Many face problems with side effects when using inhaled corticosteroids. These side effects may harm your bones, weaken your lungs, and even change your voice. This situation can cause concern and make your daily life more difficult.
You may feel frustrated when your treatment leads to other issues. It may seem that the medicine meant to help you sometimes harms you.
But there is a clear way to lower these risks and protect your health. You can follow the proper inhaler technique, adjust your dose, and heed your doctor’s sound advice. In this article, you will learn practical tips to reduce side effects from inhaled corticosteroids and enjoy better health. You deserve a treatment that really helps.
| 🔑 Key Takeaways ➤ Check your inhaler technique with your doctor. A correct method lowers unwanted effects. ➤ Rinse your mouth after you use your inhaler. This step helps keep your mouth healthy. ➤ Always choose the lowest effective dose. You and your doctor can set a dose that works best. ➤ Adjust your treatment slowly. Stopping too fast may bring withdrawal symptoms. ➤ Pick the right inhaled corticosteroids molecule and device. A good match makes your treatment work well. ➤ Keep a healthy lifestyle with a good diet and exercise. Your strong habits help reduce risks. |
Side Effects of Inhaled Corticosteroids
Below are the key side effects of Inhaled Corticosteroids:
Bone density loss
High doses of inhaled corticosteroids are linked to reduced bone mineral density. This means your bones become weaker over time, and increase your vulnerability to bone fractures.
For example, one study of Swedish COPD patients found that 19.9% had an osteoporosis-related event compared to 12.9% in controls. High-dose use of inhaled corticosteroids raised the risk by 52% while low-dose use had a lower risk.
Another study in patients with asthma showed that doubling the cumulative dose of inhaled corticosteroids was linked to a decrease in bone mineral density at the lumbar spine. These findings tell you that higher doses can measurably weaken your bones. Talk with your doctor about using the lowest effective dose and ways to protect your bone health.
Respiratory infections
Elevated doses of inhaled corticosteroids can lower your lung defenses. This means your airways become less capable of fighting off germs, which raises your risk of respiratory infections.
One study in COPD patients found that even low doses of inhaled corticosteroids increased the risk of infection with Moraxella catarrhalis. Similarly, another study on people with asthma showed that patients using the highest strength of inhaled corticosteroids had a 2.04 times greater risk of developing pneumonia or a lower respiratory tract infection compared with those not using inhaled corticosteroids.
This data tells you that as your inhaled corticosteroids dose goes up, your lung defenses drop, making it harder to fight germs. Therefore, it is important to use the lowest effective dose to help protect your lungs from infections.
Cataracts
Prolonged use of high-dose inhaled corticosteroids can cause changes in your eye’s lens, making it cloudy and leading to cataracts. Over time, this clouding affects your vision. Research shows a clear link between long-term, high-dose use and a higher likelihood of developing cataracts.
For example, one study found that users of inhaled corticosteroids had a 1.5 times higher prevalence of nuclear cataracts and a 1.9 times higher prevalence of posterior subcapsular cataracts than nonusers. However, among subjects with a lifetime beclomethasone dose over 2000 mg, 27% had posterior subcapsular cataracts compared with about 5% in nonusers.
Withdrawal symptoms
Stopping your medication abruptly may trigger withdrawal symptoms such as:
- Severe tiredness
- Joint pain
- Nausea
- Dizziness
When your body becomes accustomed to a steady level of the medication, a sudden stop can disrupt its balance.
Oral thrush
If you don’t rinse your mouth after using your inhaler, leftover medication can stay behind and create the perfect environment for yeast to grow. Oral thrush is a painful condition that causes white patches in your mouth.
A meta-analysis found that inhaled corticosteroids nearly triple your risk of developing oral thrush. For example, using a metered-dose inhaler increased the risk by about five times compared with placebo, while dry powder inhalers raised the risk about threefold.
Dysphonia
Dysphonia is the medical name used for a hoarse or altered voice. Leftover medication can build up in your mouth when you don’t use your inhaler correctly. This buildup may irritate your vocal cords and change your voice. The National Asthma Council Australia explains that poor inhaler technique is linked to dysphonia.
How to Reduce Side Effects from Inhaled Corticosteroids
Here are some strategies to reduce side effects from Inhaled Corticosteroids:
Use Proper Inhaler Technique and Device
Proper inhaler technique is key to making your inhaled corticosteroid work properly and lower side effects.
1. Learn the correct technique by following the exact method your healthcare provider shows you.
| 📹 Watch Here You can watch demonstration videos suggested by the NHS to reduce medication loss in your mouth. This method helps you use your inhaler efficiently and safely. |
2. Next, use a spacer when it is recommended. A spacer delivers the medicine deep into your lungs and cuts down on the amount that settles in your mouth. But remember, there are devices that should not be used with a spacer, such as:
- Advair Diskus
- Asmanex Twisthaler
- Pulmicort Flexhaler
- Dulera Inhaler
- Serevent Diskus
- Flovent Diskus
- Arnuity Ellipta
- Breo Ellipta
- Anoro Ellipta
- Incruse Ellipta
- Trelegy Ellipta
- Tudorza Pressair
- Seebri Neohaler
- Utibron Neohaler
- Spiriva HandiHaler
Using the wrong device with a spacer can compromise your treatment and increase side effects. Both studies stress that matching the right device with the proper technique is key.
3. Finally, practice regularly until the technique feels natural. Practice is important because incorrect use may lead to more side effects. Regular practice makes the correct method second nature, so you get the most benefit from your treatment.
Rinse Your Mouth Immediately After Inhalation
Rinsing your mouth right after you use your inhaler is key to reducing side effects.
