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Hoarse voice…any help?

Hello all,

I'm a long time allergy /  asthma patient and have been taking Breo Ellipta for a number of years. Although it helps a lot with my breathing my voice has become very hoarse and I have to strain to  be heard which is difficult as my job requires a good deal of talking. My doctor has reduced the dosage but it hasn't helped my voice. Ironically when I get a cold (which I currently have) my voice improves significantly. I've tried extreme gargling with mouthwash, tongue brushing, etc. to no avail. 

Does anyone have a suggestion that may help?

Thank you for any info.

GB

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  • Marie E Natzke

    GB, 

    Can you drink warm drinks with honey? They say to stay away from caffeine as it can dehydrate you. How much caffeine do you have in a day? Maybe try cutting back ?

  • Melissa G

    Hi GB! Welcome to AAFA! 

    So the hoarseness in your voice started after you started taking the Breo? Did your asthma improve after starting on the Breo? Maybe you could switch to a different inhaler and see if the hoarseness gets better. 

  • GB

    Thanks for the quick reply Melissa. Basically it was just as bad on my previous inhaler and got slightly worse on the Breo. My Dr. said I should stay with the Breo.

    GB

  • jtomotaki

    Interested to read other replies — I came here today to post the exact same question. My voice has gotten horribly hoarse and unpredictable since starting Breo last December. We have tried several different inhalers, but Breo is the best for breathing. 

  • K8sMom2002

    Hugs on the voice issues, GB and JTomotaki. I know how it can be to not be able to speak when your job calls for it! 

    Sometimes a hoarse voice is caused by a lot of different things that are working together and have been pushed over the tipping point by that final straw.

    Could you ask your doc to review your inhaler technique? Sometimes (this according to my mom's pulmo, so check with your doc first), the way we use inhalers can direct the meds onto the tongue and in the mouth, and not into our lungs. 

    Rinsing immediately after using inhaled corticosteroids can help reduce issues like thrush (a yeast infection of the mouth and throat). 

    Has your allergist or pulmonologist suggested you see an ENT to make sure there's nothing else going on? Sometimes hoarseness can be caused or worsened by things like thrush  or GERD (reflux) or something mechanical with the voicebox. 

    Also, post nasal drip from spiking environmental allergies can create a lovely case of laryngitis all on its own.  

    For those times, my doc has prescribed complete voice rest with lots of comforting home care measures: hot tea with lemon and honey, and gargling with warm salty water or vinegar (sounds horrible, but it really did ease a burning sore throat from really awful post nasal drip – I used dill pickle vinegar and tried to think of salt and vinegar chips! ). Many times, my doc would prescribe or suggest short stints on decongestants.

    Could you talk to your doc to see if any of those ideas might help you?

  • GB

    Thank you for the suggestions. I'll try anything. I am a coffee drinker and just finished day 1 of no coffee to see if that will make a difference. Why do you think my voice sounds much better when I have a cold? More mucus? 

    GB

  • K8sMom2002
    GB posted:

    Thank you for the suggestions. I'll try anything. I am a coffee drinker and just finished day 1 of no coffee to see if that will make a difference. Why do you think my voice sounds much better when I have a cold? More mucus? 

    GB

    Oh, my, that IS a sacrifice! Hugs on the transition. How's it going!

    As for the voice sounding BETTER when you have a cold — that's different! Could you record yourself with a cold and without so that your doc can hear the difference? 

  • GB

    Perhaps I'll try that. Fyi I am 3 days coffee and I think it may be helping. I'll know for sure when I'm over this cold. Keep you posted. 

    Thanks very much for the responses.

    GB

  • LK

    Along with the prescribed rinsing one's mouth after using Breo or other inhalers I also gargle for just a couple of seconds with water – spitting the water out the same as after rinsing one's mouth.  I figured if the powder from the inhaler wasn't good sitting in my mouth then it wasn't good sitting in my throat.  It seems the powder would already be down in my lungs so I would still be getting the full dosage of my Breo and other meds.  

  • GB

    Thanks Lisa. I use mouthwash and water every morning. It never seems to do much unfortunately.

    GB

  • K8sMom2002

    GB, how are things going? I hope the going without coffee has helped! It takes an adjustment to give up something we're used to, doesn't it?

  • GB

    Thanks Cynthia,

    I'm cautiously optimistic. I'm almost over the cold now and more than a week with no coffee and I think it's helping a lot. I'll know more in another week but will surely post back here if it makes the difference. 

    I have a long commute each day to work and giving up my best friend during the drive is tough but getting my voice back is worth it

    Cheers

    GB

  • Kathy P

    Sorry about the hoarse voice! That's not fun. I had really bad hoarseness when I switched from Advair to Dulera. It got so bad that I wound up with ulcerated vocal cords which were really painful. 

    Hoarseness can be an issue with any inhaled corticosteroids. There are different ICS, so my doc switched me to a different one and made a note not to try and in th same family as the one in Dulera again! I'm now on Breo and don't have issues with hoarseness. 

