Inhaled corticosteroids, also called steroids or Glucocorticoidscommonly used to continuously control symptoms of asthma, chronic obstructive pulmonary disease (COPD), or other chronic breathing disorders.
Inhaled steroids work by mimicking cortisol, a hormone produced by the body that usually reduces inflammation (tissue swelling).By doing so, they can relieve chronic airway inflammation, reduce bronchoconstriction (narrowing of the airways) and bronchospasm (constriction of the airways).
However, these drugs can have side effects. Some of them can be serious. This article will explain the four most common side effects of inhaled corticosteroids. It will also discuss how to treat or prevent them.
Corticosteroids should not be confused with anabolic steroids used to stimulate muscle growth.
How Oral and Inhaled Steroids Are Different
Some people who use inhaled steroids may experience hoarseness. This is called dysphonia. This may occur due to the effect of the drug on the muscles of the vocal cords.
Dysphonia affects more than 30% of people who use steroid inhalers, although symptoms tend to be mild and pose no long-term risk. Often, dysphonia lasts from days to weeks at a time.
Hoarseness due to metered-dose inhalers (MDIs) such as Flovent HFA (fluticasone), Asmanex HFA (mometasone) and Qvar Redihaler (beclomethasone) compared to dry powder inhalers (DPIs) such as Flovent Diskus, Asmanex Redihaler and Pulmicort Flexihaler To a lesser extent (budesonide).
In rare cases, high-dose steroids may cause laryngopharynx backflow. As a result, stomach acid can back up into the throat, causing pain, inflammation of the vocal cords, and laryngitis. In this case, the dose may need to be reduced or the formulation changed.
Combination inhaler for asthma
People who take inhaled steroids are at risk of developing thrush. This oral fungal infection is also known as oral candidiasis. Thrush affects about 3% of inhaled corticosteroid users. People with weakened immune systems and those who overuse or use medicines incorrectly are at increased risk.
Symptoms of oral candidiasis include:
- sore throat
- mouth or tongue irritation
- white plaque formation in the mouth
- loss of taste
- pain when eating or swallowing
- Cotton-like feeling in the mouth
The infection causes white patches to appear on the roof of the mouth or the back of the throat; they can also appear on the tongue, gums, and inside of the cheeks. If these are scraped off, they can reveal the inflamed and bleeding tissue underneath.
Thrush can be prevented by rinsing your mouth thoroughly with water and brushing your teeth immediately after inhaling corticosteroids. Some people prefer alcohol-based mouthwashes to water.
You can also reduce the risk of thrush by installing a spacer on the MDI’s nozzle. Tube extenders allow you to deliver inhaled medication down your throat instead of your mouth. (Shims don’t work in DPI, which has openings instead of tubular mouthpieces.)
If thrush does appear, more serious conditions can be treated with an antifungal mouthwash or Daflucon (fluconazole) tablets.
How to Treat Thrush
Inhaled steroids are known to increase the risk of osteoporosis (thinning and weakening of bones) in older adults. While you’re more likely to develop osteoporosis when taking oral steroids, high-dose inhalers can also cause bone brittleness.
Studies have shown that adults who use long-term, high-dose inhaled steroids have a 27 percent increased risk of fractures due to osteoporosis.
Symptoms of osteoporosis may include:
- back pain
- Decrease in height over time
- a bent posture
- easily broken bones
Many people with osteoporosis don’t even realize they have osteoporosis until they experience an unexpected fracture.
For those at highest risk for fractures, a calcium-rich diet and daily calcium supplementation (1,000 to 1,500 mg combined) are recommended. This includes postmenopausal women and older adults.
Weight-bearing exercise, such as walking and lifting weights, can help prevent osteoporosis. If bone loss is severe, your healthcare provider may need to adjust your steroid dose.
How to Treat Osteoporosis
Long-term use of oral steroids is known to increase the risk of cataracts (clouding of the lens) and glaucoma (optic nerve damage caused by elevated intraocular pressure). Inhaled steroids may also do this, especially in older adults who are already at high risk for these diseases.
A 2018 study Ophthalmology Digital Magazine Significant increases in intraocular pressure were found in adults who used inhaled budesonide for six months or longer.
Likewise, people who take high doses long-term have a greater risk of developing cataracts than those who take low doses.
blurred, dim, or cloudy vision
halo around lights
Faded or yellowed color
need brighter lights
halo around lights
nausea and vomiting
If you develop glaucoma or cataracts from inhaled steroids, your treatment may need to be adjusted. Surgical intervention may also be considered.Surgical options include laser Trabeculectomy Extracapsular surgery for glaucoma and cataracts.
Inhaled corticosteroids are an effective treatment for asthma and COPD symptoms. They work by reducing inflammation. This relieves the narrowing and constriction of the airway. However, inhaled steroids can have side effects. Some of these symptoms are mild and easy to treat, such as hoarseness and thrush. More serious side effects include osteoporosis and vision problems such as cataracts and glaucoma.
While some of the side effects of inhaled steroids are concerning, it’s always important to weigh the benefits and risks of these drugs on your respiratory function. In most cases, inhaled steroids can be safely taken under the supervision and routine care of a healthcare provider.
If you experience side effects from steroid medications, talk with your healthcare provider about alternatives or adjustments that may help. But never stop treatment without their approval. Doing so can lead to steroid withdrawal and recurrence of symptoms.
Common side effects of topical steroid use