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Hoarseness from LABA/ICS (Combination Controller Medicine)?

Quick question: do you guys ever get hoarseness from your LABA/ICS? Maybe this is just laryngitis as I’ve been on advair before, but speaking like James earl jones everyday is getting kinda old! Hmm, wonder if I could get a job as a movie theatrical trailer voice? 😂

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  • Kathy P

    Hi Emelina,

    I'm  at your description of sounding like James Earl Jones! I usually joke that I sound like Lauren Bacall!

    I currently have a really hoarse voice – it's been over 6 weeks! Haven't figured out what triggered it.

    In the past, I have had issues with a particular ICS/LABA that the doctor switched me to. It took several weeks to figure out that it was the new inhaler and then quite a while to get my vocal cords to calm down.

    There are many things that can cause hoarseness:

    • GERD
    • Inhaled corticosteroids – it's listed as a side effect
    • Allergies
    • Irritants/irritation

    If it's lasting a long time, it's a good idea to check in with your doctor. I wound up being sent to an ENT who used a scope to look at my vocal cords.

  • LK

    Em, Yep!  I certainly do!  My ENT said it's from my inhaler.  Last summer when I saw him he said I have slight thickening of the vocal chords which doesn't help.  I have also found that when I am tight but don't really realize it, I also get hoarse.  It isn't until I use my rescue inhaler and then can breathe better and talk a little more normally that I see the difference.  Sometimes it gets me for no apparent reason.  Lately I have been using that Biotene mouth gel and since it keeps my mouth moister my throat seems to not get as hoarse.

  • Pljohns

    Em-for me, the hoarseness comes when I’m having issues-the more I can’t breathe, the less voice I have.  It starts out hoarse and then goes totally away.  I use a LABA off label (it’s a COPD med) and max dose of QVAR on top of it.  I can’t take combo drugs-my lungs don’t like them!

  • Melissa G

    Em, you made me laugh! 

    How long has your voice been hoarse?

    Another member had a similar issue:

  • Deborah Bartlett
    LK posted:

    Em, Yep!  I certainly do!  My ENT said it's from my inhaler.  Last summer when I saw him he said I have slight thickening of the vocal chords which doesn't help.  I have also found that when I am tight but don't really realize it, I also get hoarse.  It isn't until I use my rescue inhaler and then can breathe better and talk a little more normally that I see the difference.  Sometimes it gets me for no apparent reason.  Lately I have been using that Biotene mouth gel and since it keeps my mouth moister my throat seems to not get as hoarse.

    🐎🐴 

  • Emelina

    Hi Kathy, Lisa, Lynn, Melissa and Debbie,  thanks for sharing your thoughts and experiences. I’ve been hoarse for about a week now. It started with URI symptoms that I think I caught from my kid. It got a bit better, but never has gone away. I had a laryngoscopy done on 4/22 and the NJH doc suggested starting a ppi to help with GERD (had a normal voice then). I’m on highest dose advair, but have been for about 1.5 months without voice issues. 

    Thanks Melissa for the link to another member’s post, I’ll check it out. It seemed like it got a bit worse today after I went outside … so maybe it’s multiple things (gerd, + allergies + physical irritation from coughing). 

  • Emelina

    I still sound like James earl jones does hoarseness that’s worse in the morning make you think of anything? I was wondering about post nasal drip maybe? The allergies have been a bit worse. I’ll try voice rest and warm drinks with honey today. Im sure the boys and dh will love it … no badgering to clean their toys up from momma!

  • LK

    Em,  When I talked with my ENT about my hoarseness from my inhaled meds, he basically said it will come and go.  No real rhyme or reason to it in my case – at least I haven't made any connections yet.  

    For me when my hoarseness is worst in the morning it seems to be related to my dry mouth and reduced swallowing during the night.  So I guess I have made one small connection!    

    I know!!    You can teach your family sign language!!  Then you won't have to speak but you can still tell them to clean up their things!  

    Hope your voice is better as the day wears on!  

  • Emelina

    Melissa, right? I’m like 2-3 octaves lower. Oldest ds laughs when it changes mid sentence. 

    Good point Lisa about morning being due to dryness. I’m beginning now to think this is viral laryngitis and just a lingering URI (or something new now?). Both kids are snotty/coughy and had sore throats. Today I can feel lots of gunk in my throat and I’m freezing to death. Man, this is the pits, I have like 0 immune system with the predisone. Cmon guys, go kill some 🦠 

  • LK

    Eeek Em!  Hope you feel better soon!  Maybe give your doctor a call?  Don't want you to get sick on top of this!   

  • Deborah Bartlett
    Melissa G posted:

    Em, you could get a side job for awhile and do some voice overs…

    Yeah…like Marge Simpon's sisters Patty and Selma! 😂

    I have been hoarse on and off myself. This weather and the pollen. I probably sound like I have been constipated for a month! LOL!!! 