    If the side effect is causing you problems, I'd talk to your doctor again to discuss other medicine options. 

  • GB

    Thanks Kathy, 

    I'm hopeful quitting coffee will help a lot. If not I'll definitely ask to try another med.

    GB

  • Kathy P

    I hope it helps! It took me a while to figure out that it was the medicine. Another option is to request an evaluation by an ENT – that was where I wound up. He also recommended an "anti-reflux" diet since I do have silent reflux as well. I just wound up with a perfect storm of things irritating my VC.

  • K8sMom2002

    GB, so glad things are working out for you so far … what are some things you're doing to help wake yourself up without the help of your former best buddy Java Joe?

  • K8sMom2002

    @GB, hoping the hoarse voice is still improving and that giving up coffee isn't too bad … wondering what sort of meds your doc suggested? 

  • GB

    Ok…the verdict is in! I'm really happy to report that my voice has returned to 90% normal!! The difference appears to be quitting coffee! Marie E. Natzke first mentioned that so a big shout out to Marie!! Thank you thank you thank you!!

    I'm so happy with it that the withdrawal from coffee has been minimal. I have a green tea in the morning and maybe on orange pekoe throughout the day and that doesn't seem to have an adverse effect.

    I have an routine appointment with my asthma doc in a couple of weeks and I can't wait to tell him as I've been complaining about this for a few years.

    Really appreciate all of the other suggestions as well.

    Cheers!

    GB

     

  • Brenda Silvia-Torma

    YAY!! That's wonderful!!! I went on the Breo website and it says that hoarseness is a common side effect….I suggest when you tell your allergist, remind him/her that this may be a resolution that could help other patients…this will put a tickle in his brain the next time he talks with someone else who is struggling with this same problem.  I've done that with my physicians and they seem to appreciate it.  

    So happy for you! Now you won't have to give up talking with your bestie during your long commute!!

  • GB
    Brenda Silvia-Torma posted:

    YAY!! That's wonderful!!! I went on the Breo website and it says that hoarseness is a common side effect….I suggest when you tell your allergist, remind him/her that this may be a resolution that could help other patients…this will put a tickle in his brain the next time he talks with someone else who is struggling with this same problem.  I've done that with my physicians and they seem to appreciate it.  

    So happy for you! Now you won't have to give up talking with your bestie during your long commute!!

    I'll will absolutely suggest it to him!

  • GB

    Hi Melissa,

    Doing good thanks. I saw my doc last week. He's a calm guy but overall was happy about the coffee issue and that quitting coffee has helped. He didn't seem to be aware it was a factor though. 

    Other good news is that 3 months ago we reduced my Breo to 50% of what I was taking earlier with no adverse effects on my breathing. I've been a running addict for years and notice even minor changes in my breathing. Also now that I'm aware of the dry vocal chord issue I am noticing that I get a bit hoarse after a longer run, I suppose due to heavier than normal breathing. Although now it recovers faster, apparently due to the reduced caffiene

    Thanks again!

    GB

  • LK

    GB,  That is awesome that just not having the coffee helped you so much!    Great news on your still doing well after reducing your Breo dosage, too!  Thank the Good Lord!!  

  • K8sMom2002

    GB, do you think it was the caffeine or the coffee itself? I can't remember if you were drinking de-caff. 

    So glad that you've seen an improvement! And yeah, your theory about the hoarseness after a run makes really good sense. Maybe it's because when we're running, we tend to mouth breathe more?

    And I love the way you did a shout-out to @Marie E Natzke … it's amazing how we help each other out in what we think are little ways but turn out to be HUGE!

  • GB

    Yep. Thanks all. I'm very happy that I found this forum. 

    GB

  • Marie E Natzke

    GB!!!!! Yea!!!!!!! I'm glad I suggested it. I read once somewhere that when your on inhalers if u have too much caffeine it can have the opposite effect on someone. I'm glad you are feeling better.  My voice is hoarse and I know it's from the Air conditioning being in it all day and all night. 

  • GB

    Cynthia,

    I've switched to tea (green) but I'm going to try decaf tea to see if it helps more. However just stopping coffee and drinking tea has helped a lot.

    If I discover any potions, etc. that help even more I'll be sure to post here

    GB

  • K8sMom2002

    Thanks! I admit, I'm rather hooked on "fully leaded" black tea … I drink it hot, cold, and room temp, as long as it's not too sweet and it's fairly strong (my mom's recipe). I've tried drinking green tea, but it tastes fairly weak to me compared to the black tea. I wonder if I could find loose leaf green tea and try that … all I've been able to find are bags.

  • jtomotaki

    @GB I am so happy to read that your hoarse voice has gotten better.

    My hoarseness began late last fall and my doctor tried me on different inhalers. But please do not assume that chronic hoarseness is caused by your inhaler, especially if it continues to worsen.

