Hostname: page-component-cb9f654ff-k7rjm Total loading time: 0 Render date: 2025-08-04T03:00:00.915Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of pharyngeal and laryngeal complications in adult asthmatics using inhaled corticosteroids

Published online by Cambridge University Press:  18 January 2008

R K Bhalla ,
A S Jones  and
N J Roland
R K Bhalla*
Affiliation:
Department of Otolaryngology, University Hospital Aintree, Liverpool, UK
A S Jones
Affiliation:
Department of Otolaryngology, University Hospital Aintree, Liverpool, UK
N J Roland
Affiliation:
Department of Otolaryngology, University Hospital Aintree, Liverpool, UK
*
Address for correspondence: Mr R K Bhalla, 17 Withins Hall Road, Woodhouses, Manchester M35 9SA, UK. Fax: +44 (0)151 529 5263 E-mail: DrRKBhalla@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To investigate the prevalence in adults of pharyngeal and laryngeal symptoms associated with the use of inhaled corticosteroids.

Design:

Prospective, observational and based on a structured, specifically designed postal questionnaire.

Setting:

University Hospital Aintree, Liverpool, UK.

Participants:

The questionnaire was distributed to 190 patients on the basis of current inhaled corticosteroid use. Recruitment was from the databases of two local general practices. Individuals were classified as mild, moderate or severe asthmatics, using the guidelines of the British Thoracic Society.

Main outcome measures:

Demographic data, including smoking history, were recorded. The number, type, strength, dosing regime and duration of individual inhaler use were recorded. Specific pharyngeal and laryngeal side effects were enquired about. Co-morbidities and preventive measures were also recorded. Results were analysed using univariate and multivariate statistical tests.

Results:

There was a 75.8 per cent response rate (144/190 questionnaires); 63 (43.8 per cent) of respondents were male and 81 (56.2 per cent) were female. The majority of our patients were either mild or moderate asthmatics. Longer use of an inhaled corticosteroid predisposed to weak voice (p = 0.0016), hoarseness (p = 0.0001) and throat irritation (p = 0.008). Hoarseness, throat irritation, sore throat and cough were observed much more frequently than anticipated. Severe asthmatics were more likely to use a spacer device compliantly (p = 0.0487; odds ratio 1.53). Side effects were more prevalent as asthma severity worsened (p = 0.0049; odds ratio 1.87).

Conclusions:

Inhaled corticosteroids cause sore throats, throat irritation, hoarseness and cough. Further research in this area is required in order to elucidate the mechanism of inflammation. Only then can effective preventive measures be introduced and implemented.

Keywords

Nebulisers and VaporisersComplicationVoiceDysphoniaCorticosteroidLarynx

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 10 , October 2008 , pp. 1078 - 1083
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1 The use of inhaled corticosteroids in adults with asthma. Drug Ther Bull 2000;38:5–8CrossRefGoogle Scholar
2 Toogood, JH, Crilly, RG, Jones, G, Nadeau, J, Wells, GA. Effect of high-dose inhaled Budesonide on calcium and phosphate metabolism and the risk of osteoporosis. Am Rev Respir Dis 1988;138:57–61CrossRefGoogle ScholarPubMed
3 Packe, GE, Douglas, JG, McDonald, AF, Robins, SP, Reid, DM. Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids. Thorax 1992;47:414–17Google Scholar
4 Maxwell, DL. Adverse effects of inhaled corticosteroids. Biomed Pharmacother 1990;44:421–7CrossRefGoogle ScholarPubMed
5 Hanania, NA, Chapman, KR, Kesten, S. Adverse effects of inhaled corticosteroids. Am J Med 1995;98:196–208CrossRefGoogle ScholarPubMed
6 Capewell, S, Reynolds, S, Shuttleworth, D, Edwards, C, Finlay, AY. Purpura and dermal thinning associated with high dose inhaled corticosteroids. Br Med J 1990;300:1548–51Google Scholar
7 Mak, VH, Melchor, R, Spiro, SG. Easy bruising as a side effect of inhaled corticosteroids. Eur Respir J 1992;5:1068–74CrossRefGoogle ScholarPubMed
8 Cumming, RG, Mitchell, P, Leeder, SR. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 1997;337:8–14CrossRefGoogle ScholarPubMed
9 Garbe, E, LeLorier, J, Boivin, J-F, Suissa, S. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. J Am Med Assoc 1997;277:722–7CrossRefGoogle ScholarPubMed
10 Roland, NJ, Bhalla, RK, Earis, J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest 2004;126:213–19CrossRefGoogle ScholarPubMed
11 Babu, S, Samuel, P. The effect of inhaled steroids on the upper respiratory tract. J Laryngol Otol 1988;102:592–4CrossRefGoogle ScholarPubMed
12 Barnes, PJ, Pedersen, S, Busse, WW. Efficacy and safety of inhaled corticosteroids. Am J Respir Crit Care Med 1998;157 (3 pt 2):S1–53CrossRefGoogle ScholarPubMed
13 Held, E, Ottervanger, V, Petersen, S, Weismann, K. Perioral dermatitis in children under steroid inhalation therapy [in Danish]. Ugeskr Laeger 1997;157:7002–3Google Scholar
14 Linder, N, Kuint, J, German, B, Lubin, D, Loewenthal, R. Hypertrophy of the tongue associated with inhaled steroid therapy in premature infants. J Paediatrics 1995;127:651–3CrossRefGoogle ScholarPubMed
15 Williams, AJ, Baghat, MS, Stableforth, DE, Cayton, RM, Shenoi, PM, Skinner, C. Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality. Thorax 1983;38:813–21CrossRefGoogle ScholarPubMed
16 DelGaudio, JM. Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy. Arch Otolaryngol Head Neck Surg 2002;128:677–81CrossRefGoogle ScholarPubMed
17 Williamson, IJ, Matusiewicz, SP, Brown, PH, Greening, AP, Crompton, GK. Frequency of voice problems and cough in patients using pressurised aerosol steroid preparations. Eur Respir J 1995;8:590–2CrossRefGoogle ScholarPubMed
18 British Thoracic Society. British guideline on the management of asthma. Thorax 2003;58(suppl 1):20–4Google Scholar
19 SAS Institute Inc. [8.2] User's Guide: Statistics Version, 5th edn. Cary, NC: SAS Institute Inc, 1985Google Scholar
20 Selroos, O, Backman, R, Forsen, KO, Lofroos, AB, Niemisto, M, Pietinalho, A et al. Local side effects during 4-year treatment with inhaled corticosteroids – a comparison between pressurised metered-dose inhalers and Turbohaler. Allergy 1994;49:888–90Google Scholar
21 Lipworth, BJ. New perspectives on inhaled drug delivery and systemic bioactivity. Thorax 1995;50:105–10CrossRefGoogle ScholarPubMed
22 Inhaler devices for asthma. Drug Ther Bull 2000;38:9–14CrossRefGoogle Scholar
23 Bryant, DH, Pepys, J. Bronchial reactions to aerosol inhalant vehicle. Br Med J 1976;1:1319–20CrossRefGoogle ScholarPubMed
24 Shim, C, Williams, MH. Cough and wheezing from beclomethasone aerosol. Chest 1987;91:207–9Google Scholar
25 Currie, GP, McLaughlin, K. The expanding role of leukotriene receptor antagonists in chronic asthma. Ann Allergy Asthma Immunol 2006;97:731–41CrossRefGoogle ScholarPubMed