Practical Considerations for Dysphonia Caused by Inhaled Corticosteroids

Abstract

Inhaled corticosteroid (ICS) therapy has become standard in the treatment of asthma. A common local adverse effect of ICS therapy is dysphonia, which has been reported to affect 5% to 58% of patients. Although causes of dysphonia associated with ICS therapy have been underinvestigated, it may result from deposition of an active ICS in the oropharynx during administration, which then causes myopathy or a mucosal effect in the laryngopharynx. Use of ICS should be considered during any evaluation of dysphonia. We recommend using the lowest effective dosage of ICS, administering medication with a spacer, gargling, rinsing the mouth and washing the face after inhalation, and washing the spacer. If dysphonia develops despite these interventions, ICS use should be suspended until symptoms resolve, provided that asthma control is not compromised.

The Clinical Pharmacology of Past, Present, and Future Glucocorticoids

“…Ciclesonide has been formulated as a solution HFA-MDI with the majority of particles within the 1.1-2.1-μm size range, resulting in a very high pulmonary deposition (52 %) [ 19 ]. In order to decrease local adverse effects (dysphonia, stomatitis, and dry mouth), it is recommended to administer medication with a spacer, gargling, rinsing the mouth, and washing the face after inhalation (if nebulizers are used), as well as washing the spacer [ 25 ]. However, no scientifi c evidence for such procedures is available with the exception of gargling, which was shown to be protective for female patients using DPIs [ 35 ].…”

Absence of gargling affects topical adverse symptoms caused by inhaled corticosteroids in females

“…Females are more likely to suffer from allergic asthma, have difficulty controlling asthma symptoms and exhibit adverse effects to drugs [1][2][3][4][5][6][7][8]. Topical (oropharyngeal) adverse events, especially voice problems, caused by inhaled corticosteroids (ICS) are also more common in females [5,8].…”

“…Females are more likely to suffer from allergic asthma, have difficulty controlling asthma symptoms and exhibit adverse effects to drugs [1][2][3][4][5][6][7][8]. Topical (oropharyngeal) adverse events, especially voice problems, caused by inhaled corticosteroids (ICS) are also more common in females [5,8]. In order to prevent the adverse events of ICS, gargling or mouth washing after inhalation method, as well as the proper inhalation technique and use of the spacer devices, is recommended as the gold standard [5,[9][10][11][12][13].…”

“…Topical (oropharyngeal) adverse events, especially voice problems, caused by inhaled corticosteroids (ICS) are also more common in females [5,8]. In order to prevent the adverse events of ICS, gargling or mouth washing after inhalation method, as well as the proper inhalation technique and use of the spacer devices, is recommended as the gold standard [5,[9][10][11][12][13]. Surprisingly, however, we were unable to find any evidence to confirm the efficiency of the gargling or mouth washing method in realworld studies [14][15][16], while the efficiency of spacer devices has been well demonstrated [11,12].…”

Are Inhaled Corticosteroids Safe for Large Airways?

“…9 Mucosal irritation and myopathy of laryngeal muscle are the major mechanisms of ICS-associated dysphonia. 10 The ICS dry-powder inhalers have a lower risk for dysphonia compared with the MDI device.…”