  • Emelina

    Oof! Ok, now about 17 days of sounding like James earl jones. I’ve tried biotene, voice rest, warm honey and tea, ppi, I’m on allergy nose and oral meds … maybe time for a doc check in? Not sure if there are any other tricks/solutions to try? 😞 

  • LK

    It's worth a call Em!  Each one of us is different as you know. Mine seems to come and go with no real correlation except I have found it is closely associated with my lungs being tight even when I do not realize it.   My doctors basically told me it's from one of my maintenance inhalers.  Guess mine is a little of both.  Please let us know what your doctor says!

  • Emelina

    Thanks Lisa. I’ll give them a call. It has been such a long year, I personally would not be offended if I could space out the time between doctors visits and calls … like no more problems until 2020! You know you’re known when the front desk ladies don’t even ask for your name or birthday anymore. 😂

  • LK
    Emelina posted:

    Thanks Lisa. I’ll give them a call. It has been such a long year, I personally would not be offended if I could space out the time between doctors visits and calls … like no more problems until 2020! You know you’re known when the front desk ladies don’t even ask for your name or birthday anymore. 😂

    YEP!!  All I have to say when I call my pulmo is my name and they know me!  Ahh, wouldn't that be nice to not have any problems for months and months!  Sigh

  • Emelina

    Hmmm, going to try nasal rinses and switch to Allegra to see if that helps with the nose and allergies since they are bugging me more. If that doesn’t help then might go see ent for a look. I think I’m gonna change my name to Eme-ribbit 🐸 

    i like how I feel after the nelimed rinse, but the kid in me feels like I’m washing my 🧠 

  • Melissa G
    Emelina posted:

    If that doesn’t help then might go see ent for a look. I think I’m gonna change my name to Eme-ribbit 🐸 

    i like how I feel after the nelimed rinse, but the kid in me feels like I’m washing my 🧠 

    What antihistamine are you currently taking?

  • Emelina

    Hi Melissa, I was on cetirizine. Going to see if Allegra helps. It just stinks though when you have indoor and outdoor allergies. Especially dust mites! 😔 I’m going to see my allergist next month and talk about immunotherapy. 

  • Melissa G

    I hear ya! And this time of year is always the worst. 

    I switched to Xyzal. And it has helped me a lot. I was on Zyrtec for awhile, then switched to Allegra but it just wasn't working anymore. 

  • Emelina

    Man, I still sound like a frog! Does it get better with a lower dose of ics/LABA? 😕

  • LK

    Em,  Sorry you are still hoarse!  Don't know about that as I have never been able to get on a lower dose!  

  • Emelina

    Hi Lisa, thanks for the input. Just thinking out loud; the 250/50 never was enough but maybe it could be now with the other stuff onboard. I’ll pester my docs and see what they say. 🤞

  • Emelina

    Referral placed to ENT (sigh); might need a sinus work up. I’m grateful for the referral but really tired of doctors! 2019 has been one heck of a year. 🤞

  • K8sMom2002

    Hugs on the sinus work up … that first year of a diagnosis feels like you live in a doctor's office or in the phlebotomist's chair … 

    But once you have everything sorted out, you see doctors (hopefully!) less.

    When's your ENT appointment?

  • Emelina

    Hi Cynthia, thanks for the hugs. Yep, you’re right, this first year is appointment after appointment, blood draws and other tests. I can look at my arms and tell a story. Still, I’m grateful for the ability to see all of these docs, get tested and find answers to feel better. Can’t wait until I have all the pieces of the puzzle and can space out appointments. I’m currently in scheduling limbo. Waiting can be the hardest part. 😖

  • Emelina

    Not until June 25. It’s getting bad enough people on the phone need me to repeat things. 😢 maybe I’ll call my pulmo and see if there’s something other than advair I can try. Just nerve wracking … need to be able to speak, but keep the lungs happy too. Such a delicate balance.

  • LK

    Em,    on the voicelessness!!  Been there and still am some days.  Trying to speak when you have no voice is also exhausting.  A call to your doctor is a good idea!

  • Breatheeasy
    Emelina posted:

    Hi Lisa, thanks for the input. Just thinking out loud; the 250/50 never was enough but maybe it could be now with the other stuff onboard. I’ll pester my docs and see what they say. 🤞

    I was on advair 500/50 twice a day. Now I’m on 250/50 twice a day. Is 250/50 the highest dose?

  • Emelina

    Howdy, 500/50 is the highest dose Inhaler. The first number is the amount of fluticasone, the second number is the amount of Salmeterol. The maximum dose is 500/50 twice per day.

  • LK
    Emelina posted:

    For you Lisa

    THANK YOU Em!!!  Made me SMILE!!    

