Dysphonia associated with the use of inhaled corticosteroids

Chmielewska, Monika; Akst, Lee M.

doi:10.1097/moo.0000000000000153

Cited by 20 publications

(16 citation statements)

References 36 publications

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“…In summary, therefore, as far as we are aware the evidence for any recommendation for regular mouth rinsing following the use of inhaled corticosteroids is entirely empirical. 42 One might speculate that, with the increasing use of pMDI devices with HFA propellants, which deliver drugs in true solution, and the increased use of pro-drugs such as ciclesonide 43 and beclomethasone dipropionate, 44 which are metabolised to be active in the lower respiratory tract rather than the mouth, this problem, if it exists, may become less prevalent.…”

Section: Beliefs Supporting Data and Panel Conclusionmentioning

confidence: 99%

“…There is in fact little clinical evidence to justify or guide such a strategy. A recent review 43 concluded that dysphonia may be improved by changing the inhaler device, or by reducing the amount and/or frequency of inhaled corticosteroid therapy, or changing the inhaled corticosteroid to ciclesonide (a small particle, true solution pro-drug not active in the upper airways).…”

Section: Beliefs Supporting Data and Panel Conclusionmentioning

confidence: 99%

See 1 more Smart Citation

Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT)

Levy¹,

Dekhuijzen

Barnes

et al. 2016

npj Prim Care Resp Med

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Health professionals tasked with advising patients with asthma and chronic obstructive pulmonary disease (COPD) how to use inhaler devices properly and what to do about unwanted effects will be aware of a variety of commonly held precepts. The evidence for many of these is, however, lacking or old and therefore in need of re-examination. Few would disagree that facilitating and encouraging regular and proper use of inhaler devices for the treatment of asthma and COPD is critical for successful outcomes. It seems logical that the abandonment of unnecessary or ill-founded practices forms an integral part of this process: the use of inhalers is bewildering enough, particularly with regular introduction of new drugs, devices and ancillary equipment, without unnecessary and pointless adages. We review the evidence, or lack thereof, underlying ten items of inhaler ‘lore’ commonly passed on by health professionals to each other and thence to patients. The exercise is intended as a pragmatic, evidence-informed review by a group of clinicians with appropriate experience. It is not intended to be an exhaustive review of the literature; rather, we aim to stimulate debate, and to encourage researchers to challenge some of these ideas and to provide new, updated evidence on which to base relevant, meaningful advice in the future. The discussion on each item is followed by a formal, expert opinion by members of the ADMIT Working Group.

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Section: Beliefs Supporting Data and Panel Conclusionmentioning

confidence: 99%

Section: Beliefs Supporting Data and Panel Conclusionmentioning

confidence: 99%

Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT)

Levy¹,

Dekhuijzen

Barnes

et al. 2016

npj Prim Care Resp Med

View full text Add to dashboard Cite

show abstract

“…Our results suggest that the use of ICS may be an independent risk factor for the development of OSA, especially in already at-risk patients such as overweight males. The use of ICS may produce local effects on the upper airway dilators that increase the risk of developing OSA, similar to the underlying mechanisms that increase the risk of dysphonia in ICS users [ 10 ]. The particle size of ICS likely influences this predisposition for OSA.…”

Section: Discussionmentioning

confidence: 99%

“…Inhaled corticosteroids (ICS) are known to increase the risk for dysphonia by causing myopathy of the vocal cord adductors [ 10 ]. In the same way, ICS may produce similar local effects on the upper airway dilators that could increase the risk of developing OSA.…”

Section: Introductionmentioning

confidence: 99%

Effects of Inhaled Corticosteroids and Particle Size on Risk of Obstructive Sleep Apnea: A Large Retrospective Cohort Study

Henao

Kraschnewski

Bolton

et al. 2020

IJERPH

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Background: Inhaled corticosteroids (ICS) produce local effects on upper airway dilators that could increase the risk of developing obstructive sleep apnea (OSA). Given that the particle size of ICS changes their distribution, the particle size of ICS may impact the risk of developing OSA. Objectives: In this large retrospective study, we explore the relationship of ICS use and OSA in patients with asthma. In addition, we seek to determine if this relationship is affected by the particle size of ICS. Methods: Using electronic health records, we established a cohort of 29,816 asthmatics aged 12 and older with a diagnosis of asthma documented by ICD-9 or ICD-10 codes between January 2011 and August 2016. We performed analyses of variance and multivariate logistic regression analysis to determine the effects ICS on the diagnosis of OSA with sub-analysis by particle size of ICS. Results: Uncontrolled asthmatics showed increased odds of receiving a diagnosis of OSA whether when looking at ACT scores (adjusted odds ratio (aOR) 1.60, 95% CI 1.32–1.94) or PFT results (aOR 1.45, 95% CI 1.19–1.77). Users of ICS also had increased odds of OSA independent of asthma control (aOR 1.58, 95% CI 1.47–1.70). Notably, users of extra-fine particle ICS did not have significantly increased odds of having OSA compared to non-users of ICS (aOR 1.11, 95% CI 0.78–1.58). Conclusions: Use of ICS appears to be an independent risk factor for OSA. Notably, extra-fine particle size ICS do not appear to be associated with an increased risk of OSA.

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“…Discontinuation or modification of inhaled corticosteroids should be considered, if possible. 4,8 Endoscopic excision in selected cases, and pulse dye or potassium titanyl phosphate (KTP) laser to treat fungal lesions have been described as adjuncts to management. 5,9 Laryngeal cryptococcosis remains a rare cause of hoarseness.…”

mentioning

confidence: 99%

Laryngeal Cryptococcal Infection

2019

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Dysphonia associated with the use of inhaled corticosteroids

Abstract: Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints.

Cited by 20 publications

References 36 publications

Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT)

Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT)

Effects of Inhaled Corticosteroids and Particle Size on Risk of Obstructive Sleep Apnea: A Large Retrospective Cohort Study

Laryngeal Cryptococcal Infection

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