What Are Common Inhaled Corticosteroids Side Effects?

Inhaled Corticosteroids Side Effects Asthma Patients Should Be Aware of

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The risks of developing inhaled corticosteroids (ICS) side effects are generally small but there are risks nonetheless. Additionally, with good technique, use of a spacer, and following instruction in how to use your inhaled corticosteroids, most of the side effects can be prevented as well.

What Are the Common Side Effects?

Inhaled corticosteroids side effects can be broken down into two types:

  • Local adverse effects (in only one area of the body)
  • Systemic effects (throughout the body)

Local Inhaled Corticosteroids Side Effects

  • Oral Candidiasis or Thrush: Thrush is one of the most common side effects of ICS;  with up to a third of patients developing this side effect. Lowering the dosage, using a spacer, and appropriately rinsing your mouth following inhalation all help lower your risk of thrush. Thrush also can be treated with topical or oral antifungals, such as nystatin. The irritation that results almost always seems to occur as a result of medication being delivered to the side of the mouth and throat, making proper technique very important.
  • Dysphonia: Inhaled steroids can affect your voice, known as dysphonia. It may be prevented by using a spacer and treated by decreasing the ICS dose temporarily and giving your vocal chords a rest.
  • Reflex Cough and Bronchospasm: These side effects can be prevented by using a spacer and inhaling in more slowly. If needed, pretreatment with a rescue inhaler can prevent these symptoms.

    Systemic Inhaled Corticosteroids Side Effects

    While uncommon, a number of systemic effects can occur with inhaled corticosteroids. Generally, there is a higher risk with increasing doses of inhaled corticosteroids. Potential side effects include:

    • Poor Growth: While poor growth can result from ICS, poorly controlled asthma can also lead to poor growth in children. In general, low and medium doses of ICS are potentially associated with small, non-progressive but reversible declines in growth of children. As a result, you and your asthma provider should not only carefully monitor growth, but try to use the lowest possible dose that gets good control of your child's asthma. You must weigh the potential benefits of good asthma control with the small but real possible side effect of slowed growth.

    • Bone Density: Low doses of ICS do not appear to affect bone density, but there are more effects as doses are increased. If you have risk factors for osteoporosis or already have a low bone density, you may want to consider taking calcium and vitamin D supplements or a bone-protecting treatment like a bisphosphonate.

    • Disseminated Varicella: This is when the chickenpox virus spreads throughout your body. While there is a theoretical risk, no cases of disseminated varicella have been reported with ICS. Kids who do not have the chicken pox during their first year of life should receive the varicella vaccine.

    • Easy Bruising: Bruising and thinning of the skin occur in patients using ICS. The effect is dose dependent so decreasing the dose may be helpful.

    • Cataracts and Glaucoma: Low and medium doses of ICS have not been associated with cataracts in kids, but a cumulative, lifetime effect associated with increased risk of cataract has been noted in adults. Only patients with a family history of glaucoma (elevated eye pressure) appear to have an increased risk of glaucoma with ICS use. As a result, patients on ICS should have periodic eye exams, especially if you are taking high doses or you have a family history of elevated eye pressure.

    • Adrenal Gland Suppression: This potential side effect is extremely rare, but can occur in some people and usually at higher ICS doses.

    • Elevated Blood Sugar: ICS rarely causes an elevation in blood sugar, and, if this side effect does occur it is almost always at higher doses of ICS.


    National Heart, Lung, and Blood Institute.  Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma