Side Effects of Inhalers: How to Manage and Prevent (2025)

Inhalers are essential tools for managing respiratory conditions like asthma, chronic obstructive pulmonary disease (COPD), and other breathing disorders. They deliver medication directly into the lungs, providing quick and effective relief from symptoms such as wheezing, shortness of breath, and chest tightness.

However, while inhalers are generally safe and beneficial when used correctly, they can also cause side effects—some mild and temporary, others more serious if left unchecked. Understanding the potential side effects of inhalers can help patients use them more effectively and avoid unnecessary complications.

Common Side Effects of Inhalers

Inhalers are essential for managing asthma and other respiratory conditions, but they can cause unwanted reactions. Users often notice specific symptoms related to the mouth, throat, and voice due to direct contact with inhaled medication.

Throat Irritation

Throat irritation frequently happens when medicine particles deposit on the throat lining instead of the lungs. It may feel like mild burning, scratching, or soreness. This is more common with corticosteroid inhalers, but can occur with bronchodilators as well.

The severity depends on the type of inhaler, dose, and technique used. Improper inhaler technique, such as not rinsing the mouth after each use, can increase irritation. Throat discomfort often improves with technique adjustments and rinsing the mouth, but some may need to consult their healthcare provider if it persists or worsens.

Hoarseness of Voice

Hoarseness, or a change in the quality of voice, is a recognizable side effect, especially in those who use inhaled corticosteroids regularly. It often manifests as a weak, raspy, or breathy voice. This occurs when medication causes slight inflammation or irritation of the vocal cords.

Risk factors include higher doses, daily use, and not using a spacer device. Hoarseness usually develops over days to weeks. It can often be minimized by using a spacer with inhalers and rinsing the mouth and throat after inhalation. If symptoms continue, dosage adjustments may be needed under medical guidance.

Coughing

Some individuals develop a cough directly after using an inhaler. This can be triggered by the force of inhalation, cold aerosol, or irritation from medication residue. The cough is often dry and happens instantly or within minutes of using the inhaler.

Improper technique, such as inhaling too forcefully, can make coughing worse. Using a spacer or practicing slower, gentler breaths may help. For most, the coughing is brief and settles without intervention, but persistent cough should be discussed with a healthcare professional.

Dry Mouth

Dry mouth is a common complaint, particularly with inhalers that contain anticholinergic drugs, but it can also occur with other types. Decreased saliva can make the mouth feel sticky, increase the risk of dental issues, and alter the sense of taste.

Regular and prolonged use raises the chances of experiencing dry mouth. To manage dryness, users can drink water frequently, chew sugar-free gum, or use saliva substitutes. Good oral hygiene is important to prevent cavities and infections, as the reduction in saliva can make these more likely.

Serious Adverse Reactions

Some inhalers can cause uncommon but potentially severe health issues. These effects require immediate attention and, if ignored, may result in serious medical complications.

Paradoxical Bronchospasm

Paradoxical bronchospasm is a rare reaction where inhaler use leads to sudden worsening of breathing problems. Instead of relieving airway constriction, the inhaler causes increased wheezing, cough, shortness of breath, or tightness in the chest.

This reaction may be life-threatening if not recognized and treated quickly. Paradoxical bronchospasm usually happens shortly after inhaler use, especially with fast-acting bronchodilators or certain preservatives in the inhaler formulation.

Patients should stop using the inhaler immediately and seek emergency care if symptoms worsen right after use. The device should not be used again until evaluated by a healthcare professional. Individuals with a history of severe asthma attacks should use caution and monitor their symptoms closely.

Allergic Reactions

Allergic reactions to inhalers can range from mild skin rash to severe anaphylaxis. Signs can include hives, swelling of the lips, face, or tongue, and difficulty breathing.

These reactions can be caused by the active drug or by inactive ingredients such as propellants or flavorings. Anaphylactic reactions, while rare, require urgent medical intervention.

Inhalers containing steroids or beta-agonists may increase the risk of allergic reaction in some patients. Individuals who experience any allergic symptoms should stop using the inhaler and consult a healthcare provider without delay.

Adrenal Suppression

Long-term use of inhaled corticosteroids can suppress adrenal gland function. Symptoms may include fatigue, weakness, nausea, vomiting, low blood pressure, and, in severe cases, adrenal crisis.

The risk increases with high doses or extended use. Children may also experience slowed growth due to adrenal suppression. Regular medical check-ups are important for those on long-term inhaled steroids to monitor adrenal function.

