Table of ContentsView AllTable of ContentsHoarsenessOral ThrushOsteoporosisVision Problems
Table of ContentsView All
View All
Table of Contents
Hoarseness
Oral Thrush
Osteoporosis
Vision Problems
Inhaled corticosteroids, also known as steroids orglucocorticoids, are generally used on an ongoing basis to control symptoms ofasthma,chronic obstructive pulmonary disease (COPD), or other chronic breathing disorders.
These medications can have side effects, however. Some of these may be serious. This article will explain the four most common side effects of inhaled corticosteroids. It will also discuss ways they can be treated or prevented.
Corticosteroids should not be confused withanabolic steroids, which are used to stimulate muscle growth.
How Oral and Inhaled Steroids Differ
Some people who use inhaled steroids may develop a hoarse voice. This is referred to asdysphonia. This can occur due to the drug’s effect on the muscles of the vocal cords.
Dysphonia is reported in up to 50% of people on steroid inhalers, although the symptom tends to be mild and pose no long-term risks.Generally, dysphonia lasts for days to weeks at a time.
Metered-dose inhalers (MDIs)like Asmanex HFA (mometasone), Qvar Redihaler (beclomethasone), and fluticasone propionate HFA tend to cause less vocal hoarseness than certaindry-powder inhalers (DPIs)like Diskus inhalers.
Rarely, high-dose oral steroids and not usually inhaled steroids may cause laryngopharyngeal reflux. With this, stomach acids back up into the throat, causing pain, vocal cord inflammation, andlaryngitis. In such cases, the dose may need to be reduced, or the formulation switched.
Combination Inhalers Used in the Treatment of Asthma
People who take inhaled steroids areat risk for oral thrush. This fungal infection of the mouth is also known asoral candidiasis. Oral thrush affects roughly 3% of users of inhaled corticosteroids. The risk is increased in people with a weakened immune system as well as in those who overuse the drug or use it incorrectly.
Symptoms of oral candidiasisinclude:
The infection causes white patches to develop on the roof of the mouth or back of the throat; they can also appear on the tongue, gums, and inner cheeks. If these are scraped off they may reveal inflamed and bleeding tissue underneath.
If thrush does develop, your physician will likely prescribe an antifungal mouth rinse or in severe cases may prescribe Diflucan (fluconazole) tablets.
How Oral Thrush Is Treated
Inhaled steroids, particularly at high doses, may place older adults at an increased risk forosteoporosis(thinning and weakening of bones). Though osteoporosis is far more likely when taking oral steroids, high-dose inhalants can also contribute to bone brittleness.
Studies suggest that adults who use long-term, high-dose inhaled steroids have a 27% greater risk of fractures due to osteoporosis.
Symptoms of osteoporosis may include:
Many people with osteoporosis do not even realize they have it until they experience an unexpected bone fracture.
Weight-bearing exercises (such as walking and lifting weights) can help prevent osteoporosis. If bone loss is severe, it may be necessary for your healthcare provider to adjust your steroid dose.
How Osteoporosis Is Treated
A 2018 study in theDigital Journal of Ophthalmologyfound that adults who used inhaled budesonide for six months or more had significant increases in inner eye pressure.
Similarly, people who take high doses over a long period of time were found to be at greater risk of cataracts than those who received lower doses.
Cataract SymptomsBlurred, dim, or cloudy visionLight sensitivityHalos around lightsFading or yellowing of colorsNight blindnessNeed for brighter lightsGlaucoma SymptomsEye painBlurred visionHalos around lightsEye rednessSevere headacheNausea and vomiting
Cataract SymptomsBlurred, dim, or cloudy visionLight sensitivityHalos around lightsFading or yellowing of colorsNight blindnessNeed for brighter lights
Blurred, dim, or cloudy vision
Light sensitivity
Halos around lights
Fading or yellowing of colors
Night blindness
Need for brighter lights
Glaucoma SymptomsEye painBlurred visionHalos around lightsEye rednessSevere headacheNausea and vomiting
Eye pain
Blurred vision
Eye redness
Severe headache
Nausea and vomiting
If you develop glaucoma or cataracts due to inhaled steroid use, your treatment may need to be modified. Surgical intervention may also be considered. Surgical options include laser trabeculectomy for glaucoma andextracapsular surgeryfor cataracts.
Summary
A Word From Verywell
While some of the side effects of inhaled steroids are concerning, it is always important to weigh the benefits of these medications on your respiratory function against the risks. In most cases, inhaled steroids can be taken safely under the supervision and routine care of a healthcare provider.
If you are experiencingside effectsfrom a steroid drug, speak with your healthcare provider about alternatives or adjustments that may help. But never stop treatment without their approval. Doing so can lead tosteroid withdrawaland a return of symptoms.
Common Side Effects of Topical Steroid Use
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Henriksen DP, Davidsen JR, Christiansen A, Laursen CB, Damkier P, Hallas J.Inhaled corticosteroids and systemic or topical antifungal therapy: A symmetry analysis.Ann Am Thorac Soc.2017;14(6):1045-7. doi:10.1513/AnnalsATS.201612-1043LE
Erdoğan T, Karakaya G, Kalyoncu AF.The frequency and risk factors for oropharyngeal candidiasis in adult asthma patients using inhaled corticosteroids.Turk Thorac J. 2019;20(2):136-9. doi:10.5152/TurkThoracJ.2019.17011916
Centers for Disease Control and Prevention.Candida infections of the mouth, throat, and esophagus.
Pandya D, Puttanna A, Balagopal V.Systemic effects of inhaled corticosteroids: An overview.Open Respir Med J.2014; 8;59-65. doi:10.2174/1874306401408010059
Chee C, Sellahewa L, Pappachan JM.Inhaled corticosteroids and bone health.Open Respir Med J.2014;8:85-92. doi:10.2174/1874306401408010085
Shroff S, Thomas RK, D’Souza G, Nithyanandan S.The effect of inhaled steroids on the intraocular pressure.Digit J Ophthalmol.2018;24(3):6-9. doi:10.5693/djo.01.2018.04.001
Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol.2013;9(1):30. doi:10.1186/1710-1492-9-30
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