4 Common Side Effects of Inhaled Steroids

A man with asthma using his inhaler
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Steroids have gotten a bad rap in the press due in large part to their illegal use in professional and amateur athletes. In the end, steroids are simply chemical compounds, often hormonal, that your body produces naturally to regulate growth and help your organs function normally.

Many steroids today are man-made and consist of two main types: corticosteroids and anabolic steroids. Of these, corticosteroids are commonly in an inhalant form to treat asthma and other forms of respiratory disease.

Inhaling steroids helps relieve breathing restriction by delivering the drug right where it is needed most. Prolonged use, however, can result in a number of side effects, ranging from mild and transient to potentially debilitating.

Here are the four most common side effects you should be aware of:

Hoarseness (Dysphonia)

Some people using inhaled steroids will experience hoarseness of voice known as dysphonia. This is directly related to the effects of the drugs as they pass over the vocal cords and occurs in more than 30 percent of people on steroid inhalers. Within this context, dysphonia not considered a serious condition and will typically rectify itself within five to 20 minutes.

The use of a metered dose inhalers (MDI) such as Flovent, QVAR, and Azmacort may cause less vocal hoarseness than a dry-powder version such as Pulmicort, Asmanex, or Advair. A spacer may also help but allowing greater diffusion of the inhalant.

Thrush (Oral Candidiasis)

People who take inhaled steroids are at risk for thrush, a fungal infection of the mouth commonly referred to as oral candidiasis. Symptoms can include a sore throat, tongue or mouth irritation, and the development of white patches in the mouth.

In those using steroid inhalers, the raised, removable plaques will appear mostly on the roof of the mouth or the back of the throat (although they can also appear on the tongue, gums, and inside of the cheeks).

Thrush can be prevented by rinsing your mouth with an alcohol-based mouth rinse and/or brushing immediately after use. If thrush does appear, it can be treated with an antifungal mouth rinse (such as a nystatin oral suspension) or with Diflucan (fluconazole) tablets for more severe cases.

Bone Loss (Osteoporosis)

Inhaled steroids are known to place older adults at an increased risk for osteoporosis (the progressive loss and weakening of bone). While osteoporosis is far worse when taking oral steroids, high-dose inhalants can also contribute to increasing bone brittleness. High-dose is typically defined as being more than 2000 micrograms per day over a period of several years. 

Calcium-rich diets or supplements (three servings of dairy per day or roughly 1500mg of calcium) are recommended for those at highest risk. Weight-bearing exercises (such as walking) and an adjustment in the steroid dose may also help if bone loss is particularly severe. 

Vision Problems (Cataracts and Glaucoma)

Inhaled steroids are believed to cause an increase in the development of cataracts and glaucoma in the people over 60. While the exact incidence of these is unknown (mainly because visual problems are common in older people), we do know that high-dose inhaled steroids can increase eye pressure in people with glaucoma by more than 40 percent.

Similar findings were seen in the development of cataracts, wherein a lifetime dose of two million micrograms of an inhaled steroid (suggesting high-dose, long-term use) was linked to an increased clouding of the lens.

For older persons on inhaled steroids, routine annual eye exams by a qualified optometrist or ophthalmologist are recommended.

A Word From Verywell

While some of the side effects associated with inhaled steroids may seem concerning, it is always important to weigh the benefits of improved respiratory function against the possible consequences of use. In most cases, when used properly, inhaled steroids will return more in the way of improved health than living without them (especially when compared to the side effects of oral and injected steroids).

If experiencing side effects that truly concern you, speak with your doctor about alternatives or adjustments that may help. Never alter the frequency or usage of your treatment without first getting input from your health provider.

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