    I have just received results of a thyroid ultrasound showing a 2.1cm mass between thyroid and my trachea. This SO explains my voice.

    Anxiously awaiting word from my doctor on the next steps …. CT w/ contrast, most likely.

    — Jenny

  • LK

    Oh, Jenny, sending hugs your way!!      Will keep you in my prayers.   Good advice to look for other causes of a problem.  When will your doctor get back in touch with you?

  • jtomotaki

    Thanks @LK . Hoping to hear back from dr today, but it is already 4:41pm ….  I am trying not to fret, worry, and google too much for now.

  • LK

    Wise decision to not go looking at too many odd bits of information.  Just makes a body worry needlessly.  Hope they get back to you early tomorrow if not today.  

  • Marie E Natzke

    Jtomotaki

    🙏🙏🙏🙏 

    GB, caffeine can dehydrate a person. After reading your post about running maybe your not hydrating enough? 

  • Brenda Silvia-Torma
    jtomotaki posted:

    I have just received results of a thyroid ultrasound showing a 2.1cm mass between thyroid and my trachea. This SO explains my voice.

    Anxiously awaiting word from my doctor on the next steps …. CT w/ contrast, most likely.

    — Jenny

    Hi Jenny, I'm so glad you obtained further testing and figured out the source of your hoarse voice!!  Years ago, I had two fine needle aspiration (FNA) biopsies for thyroid nodules. Are you seeing an endocrinologist? Here's a great resource from Thyca for you to read: . As the handbook notes,

    • More than 90% of nodules are benign, which means that they are not cancerous.
    • Thyroid nodules are very common. They become more common as people get older.

    I used to be a Thyca peer-to-peer support volunteer and would be happy to talk with you further. Feel free to PM me.  

    Sending hugs and good thoughts!!!

  • jtomotaki

    Hi @Melissa G I don't have any thyroid nodules, just a mass between and above the upper left lobe and my trachea. Thyroid actually looks quite good.

    I have a ct w/ contrast scheduled for Monday morning and I have been referred to the Texas Voice Center here in Houston.  I have heard they are the best!

    I saw a cardiologist yesterday to make sure all is good for surgery. He said something that made me feel validated. He said "If I were a betting man, I would bet that this mass constricting your trachea is causing all of your chest pressure and shortness of breath and definitely hoarseness symptoms. It needs to come out soon." 

    As for how I am doing, well …. trying to take it one day at a time for now. I want to rush everything. I want the CT NOW and I want surgery yesterday already but things like this don't happen that way except on tv, I suppose.

    Thanks for checking in.

    Jenny

     

  • Melissa G

    Sounds like you are making progress! I am like you, I have very little patience and want things done now or even better…yesterday! That is great that you have been referred to the Texas Voice Center.  on Monday and  keep us updated! 

  • LK

    Jenny, Best of luck with all your upcoming procedures and tests!!  

  • jtomotaki

    Hi @Melissa G   The CT scan showed nothing. It was completely unremarkable!!! I saw the ENT @ the voice center. He has diagnosed me with glottal insufficiency and prescribed 8 weeks of voice therapy. If that doesn't help, then we would discuss collagen injections as the next step.

    I really wonder what could have caused this, though! 

    I am no longer taking any steroid inhalers. I stopped arnuity about a month ago, and NONE of my asthma symptoms have changed. My allergist told me to continue off of it for now. My "daily voice" is greatly greatly improved so I know much of it was caused by the inhaler. However when I turn my head or look up or lay down on my side or my back, my voice completely goes away. It is SO WEIRD!!

    The ENT explained that in a neutral upright position, the surrounding muscles are compensating and forcing the vocal cords to close like they are supposed to, but that doesn't happen in other positions.

    Who knows what the radiologist saw on the original ultrasound. ENT is convinced it was a false finding so for now I will trust him.

    Next step is a pulmonologist to figure out what is causing the shortness of breath and chest pressure. It really hurts to take a deep breath and that is frustrating and limits my activity level. Asthma and cardiac stuff have been ruled out.

    My apologies for forgetting to update my post!

    Have a great weekend and thank you for checking on on me!!

    Jenny

  • Melissa G

    Oh Jenny, I am so sorry! I know how it feels to have testing done and they find nothing! It's not that you want "to have" anything, you just want answers! 

    When do you see the pulmo? What  have been done or if any at all?

  • jtomotaki

    Yes, it is frustrating …. I want answers!

    The pulmo appt is this Tuesday 9/11. I was excited to get in so quickly. So far the only lung function tests I have had are computer spirometry and the nitrous breathing test for inflammation (I have forgotten what it is called). 

    I have no idea what to expect at the pulmo appt. I hope he will actually do tests at my initial appointment instead of saying "Okay you need to come back 17 times for all these tests." 😒😒

     

  • Melissa G

    Good luck on Tuesday! I hope they are able to get the testing done then too! I don't like going back for additional testing either. I like the one and done type thing.