Inhaled Steroids Linked to Oropharyngeal Side Effects

Inhaled corticosteroids used to treat asthma can cause a number of oropharyngeal adverse events, including candidiasis and dysphonia, US researchers report in the Annals of Allergy, Asthma, and Immunology for March.

The oropharyngeal side effects that arise with inhaled steroid use can affect adherence to these medications. However, these adverse events have received much less attention than the drugs' systemic side effects, note Dr. Gary S. Rachelefsky from UCLA School of Medicine, and colleagues

The investigators searched MEDLINE and EMBASE to identify studies that looked at oropharyngeal adverse events with inhaled corticosteroid use. Data from 23 studies with 59 drug arms were included in the analysis.

The team found that inhaled corticosteroids at all doses, either alone or combined, and regardless of the device, increase the risk oral candidiasis, dysphonia, and pharyngitis (p < 0.05 for all).

Relative to placebo controls, metered-dose and dry-powder steroid inhalers raised the risk of oral candidiasis by 5.40- and 3.24-fold, respectively. The corresponding odds ratios with regards to dysphonia were 5.68 and 3.74, and for pharyngitis they were 1.98 and 1.81.

Such events, Dr. Rachelefsky and colleagues say, "may be reduced by postdose mouth rinsing or use of a spacer."

Ann Allergy Asthma Immunol 2007.