Side effects of steroid inhaler

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Side Effects of Steroid Inhalers

Steroid inhalers, commonly used for managing asthma, are effective but can have various side effects. These side effects can be categorized into local and systemic effects, with the severity often depending on the dosage and duration of use.

Local Side Effects of Steroid Inhalers

Throat and Voice Issues

One of the most common local side effects of inhaled corticosteroids is throat and voice problems. Studies have shown that a significant number of patients using pressurized aerosol inhaled steroids report symptoms such as voice dysphonia and throat irritation. Specifically, 58% of patients reported these symptoms compared to only 13% in a control group . Additionally, cough induced by the inhaler was reported by 34% of patients . These symptoms were prevalent regardless of the type of steroid used, whether beclomethasone dipropionate or budesonide .

Oral Candidiasis and Dermatitis

Oral candidiasis, a fungal infection in the mouth, is another frequent local side effect. This condition, along with perioral dermatitis, has been observed in patients using inhaled steroids . The incidence of these side effects can be influenced by the frequency and technique of inhaler use .

Cough and Wheezing

Cough and wheezing are also notable side effects, particularly with beclomethasone dipropionate aerosol. In some cases, these symptoms are severe enough to prevent continued use of the inhaler. Pretreatment with a bronchodilator has been shown to mitigate these effects in some patients .

Systemic Side Effects of Steroid Inhalers

Adrenal Suppression

Prolonged use of high-dose inhaled corticosteroids can lead to systemic side effects such as adrenal suppression. This condition occurs when the body's adrenal glands produce insufficient steroid hormones due to the external supply from the inhaler. Studies have shown that even therapeutic doses can cause mild suppression of the hypothalamic-pituitary-adrenal (HPA) axis in children .

Bone Density and Growth Retardation

Long-term use of inhaled steroids, especially at high doses, can affect bone mineral density and growth in children. Research comparing beclomethasone dipropionate and fluticasone propionate found that beclomethasone significantly decreased serum cortisol levels and slowed growth rates in children, whereas fluticasone did not show these effects at equivalent doses . Additionally, both fluticasone and budesonide have been shown to reduce growth rates in young children .

Cataracts and Glaucoma

There is also concern about the potential for cataracts and glaucoma with prolonged high-dose inhaled steroid use. These conditions are part of the broader spectrum of systemic side effects that can occur with these medications .

Conclusion

While inhaled corticosteroids are highly effective in managing asthma, they come with a range of potential side effects. Local side effects such as throat irritation, oral candidiasis, and cough are common, while systemic effects like adrenal suppression, reduced bone density, and growth retardation are more serious concerns, particularly with long-term high-dose use. Monitoring and managing these side effects are crucial for the safe and effective use of steroid inhalers.