This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Inhaled steroids (unwanted effects)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Inhaled corticosteroids produce fewer adverse effects in comparison with systemic steroids because the dosages used are much lower. Side effects are much more likely to occur with higher doses (>800micrograms per day of beclomethasone or equivalent, in adults) and when inhaler technique is poor (1).

Recognised side effects include:

  • local
  • Candida albicans infection of the oropharynx
  • rarely, bronchospasm related to the flurocarbon carrier; prevented by a powder device or aerosol without carrier
  • myopathic weakness of the adductor muscles of the vocal cords leading to dysphonia
  • reflex cough
  • sore throat (2)
  • systemic
  • adrenal suppression, acute adrenal crisis (2)
  • bruising and cutaneous thinning
  • reduced bone mineral density, osteoporosis, bone fractures
  • children may suffer from growth hormone and androgen suppression, retarding growth, with doses of budesonide and beclomethasone of as little as 400 micrograms/square metre (1). However, control of severe asthma should override this concern
    • although transient reduction in growth velocity may be observed, the evidence is inconclusive to suggest that the final adult height is affected significantly with the use of inhaled corticosteroids (1)
  • eyes – cataracts (usually posterior subcapsular), glaucoma (2)
  • pneumonia (1)
  • haematological:
    • reduction in circulating eosinophils
    • increase in circulating neutrophils

There is no evidence of adverse effects on pregnant women, their fetuses, the course of labour or delivery (4). Breast feeding is not contraindicated in patients taking inhaled steroids as these drugs are not present in milk.

Steps to minimize adverse effects of inhaled steroids include:

  • use of a spacer device
  • rinse the mouth with water after inhalation to minimize the risk of candidiasis
  • prescribe the minimum effective dose of inhaled corticosteroids to reduce bone and adrenal cortex effects (3)
  • if high doses of steroids are required consider an add on agent (beta-2-agonists) (1).

Reference:


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.