dog and I will be 70.”

Barbara in Anacortes, Washington was also happy with Qvar (beclomethasone):

“Like a writer today, my asthma inhaler gave me laryngitis. I switched to Qvar. Problem solved. Breathing easy.”

The People’s Pharmacy Perspective:

Fluticasone is a powerful corticosteroid. Beclomethasone is not quite as strong. That might account for the different reactions from Barbara and Mary.

What do you do about dysphonia? Have you figured out a way to overcome the “too hoarse to talk” problem? We know that other readers would love to hear your solutions in the comment section below.