Healthcare providers may recommend the lowest effective steroid dose and additional precautions during stressful situations such as surgery or serious illness. Gradual dose reduction under supervision is important to prevent sudden adrenal insufficiency.

Differences by Inhaler Type

Each type of inhaler contains different active ingredients and works in unique ways. Side effects can vary significantly based on whether an inhaler uses corticosteroids, bronchodilators, or a combination of medications.

Corticosteroid Inhalers

Corticosteroid inhalers reduce inflammation in the airways and are mainly used for long-term asthma control. The most common side effects include hoarseness, sore throat, and oral thrush (a fungal infection in the mouth). Rinsing the mouth after each use helps lower the risk of oral thrush.

Less commonly, some people may experience cough or a mild taste disturbance. When corticosteroids are used at high doses over long periods, there is a small possibility of systemic effects such as bone thinning, slow growth in children, and easy bruising. However, these risks are lower with inhaled forms than with oral steroids.

Note: There are rare reports of mood changes or insomnia. Inhaled corticosteroids are typically considered safe for most patients when used as directed.

Bronchodilator Inhalers

Bronchodilator inhalers are designed to relax the muscles around the airways, which helps relieve symptoms like wheezing and shortness of breath. There are two main types: short-acting (for quick relief) and long-acting (for ongoing control).

Typical side effects include shakiness (tremor), nervousness, and headache. Some users experience a rapid heartbeat (palpitations) or mild muscle cramps. These effects are often mild and short-lived, especially with proper use.

Occasionally, higher doses can cause chest pain or irregular heartbeats, particularly in people with heart problems. Bronchodilators do not cause oral thrush, but they can lead to dry mouth or throat irritation.

Combination Inhalers

Combination inhalers contain both a corticosteroid and a long-acting bronchodilator, addressing both airway inflammation and constriction. As a result, these inhalers can cause side effects associated with either component.

Common side effects include hoarseness, oral thrush, headache, and tremor. Some people may also notice a fast heartbeat or mild muscle cramps. Rinsing the mouth after each use remains important to prevent thrush.

In rare cases, combination inhalers may increase the risk of pneumonia in people with chronic lung disease. Risk of systemic corticosteroid side effects remains low, but may increase with prolonged or high-dose use. Following prescribed dosing helps limit unwanted effects.

Long-Term Risks of Inhaler Use

Long-term inhaler use can cause several specific side effects, particularly with higher doses or improper technique. Patients should understand these risks to manage and monitor their health effectively.

Oral Thrush

Inhaled corticosteroids can lead to oral thrush, a fungal infection in the mouth. This happens because medication particles sometimes settle in the throat and mouth rather than reaching the lungs. The main symptoms are white patches, redness, and soreness in the mouth and throat, which may cause discomfort during eating or speaking.

Risk factors include poor inhaler technique, not rinsing the mouth after use, and higher dosage levels. Oral thrush can often be managed with antifungal medications prescribed by a physician.

Note: Prevention involves rinsing the mouth and gargling with water after using each dose. Using a spacer device can further reduce medication deposits in the mouth.

Osteoporosis

Long-term, high-dose inhaled corticosteroids may increase the risk of decreased bone mineral density. This can raise the likelihood of fractures, especially in older adults or those with additional risk factors such as smoking or low calcium intake.

Risk is typically lower than with oral steroids, but it still exists, particularly when inhalers are used daily for extended periods. Signs like persistent back pain or unexplained fractures may signal bone loss and should prompt medical attention.

To help prevent osteoporosis, patients are advised to maintain adequate calcium and vitamin D intake, engage in regular weight-bearing exercise, and have periodic bone density assessments, especially if they are on higher doses.

Growth Suppression in Children

Inhaled corticosteroids can potentially slow growth in children if used over a long period, particularly at higher doses. Clinical studies have found small but measurable reductions in growth velocity, especially in the first year of treatment.

Pediatricians typically use the lowest effective dose to control asthma or respiratory symptoms and regularly monitor a child’s growth with height charts. If slowed growth is noted, they may adjust the medication dose or explore alternative therapies.

While most children reach their expected adult height, ongoing assessment is critical. Parents and caregivers should discuss any concerns about growth with their child’s healthcare provider to ensure proper management.

Managing and Reducing Side Effects

Effective strategies exist to minimize inhaler side effects, emphasizing how medications are taken and maintained. Small adjustments in daily habits and device use significantly lower risks of discomfort or complications.