  • Breatheeasy
    Emelina posted:

    Howdy, 500/50 is the highest dose Inhaler. The first number is the amount of fluticasone, the second number is the amount of Salmeterol. The maximum dose is 500/50 twice per day.

    Good. I was lil confused because you said you take 250/50 and you’re on the highest dose. Maybe you were on the higher dose earlier. 

  • Emelina

    I called my PCP, he’s at a loss since I’m on therapy for gerd and rhinitis. He said NJH mentioned exploring the sinuses in the future wouldn’t be unreasonable. So I’m waiting to see ENT on June 25. I’m going to be naughty and see if I can reach out to the doc and get a cancellation spot, and maybe do the sinus CT before hand. I think I just need to have someone do a repeat laryngoscopy. I’m worried it’s my LABA/ics. 😬 it’s hard because it makes it difficult to talk on the phone and everyone thinks I’m contagious with something 🙄

  • Breatheeasy

    Did they test you for laryngitis? It’s hard to catch. Or at least was when someone I know caught it.

  • Emelina

    Howdy breatheeasy, I had a laryngoscopy when I was at National Jewish just prior to getting this awful froggy voice. At that time the cords looked fine, it was just the back of my throat that looked a little red and cobblestoned. The doc thought this could have been due to acid or allergies, so that’s when we started lansoprazole. I would have figured a viral laryngitis would have gone away by now; hopefully a repeat scope could answer this question? 🤞

    it seems like the docs are just going through this by system … gut: on acid meds, nose: on allergy meds and nose steroids, sinuses: ?? My thought is if the sinuses look ok, then we’ll just have to blame this on the advair. Not sure what we’ll do if that’s the case 😬. A friend said I could either ignore it (hard since I have to talk a lot at work) or change LABA/ics 😖. Feels like being between a rock and a hard spot. I struggle with some breakthrough symptoms but the meds have really helped decrease the frequency and depth of the symptoms and flares. 

  • Emelina

    Yahooo! There was a cancellation (due to possible snow storm) so got my appointment moved up to this Wednesday! Might need a sleigh and reindeer to get there but an appointment is an appointment! 

  • Kathy P

    Hey Em – glad you snagged an earlier appointment! Hope they have some ideas for figuring it out.

    I've been hoarse/squeaky since early March! It's slowly settling down, but still hanging around. The "thickness" feeling in my throat is mostly gone. I have a follow-up tomorrow for more allergy testing, but I suspect no one will ever figure out what was going on. I just hope it finally goes away and stays away!

  • Emelina

    Lol Debbie, Uber sky ride! Awesome

    Kathy, I was super excited to be able to snag that appointment. Boo on not being able to find answers for your hoarseness and squeakiness. I hope tomorrow’s allergy testing goes well. Like you, whatever it is, I hope it goes away and stays away. You don’t realize how much you use your voice and it impacts how others perceive you, until something changes about it. 😦 here’s hoping they find some answers for ya

  • Melissa G

    Em, that is great that you have an appt tomorrow! Wow, snow storm…I couldn't imagine getting snow this time of year. 

  • Emelina

    Hooray, made it to my ent appointment despite the snowmageddon. I had a good appointment. The laryngoscopy showed no lesions or plaques on the cords. Things were a bit swollen bluish to the back of the larynx and under the cords (suggestive of reflux). So he thinks this hoarseness could be from GERD and voice overuse +/- sinusitis. So, CT scan next week, keep taking lansoprazole twice per day (gross) and go to speech therapy + take it easy with the voice while allowing everything to heal. He mentioned I could take an antifungal for a couple months to prevent developing thrush because of steroids, but didn’t think it would be high yield. Thank goodness for specialists. 

    I’m kinda liking this Afrin/lidocaine spray they used for the laryngoscopy. I didn’t realize I was so congested until now … it’s like having a new turbo nose! 🤣

  • Emelina

    Tip for anyone reading this that may need a laryngoscopy. Please feel free to ask for more numbing if the local anesthesia is not adequate. My first laryngoscopy was a dream. The doc numbed my nose sequentially with lidocaine. The nozzle of the spray bottle was inserted deeper over about 4 trips to fully numb my nose and upper airway, then he sprayed the back of the throat. The result was there was almost no discomfort or gagging sensation. The pictures and views of the larynx were wonderful. 

    My 2nd laryngoscopy local anesthesia was 3 quick puffs of a lidocaine Spray and the result was much more uncomfortable. I could feel most of the nasal exam and was uncomfortable with the scope in the posterior pharynx. I felt gaggy and could feel many of the scope movements which triggered swallowing and obscured the views. It was a harder exam for both me and the doctor. There is no shame in asking for more numbing! It will help you, the doc, and get you better pictures! 

  • LK

    Very good point Em!

    I have had one laryngoscopy and thankfully it went as well as your first one.