Side effects of inhaler use
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Common Local Side Effects of Inhaler Use
Inhaler use, especially with inhaled corticosteroids (ICS), is often linked to local side effects in the mouth and throat. These include oropharyngeal candidiasis (oral thrush), dysphonia (voice changes or hoarseness), pharyngitis (sore throat), cough, reduced saliva flow, dental caries, dental erosion, and periodontal disease. These effects are generally considered minor but can impact quality of life and reduce adherence to therapy. The risk of these side effects can be influenced by the type of inhaler device, the formulation of the medication, and how well patients follow administration instructions. Using a spacer device can help reduce the risk of these local side effects, particularly dysphonia and structural changes in the vocal folds1567.
Systemic Side Effects of Inhaled Medications
While inhaled medications are designed to minimize systemic exposure, some systemic side effects can still occur, especially at higher doses or with long-term use. Reported systemic effects include decreased bone mineral density, increased risk of respiratory infections (such as pneumonia and mycobacterial infections), and a possible increased risk of cataracts. However, studies on these risks have shown conflicting results and are often limited by small sample sizes and other biases. More research is needed to clearly define the magnitude of these risks.
Adverse Events with Combination Inhaler Therapies
Combination inhalers, which may include corticosteroids, long-acting beta-agonists, and antimuscarinic agents, are associated with a range of adverse events. Commonly reported issues include device use problems, oropharyngeal and vocal problems, pneumonia, candida infections, and urinary retention. Some studies have also found a higher risk of vascular disorders and rare effects such as decreased body height and hearing issues. The risk profile can vary between different combination products, with some showing higher risks for specific side effects like pneumonia or candida infection23.
Behavioral and Nocebo-Related Side Effects
Behavioral side effects, such as mood or behavioral changes, have been reported in children using inhaled corticosteroids, though these are likely underreported in official databases. Additionally, some patients may experience nonspecific symptoms they attribute to inhaler use, known as the nocebo effect. These symptoms are not caused by the medication itself but by patient beliefs and concerns, which can negatively impact adherence to treatment48.
Safety of Inhaled Salbutamol in Young Children
Inhaled salbutamol, a common reliever medication, is generally safe for use in children under two years old with acute wheezing. Studies show no significant difference in adverse reactions compared to placebo, and severe side effects are rare. The metered-dose inhaler formulation appears to be safer than nebulized forms, with fewer reported adverse reactions.
Conclusion
Inhaler use is associated with a range of local side effects, particularly in the mouth and throat, and less commonly with systemic effects. The risk of side effects can be influenced by the type of medication, device, and patient technique. While most side effects are minor, they can affect adherence and quality of life. Awareness of these risks, proper inhaler technique, and the use of spacers can help minimize adverse effects. Behavioral and nocebo-related symptoms should also be considered, especially in children and patients with concerns about medication use. Overall, inhalers remain a safe and effective treatment when used correctly, but ongoing monitoring for side effects is important.
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