Proper Inhaler Technique

Using the correct inhaler technique ensures medicine reaches the lungs effectively. Incorrect technique can lead to more medication remaining in the mouth or throat, which increases local side effects like hoarseness or oral thrush. Patients should always shake their inhaler if required and exhale fully before using it.

It is important to form a tight seal with the lips around the mouthpiece. Breathing in slowly and deeply as the inhaler is pressed delivers more medication to the lungs. Holding the breath for 5 to 10 seconds allows the medicine to settle.

Regular review of technique—even via demonstration to a clinician—helps identify and correct errors. Written directions and manufacturer videos can also clarify the best steps.

Use of Spacers

Spacers attach between the inhaler and mouth and help reduce side effects by holding the medication in a chamber. This makes it easier to inhale all the medicine with a single slow breath. Using a spacer can lower the risk of side effects such as oral thrush or sore throat by decreasing the amount of medicine that deposits in the mouth.

Certain medications, especially corticosteroid inhalers, are more likely to cause issues without a spacer. Spacers are usually made of plastic and are easy to clean with mild soap and water. They are especially recommended for children, though adults can benefit as well.

Proper use of a spacer involves shaking the inhaler, attaching the spacer, and ensuring a good seal around the mouthpiece. Inhaling slowly and holding the breath afterward optimizes the medication’s effect.

Regular Oral Hygiene

Rinsing the mouth with water after inhaler use removes residue that could otherwise irritate the mouth or throat. For steroid inhalers in particular, thorough rinsing and then spitting out the water rather than swallowing it prevents oral thrush and hoarseness.

Brushing teeth regularly and maintaining good oral health further lowers the risk of irritation. Those using inhalers frequently might notice dryness or a mild aftertaste; consistent rinsing helps with both.

Some healthcare providers recommend using mouthwash if irritation or thrush develops, but plain water is usually sufficient. Following these steps after every inhaler use becomes an easy routine to protect oral and throat health.

Drug Interactions and Precautions

Inhaler medications can interact with other prescribed drugs and health conditions. Some groups, such as pregnant individuals and older adults, require additional precautions to reduce risk.

Interactions with Other Medications

Certain inhalers—especially bronchodilators and corticosteroids—can interact with other medications used for heart conditions, depression, and seizures. For example, combining beta-agonist inhalers with some beta-blockers may reduce the effectiveness of asthma treatment or worsen breathing problems.

Medicines used for depression, like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, may increase the risk of side effects such as increased heart rate or blood pressure. People taking diuretics or medications that affect potassium levels should also use inhalers with caution, as combined use can sometimes lead to dangerously low potassium levels.

Always inform a healthcare provider of all medications being taken, including over-the-counter products and supplements. This helps prevent serious interactions or unexpected side effects.

Considerations for Pregnancy

The safety of inhaler use during pregnancy depends on the specific medication. Inhaled corticosteroids are generally considered safe and are often preferred for managing asthma, as uncontrolled asthma poses risks for both mother and baby. However, some inhalers—especially oral or high-dose corticosteroids—may increase the risk of certain pregnancy complications if not closely monitored.

Short-acting bronchodilators may be recommended for quick relief of symptoms, but regular maintenance therapy should always be reviewed with a healthcare provider. Whenever possible, the lowest effective dose is used to balance control of symptoms with safety for the developing fetus.

Women considering pregnancy or who become pregnant while using an inhaler should notify their healthcare provider promptly. Close follow-up is recommended to adjust treatment as needed and minimize any health risks.

Monitoring in Older Adults

Older adults are more likely to have other health conditions or take multiple medications, increasing the risk of drug interactions with inhalers. Steroid inhalers may carry higher risks of side effects like osteoporosis, increased blood sugar, or glaucoma in this group.

Some inhalers, such as anticholinergics, may worsen symptoms of prostate enlargement or cause confusion in older individuals. Monitoring for side effects—including tremors, heart palpitations, or changes in mental status—is essential.

Regular medication reviews with a healthcare provider are recommended. Adjustments may be needed to doses or drug choices to avoid complications and maintain effective symptom control.

Final Thoughts

Inhalers play a vital role in respiratory care, offering fast and targeted relief for millions of people worldwide. But like any medication, they are not without risks. Being aware of possible side effects—ranging from throat irritation and hoarseness to more serious issues like increased heart rate or dependence on rescue inhalers—can empower patients to use their devices responsibly.

Always follow your healthcare provider’s instructions, report any unusual symptoms, and make regular check-ins part of your treatment plan to ensure your inhaler therapy is both safe and effective.