Flovent inhalers, including Flovent HFA and Flovent Diskus, are widely prescribed to help prevent asthma symptoms. Both contain fluticasone propionate, a corticosteroid that reduces airway inflammation. While Flovent is effective in preventing asthma symptoms, it may cause side effects, some mild, others more serious.
A large review of studies with over 66,000 people found that using inhaled corticosteroids like Flovent for a year or more can raise the risk of getting pneumonia by about 41%.
Recognizing the potential side effects of Flovent inhalers can help you use it safely and respond appropriately if problems arise.
Quick Recap
Common Side Effects of Flovent Inhaler
Since both Flovent Diskus and Flovent HFA use the same medication, they usually cause the same side effects. These are mostly mild and happen due to how the drug affects the airways or the mouth and throat.
Common side effects of Flovent HFA and Diskus include:
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- Upper respiratory tract infections or inflammation
- Throat irritation
- Sinusitis
- Oral thrush (candidiasis)
- Headache
- Cough
- Bronchitis
Device-Specific Side Effects
Although both forms deliver the same medication, the delivery method can influence how the body reacts.
Flovent HFA is a pressurized metered-dose inhaler (pMDI) that uses a chemical propellant to release the medication. On the other hand, Flovent Diskus is a dry powder inhaler (DPI) that releases the medication in powder form when you inhale.
For instance, dysphonia is more commonly linked to Flovent HFA. It refers to changes in voice quality due to effects on the vocal cords. Symptoms may include hoarseness, vocal strain, or a weak or breathy voice.
In one observational study, 154 patients used a pMDI for two years before switching to a DPI. After the switch, the rate of dysphonia dropped from 21% to 6%, suggesting that dry powder inhalers may exert less strain on the vocal cords.
Another study reviewed multiple clinical trials and found that steroid inhalers using the pMDI type had a 5-fold higher risk of causing dysphonia, while those using the DPI had a 3-fold higher risk.
Meanwhile, Flovent Diskus may be more likely to cause:
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- Rhinitis
- Nausea or vomiting
- Stomach discomfort
- Fever
Note that these side effects are not entirely exclusive to one device. Both forms of Flovent can cause them because the underlying cause is still the fluticasone propionate. What varies is how often they occur with each delivery method.
Serious Side Effects of Flovent Inhaler
Using Flovent can also cause serious side effects that require immediate medical attention. These include:
1. Fungal infections in the mouth or throat (oral thrush)
Flovent is an inhaled corticosteroid that helps reduce inflammation by lowering the immune response in the airways. However, it also weakens the natural defenses in the mouth and throat.
Candida yeast, which normally lives in small amounts in your mouth, can start to grow too much. This happens because your immune system isn’t as active, and Candida grows well in warm, moist places.
It also sticks easily to the inside of your mouth and forms protective layers, making it harder for your body to fight off. This can lead to an overgrowth known as oral thrush, also called oropharyngeal candidiasis.
Symptoms are:
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- White patches on the tongue, inner cheeks, or roof of the mouth
- Soreness or burning sensation in the mouth
- Difficulty swallowing or a cottony feeling
The most effective way to prevent this is to rinse your mouth and spit after every dose of Flovent.
2. Weakened immune system
As mentioned earlier, Flovent can weaken the body’s immune defenses. This doesn’t just lead to oral thrush. It also increases the risk of more serious infections, such as latent tuberculosis or herpes simplex. The risk is higher if you already have a weakened immune system or a history of infections.
Some of the possible complications include:
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- Reactivation of tuberculosis
- Worsening of fungal, bacterial, or viral infections
- Eye infections (ocular herpes simplex)
A large study compared Flovent with another inhaled corticosteroid, budesonide. It found that people using Flovent had a 28% higher risk of TB. For every 100,000 people per year, around 275 Flovent users developed TB, compared to 214 budesonide users.
Another analysis found that TB risk may continue for up to 3 years after stopping Flovent, especially in people with COPD.
Be more cautious when using Flovent if you have other health conditions (comorbidities). Watch for early signs of infection such as:
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- Fever or chills
- Persistent cough
- Eye pain or vision changes
- Skin lesions or worsening sores
- Fatigue or muscle aches
Avoid close contact with people who have infections like chickenpox or measles. If you’re exposed, let your doctor know right away to get preventive treatment. Try to use the lowest dose of Flovent that can still manage your symptoms.
3. Reduced adrenal function
Reduced adrenal function, also known as adrenal insufficiency, means your adrenal glands aren’t producing enough of certain hormones, especially cortisol. Your body relies on cortisol to manage stress, regulate blood pressure, and maintain stable energy levels.
When cortisol levels are too low, especially during physical or emotional stress, your body may struggle to cope. This can lead to an adrenal crisis, which is life-threatening. Warning signs include:
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- Severe fatigue
- Nausea, vomiting, or diarrhea
- Low blood pressure
- Dizziness or fainting
- Confusio
- Unexplained weight loss
- Stomach pain
- Loss of appetite
- Craving for salty foods
Doses under 500 mcg per day are usually thought to be safe. However, a 2012 study found that even moderate doses (500 mcg or less per day) caused adrenal insufficiency in 14 children.
