Side effects of inhaler
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Side Effects of Inhalers: A Comprehensive Overview
Inhalers are a cornerstone in the management of respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). However, their use is not without side effects, which can be both local and systemic. This article synthesizes the findings from multiple studies to provide a clear understanding of these side effects.
Local Side Effects of Inhaled Corticosteroids (ICS)
Hoarseness and Oropharyngeal Candidiasis
One of the most common local side effects of inhaled corticosteroids (ICS) is hoarseness and oropharyngeal candidiasis. These side effects are often seen in patients using pressurized metered-dose inhalers (pMDIs) . A study comparing pMDIs with Turbuhaler found that switching to Turbuhaler significantly reduced the incidence of these side effects. Specifically, the frequency of local side effects decreased from 21% to 6% in experienced pMDI users after switching to Turbuhaler .
Cough and Wheezing
Cough and wheezing are also frequent side effects associated with inhaled corticosteroids, particularly beclomethasone dipropionate aerosol (BA). In a study, 20% of asthmatic patients experienced severe cough and wheezing after inhaling BA, which interfered with their compliance to the therapy. Pretreatment with a bronchodilator like albuterol was found to attenuate these side effects in some patients .
Pharyngeal Deposition
The deposition of the drug in the oropharynx can lead to an unpleasant taste and potential side effects such as pharyngeal candidiasis and hoarseness. This is particularly an issue with pMDIs, where up to 80% of the drug can be deposited in the oropharynx . Using a spacer device can help mitigate these issues by improving drug delivery to the lungs and reducing oropharyngeal deposition 56.
Systemic Side Effects
Cardiovascular and Metabolic Effects
Systemic side effects are less common but can occur, especially with higher doses of inhaled medications. For instance, inhaling an increased dose of albuterol can lead to systemic beta-adrenergic side effects such as increased heart rate, elevated blood pressure, and changes in serum glucose and insulin levels. These effects were observed as early as five minutes after inhalation and peaked within 30 minutes . Interestingly, mouth rinsing and gargling after inhalation did not significantly reduce these systemic side effects .
Bronchodilation and Plasma Concentrations
The mode of inhalation can also influence the side effects and efficacy of the medication. For example, different inspiratory flows through a dry powder inhaler (DPI) like the Turbuhaler resulted in comparable bronchodilation but slightly reduced side effects and lower plasma concentrations of terbutaline when the inspiratory flow was reduced to approximately 34 L/min .
Conclusion
Inhalers, while effective in managing respiratory conditions, come with a range of side effects that can impact patient compliance and overall treatment efficacy. Local side effects such as hoarseness, oropharyngeal candidiasis, cough, and wheezing are common but can be mitigated by using devices like Turbuhaler or spacer devices. Systemic side effects, although less frequent, can occur with higher doses and are not significantly reduced by simple measures like mouth rinsing. Understanding these side effects and their management is crucial for optimizing inhaler therapy and improving patient outcomes.
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