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Side Effects With Inhaled Corticosteroids: Systematic Review

Published in Asthma

Side Effects With Inhaled Corticosteroids: Systematic ReviewThe authors also showed that immediately after inhalation of 200 ^g of FP, there were significant amounts of FP in the esophagus (3.3 ^g). Even after 30 min, FP remained detectable and the amount of drug recovered was affected by whether the patient was prone or remained upright (0.67 ^g if the patient laid down immediately or 0.11 ^g if they remained standing). This study implies that if asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal candidiasis. review

In addition, by changing the FP inhalation times to before breakfast and dinner, the remaining FP in the esophagus would be removed by the passage of food and would not remain in the esophagus. Thus, physicians need to be aware of the possibility of esophageal candidiasis with FP therapy and advise patients on how to potentially minimize their risk for this side effect.
Dysphonia or hoarseness, cough, and pharyngitis have also been reported with ICS use. Dysphonia is observed in 5 to 50% of patients receiving ICS. Dysphonia appears to be a direct effect of the corticosteroid, as dysphonia was absent when the propellant or excipients were administered without ICS. Dysphonia was associated with vocal stress and increasing dosages of ICS and was more frequently observed in patients using a spacer de-vice.- Compared with placebo, there were no differences in the rates of dysphonia with MF (100, 200, and 400 ^g bid) or BDP at 168 ^g bid (frequency of dysphonia was 1 to 3%). However, at doses of MF between 800 ^g and 1,600 ^g, 7 to 12% of patients reported dysphonia.

Cough during ICS inhalation has been reported in 34% of adults, with no difference in the incidence of this side effect between BDP and BUD. While the risk of oropharyngeal soreness/hoarseness reported for adults in systematic reviews with BUD was no different than with placebo, it was increased with FP dose.’ Moreover, the incidence of hoarseness was 4% in patients receiving FP at 220 ^g bid vs < 1% for triamcinolone acetonide (TAA) at 600 ^g bid over 12 weeks. Although hoarseness was lower with CIC at 640 ^g/d (2.4%) compared with FP at 880 ^g/d (4.6%), this difference was not significant (p = 0.07), and there was no significant difference between the two groups in the frequency of pharyngitis (4.1% vs 5.4%, respectively; p = 0.28). In a systematic review of comparative studies, pharyngitis was more likely with FP at twice the dose of BDP or BUD.