In a case report, a 55-year-old woman used 220 mcg of Flovent twice daily as prescribed and was later diagnosed with adrenal insufficiency. Blood tests showed an undetectable morning cortisol level and low levels of another hormone called DHEA-S.
Symptoms can be mild and easy to miss. Ask your doctor about regular morning cortisol tests, especially if you feel unusually tired or unwell.
4. Serious allergic reactions
Though rare, you may develop an allergic reaction to fluticasone or to other ingredients in the inhaler. This includes milk proteins in Flovent Diskus and the HFA-134a propellant in Flovent HFA. During an allergic reaction, your immune system releases histamine and other chemicals, affecting your skin, airways, or whole body.
Symptoms include:
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- Rash, itching, or hives
- Swelling of the face, lips, tongue, or throat
- Trouble breathing
- Feeling faint or unusually tired
- Tightness in the chest
Immediate medical attention is required if any of these symptoms occur.
5. Bone thinning or weakness (osteoporosis)
Osteoporosis is a well-documented side effect of long-term oral corticosteroid use. Some studies have shown that bone loss can begin as early as three days after starting treatment. Previous studies have shown that inhaled corticosteroids (ICS) may lead to similar effects.
One possible explanation is that ICS like Flovent may reduce the activity of cells that build and repair bone. They may also interfere with calcium levels, and when calcium levels drop, the body draws it from the bones, which can slowly weaken them over time.
Currently, evidence is mixed on how much ICS affects bone metabolism or increases osteoporosis risk in people with asthma. Still, it’s important to stay aware of the potential risk, especially if you have other factors that affect bone health, including:
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- Family history of osteoporosis
- Postmenopausal status
- Tobacco use
- Older age
- Poor nutrition
- Long-term use of medications that affect bone density (e.g., anticonvulsants, oral steroids)
Osteoporosis usually develops without any obvious signs. Later on, it can cause bone pain, easy fractures, or a loss of height with a hunched back.
Experts recommend maintaining adequate calcium and vitamin D intake, which may include supplements if needed.
6. Slowed growth in children
Steroids can interfere with the body’s natural growth process in several ways. For example, they can:
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- Disrupt the normal release of growth hormone
- Reduce the activity of important growth-related proteins
- Slow down bone-building cells
- Lower collagen production, which supports bone and tissue growth
- Decrease adrenal hormones that help with development
- Affect calcium levels by making it harder to absorb from food and causing more to be lost in urine, which can weaken bones
Altogether, too much corticosteroid can stop a child from growing normally.
But it’s also important to remember that chronic illnesses like asthma can affect growth on their own, even without steroid treatment. The reason for this isn’t fully understood, but it may be due to the body’s own stress hormones and inflammation from being sick.
One study followed 82 young children with asthma who hadn’t taken steroids yet. It found that those with more severe asthma were shorter for their age than those with milder forms. This suggests that both the disease and the treatment can affect growth.
Because of this, it’s generally recommended that the smallest effective dose should be used in pediatric patients to minimize this risk.
7. Eye problems (glaucoma, cataracts, vision changes)
Steroid use is the fourth most common cause of cataracts that are not caused by aging or injury, and it accounts for nearly 5% of all cataract removal surgeries. This condition occurs when the clear lens of your eye becomes cloudy, making it harder to see.
Additionally, steroids can raise eye pressure, called intraocular pressure (IOP). This increases the risk of developing another vision problem called glaucoma, a condition that can damage the optic nerve and lead to vision loss.
Symptoms of these vision problems include:
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- Blurred or cloudy vision
- Seeing halos around lights
- Eye pain or pressure
- Gradual loss of peripheral vision
If you’re taking long-term Flovent treatment, get regular eye exams, and tell your doctor immediately if you notice any of the symptoms above.
8. Increased wheezing
Instead of feeling relief, you might feel more wheezing, coughing, or tightness in the chest just seconds to minutes after inhaling Flovent. This is known as paradoxical bronchospasm and can be dangerous.
In a recent case report, a 14-year-old girl started coughing and wheezing about 20 minutes after using a Flovent Diskus. Doctors then performed allergy skin tests, but all tests returned negative, meaning she wasn’t allergic to them.
If this happens, stop using the medication immediately. Use a rescue inhaler (like albuterol) if prescribed, and call your doctor or go to the ER if symptoms worsen.
Summary
Most side effects of the Flovent inhaler are mild and affect the mouth, throat, or lungs, like cough, sore throat, or oral thrush. However, some effects depend on the type of inhaler. For example, voice changes are more common with Flovent HFA, while nasal or stomach issues may show up more with Flovent Diskus.
Flovent can also cause serious problems. It may weaken your immune system and increase your risk of infections like tuberculosis. Long-term use can affect adrenal function, slow growth in children, and weaken bones. It may also increase your risk of eye problems like glaucoma or cataracts. Rarely, it can cause allergic reactions or make breathing worse right after use.
To stay safe, always rinse your mouth after each dose, use the lowest effective dose, and let your doctor know if you notice anything unusual, like fatigue, vision changes, or signs of infection.
Frequently Asked Questions
Related Articles
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