The Asthma - Candida Link

Inhaled steroids for the treatment of asthma have become a standard in Australia and many countries around the world. They are an essential cornerstone in the management of persistent asthma. However, a small percentage of people may experience an overgrowth of candida in the mouth and throat as a side effect of these medications.

Candida infections occur because the corticosteroids inhalers that depress the immune system in the lungs have the same effect on the surface of the throat. With a typical inhaler most of the drugs ends up on your throat on its way to the lungs. Unfortunately, this makes the surface area in these areas more prone to pathogenic microbes such as Candida spp.

What is candida?

Candida albicans is a type of yeast and the usual pathogen responsible for yeast infections such as thrush and oral candidiasis. There are several species of candida, the most prominent being candida albicans. We all host levels of candida in our bodies however in excess, this infection can trigger the release of inflammatory mediators resulting in localised tissue irritation and damage. Characteristics of candida infection include white blotches or spots on the mucosa of the mouth, throat or tongue.

Candida spp. can be difficult to treat. Prolonged use of antifungal medication and use of corticosteroid oral asthma treatments supress the immune system, and the infecting pathogen ingeniously creates a protective wall around itself - known as a biofilm, which is resistant to treatment and our immune system defenses allowing infections to persist and thrive in the body.

How to reduce candida from asthma medication

Rinsing and gargling with water and brushing teeth after inhaling doses of steroids can help reduce risk of infection. 

Using a spacer

A spacer is a chamber that connects to the end of the puffer—spreading out the medication and allowing slower inhalation into the lungs. It helps transport steroid into lungs where it is needed and reduces the risk of it settling in the mouth and throat.

Tea tree oil

Tea tree (Melaleuca alternifolia) is a natural anti-fungal agent. Brushing teeth using tea tree toothpaste or gargling with tea tree mouthwash can reduce fungal infection.

Anti-candida diet

Candida thrives on sugar, eliminating simple sugars from the diet can help reduce its spread. Sugars to reduce include honey, dried, fresh fruit and fruit juice; refined sugar, sweets, soft drinks and alcohol. High carbohydrate foods such as grains and starchy vegetables (peas, carrots, pumpkin and potato) should be consumed sparingly.

Some people with candida infections develop an intolerance to yeasts found in foods and may find avoiding these foods along with fermented foods helpful. This includes bread, vinegar, pickles, alcohol, vegemite and other yeast spreads, processed/deli meats, mushrooms, cheese and leftover foods.

Base diet on natural, fresh wholefoods. Include plenty of vegetables and protein from fresh fish, lean meat, nuts, seeds and legumes. Natural, unsweetened yoghurt can be helpful to restore healthy levels of bacteria or supplement with a probiotic. 

Probiotic supplement

Saccharomyces boulardii is a healthy yeast that has been shown to reduce populations of candida. It does this by reducing their ability to adhere to the oral mucosa - preventing colonisation. Saccharomyces boulardii supports levels of other healthy flora to further prevent invading pathogens in the mouth and throat. Other species of probiotics may promote healthy gut bacteria and help against proliferation of Candida. 

Garlic

Garlic contains the compound allicin which offers antifungal activity against candida albicans. However, mincing and cooking with garlic destroys many of the antifungal properties. 

Supplementing with a high-strength garlic capsule will offer a more therapeutic action. 

Oregano oil

Oregano oil contains the constituents carvacrol and thymol offering a strong antimicrobial action against candida and other micro-organisms. Oregano oil is available in capsule or liquid form.

Supporting immunity

Herbal medicine which helps with immunity include:

• Echinacea root 
• Andrographis
• Astragalus
• Siberian Ginseng 

Caution is advised when supplementing with any new herbal medicine to avoid any allergic or adverse reaction. 

Zinc and vitamin C are essential for the immune system to work efficiently, especially when any infection is involved. 

Vitamin D levels are often low in people who suffer from asthma and may increase their susceptibility to infection.  

The information provided is not intended to be used for diagnosis or treatment. If you are experiencing any health concerns, please consult your doctor for advice.

References

1. Ellepola AN, Samaranayake LP. Inhalational and topical steroids, and oral candidiasis: a mini review. Oral Dis. 2001 Jul;7(4):211-6 https://www.ncbi.nlm.nih.gov/pubmed/11575870
2. Heman-Ackah YD, et al. Laryngeal thrush from asthma inhalers. Ear Nose Throat J. 2012 Jan;91(1):E24-5  http://www.entjournal.com/article/laryngeal-thrush-asthma-inhalers
3. Murzyn A, et al. Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation. PLoS One. 2010 Aug 10;5(8):e12050 https://www.ncbi.nlm.nih.gov/pubmed/20706577
4. Matsubara VH, et al. Probiotics as antifungals in mucosal candidiasis. Clin Infect Dis. 2016 May 1;62(9):1143-53  https://www.ncbi.nlm.nih.gov/pubmed/26826375
5. Shuford JA, et al. Effects of fresh garlic extract on Candida albicans biofilms. Antimicrob Agents Chemother. 2005 Jan;49(1):473 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC538912/
6. Cleff MB, et al. In vitro activity of origanum vulgare essential oil against candida species. Braz J Microbiol. 2010 Jan-Mar,41(1):116-123 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768597/