4 Common Side Effects of Inhaled Steroids

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Inhaled corticosteroids, also known as steroids or glucocorticoids, can cause side effects like insomnia or thrush, and strategies like rinsing your mouth after you use them might help reduce some side effects.

These medications are generally used on an ongoing basis to 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 normally reduces inflammation. Corticosteroids alleviate chronic airway inflammation, reducing bronchoconstriction (airway narrowing) and bronchospasms (airway contractions).

Corticosteroids should not be confused with anabolic steroids, which are used to stimulate muscle growth.

Close up of a person using an inhaler
Martin Barraud / Getty Images

Hoarseness

Some people who use inhaled steroids may experience vocal hoarseness, referred to as dysphonia. This side effect can occur due to the drug's effect on the muscles of the vocal cords.

Dysphonia affects more than 30% 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 because the inhaled steroids affect the function of the vocal cord muscles over time.

Metered-dose inhalers (MDIs) like Flovent HFA (fluticasone), Asmanex HFA (mometasone), and Qvar Redihaler (beclomethasone) tend to cause less vocal hoarseness than dry-powder inhalers (DPIs) like Flovent Diskus, Asmanex Redihaler, and Pulmicort Flexihaler (budesonide).

Rarely, high-dose steroids may cause laryngopharyngeal reflux, in which stomach acids reflux into the throat, causing pain, vocal cord inflammation, and laryngitis. In such cases, the dose may need to be reduced or the formulation switched.

Oral Thrush

People who take inhaled steroids are at risk for oral thrush, a fungal infection of the mouth also known as oral candidiasis. Oral thrush affects roughly 3% of users of inhaled corticosteroids, and there's an increased risk with a weakened immune system or if the drug is overused or used incorrectly.

Symptoms of oral candidiasis include:

  • Sore throat
  • Mouth or tongue irritation
  • Formation of white patches in the mouth
  • Loss of taste
  • Pain while eating or swallowing
  • A cotton-like feeling in the mouth

With oral thrush, a superficial white growth can be easily scraped off, often exposing inflamed and bleeding tissue underneath. The infection mainly develops on the roof of the mouth or back of the throat, and can also appear on the tongue, gums, and inner cheeks.

Thrush can be prevented by rinsing your mouth thoroughly with water and brushing your teeth immediately after inhaled corticosteroid use. Instead of water, some people prefer an alcohol-based mouthwash.

You can also reduce your risk by attaching a spacer to the mouthpiece of the MDI. The tubular extender allows you to deliver more of the aerosolized inhalant into your throat instead of the mouth. (Spacers do not work in DPIs, which have an opening rather than a tube-like mouthpiece.)

If thrush does develop, it can be treated with an antifungal mouth rinse or with Diflucan (fluconazole) tablets for more severe cases.

Osteoporosis

Inhaled steroids are known to place older adults at an increased risk for osteoporosis (progressive 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:

  • Back pain
  • Loss of height over time
  • A stooped posture
  • Bones that break very easily

Many people with osteoporosis do not even realize they have it until they experience an unexpected bone fracture.

A calcium-rich diet paired with a daily calcium supplement (1,000 to 1,500 milligrams combine) is recommended for those at the highest risk of bone fractures, including post-menopausal women or older adults.

Weight-bearing exercises (such as walking) and an adjustment in the steroid dose may also help if the bone loss is severe.

Vision Problems

The long-term use of oral steroids is known to increase the risk of cataracts (clouding of the eye lens) and glaucoma (optic nerve damage caused by increased inner eye pressure). It is possible for inhaled steroids to do the same, especially in older adults already at high risk of cataracts and glaucoma.

A 2018 study in the Digital Journal of Ophthalmology found that adults who used inhaled budesonide for no less than six months had significant increases in inner eye pressure.

Similarly, inhaled steroid users exposed to a lifetime dose of two million micrograms (suggesting high-dose, long-term use) were found to be at greater risk of cataracts than those who received lower doses.

Cataract Symptoms
  • Blurred, dim, or cloudy vision

  • Light sensitivity

  • Halos around lights

  • Fading or yellowing of colors

  • Night blindness

  • Need for brighter lights

Glaucoma Symptoms
  • Eye pain

  • Blurred vision

  • Halos around lights

  • Eye redness

  • Severe headache

  • Nausea and vomiting

If you develop glaucoma or cataracts develop due to inhaled steroid use, the benefits and risks of your treatment need to be weighed on an individual basis and your treatment may need to be modified. Surgical intervention may also be considered, including laser trabeculectomy for glaucoma or extracapsular surgery for cataracts.

A Word From Verywell

While some of the side effects of inhaled steroids are concerning, it is always important to weigh the effect on your respiratory function against the possible consequences of use. In most cases, inhaled steroids can be taken safely under the supervision and routine care of a doctor.

If you are experiencing side effects from a steroid drug, speak with your doctor about alternatives or adjustments that may help. But never stop treatment without your doctor's OK as this can lead to steroid withdrawal and a rebound of symptoms.

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