One Australian study with 380 patients found that 30.5% of them did not rinse properly. However, patients who got advice from a healthcare professional rinsed correctly more often and understood why rinsing matters. Most patients—about 90%—knew that rinsing could lower oropharyngeal side effects, but only 5.5% knew it might also reduce systemic effects.
So, start by rinsing and spitting out water right after you inhale the medication. Then, if possible, brush your teeth to remove any leftover medication. This simple step clears away residue that might irritate your mouth, and it helps prevent problems like oral thrush and dysphonia. Following these steps protects you from uncomfortable side effects.
Use the Lowest Effective Dose
Using the lowest effective dose is essential to minimizing the side effects of inhaled corticosteroids. Work with your doctor to adjust your dose. This collaboration tailors your treatment to your specific needs. You should start at the minimum dose that controls your asthma.
Studies show that high doses increase risks like bone density loss, respiratory infections, and cataracts. Starting at the lowest effective dose reduces your exposure to these potential systemic side effects.
For example, one trial found that patients on budesonide experienced a 0.35% drop in lumbar bone mineral density over two years, while another study with beclomethasone reported a decrease of up to 0.83%. High-dose use raises the risk of respiratory infections; one study reported an adjusted odds ratio of 1.64 for pneumonia with fluticasone, and another found that current users had a rate ratio of 1.83 compared to non-users.
High doses may affect your eyes as well. One study with over 30,000 patients showed about a 5% increase in the odds of developing cataracts. These numbers tell you that the risk rises with dose. Starting at the lowest effective dose can help protect your bones, lungs, and eyes. Talk with your doctor to choose the best dose for you.
| 🗒️ Additional Note Regular monitoring also plays a role in keeping your dose low. You need regular evaluations through periodic check-ups so your doctor can safely lower your dose when your asthma is well controlled. This process allows for timely adjustments based on your current health status. For example, if you remain on a high dose without proper monitoring, you might face systemic side effects similar to those seen in studies where doses exceeded safe limits. |
Adjust Your Treatment Gradually
Adjusting your treatment gradually is vital for both safety and effectiveness. Do not stop your medication abruptly. Instead, taper off slowly.
Stopping suddenly can lead to withdrawal symptoms like severe tiredness, joint pain, nausea, and dizziness, and may trigger adrenal insufficiency with signs such as hypotension and dehydration.
Next, schedule regular follow-ups with your doctor. They will check your symptoms and adjust your dose safely when needed. You may need temporary increases in your steroid dose during stress, illness, or surgery.
This close monitoring helps your body recover its normal hormone balance and prevents unpleasant withdrawal effects.
Choose the Right inhaled corticosteroids Molecule and Device
Choosing the right inhaled corticosteroids molecule and device is key to managing your treatment effectively. Start by discussing your options with your doctor.
For example, an Australian review from 2024 showed that device selection should be based on your inspiratory flow, coordination, and personal preference.
There are more than 230 drug‐delivery system combinations available. For example:
| Medication | Brand Names | Delivery Devices |
| Beclometasone Dipropionate | Clenil Modulite, Qvar | Metered-dose inhaler (MDI) |
| Budesonide | Pulmicort Flexhaler, Easyhaler Budesonide, Novolizer Budesonide | Dry powder inhaler (DPI) |
| Ciclesonide | Alvesco | MDI |
| Fluticasone Propionate | Flovent HFA, Flovent Diskus, Flixotide | MDI, DPI |
| Mometasone Furoate | Asmanex Twisthaler | DPI |
| Fluticasone Propionate + Salmeterol | Advair Diskus, Seretide | DPI, MDI |
| Budesonide + Formoterol | Symbicort | DPI, MDI |
| Beclometasone Dipropionate + Formoterol | Fostair | MDI |
If you have trouble with a strong, deep breath, your doctor may suggest a soft mist inhaler over a dry powder inhaler. This tailored approach helps ensure you use your inhaler correctly.
When it comes to the inhaled corticosteroids molecule, ask which one suits your needs best. Cost, efficacy, and safety should all be considered. For example, one review from 2014 found that fluticasone may be more likely to affect the hypothalamo-pituitary-adrenal axis and bone density than budesonide.
Next, consider your age, other medications, and health conditions. Your doctor can help you select an inhaled corticosteroid that fits your health profile, so you stay safe and your treatment stays effective while keeping side effects to a minimum.
Maintain a Healthy Lifestyle
Maintaining a healthy lifestyle is key to reducing side effects from inhaled corticosteroids.
1. First, avoid smoking because it makes your medicine less effective and worsens side effects. Studies show that quitting smoking improves lung function. For example, one study found that smokers who quit for 6 weeks had an increase in FEV1 by about 407 mL and a reduction in sputum neutrophils by 29%. These improvements mean you can breathe better and reduce inflammation.
2. Next, support your bone health. Follow a balanced diet rich in calcium and vitamin D and do weight-bearing exercises. A Cochrane review found that, after 2 years, patients taking calcium and vitamin D had a significant improvement in bone mineral density—about a 2.6-unit gain in the lumbar spine and a 2.5-unit gain in the forearm—compared to those who did not take them. Strong bones lower your risk of fractures and other bone issues linked to long-term corticosteroid use.
3. Finally, keep an eye on your overall health because regular exercise and a healthy diet also boost your immune system and reduce the risk of respiratory infections.
Final Words
Reducing side effects from inhaled corticosteroids is all about careful use and smart choices. You can protect your bones, lungs, eyes, and voice by using the correct inhaler technique and rinsing your mouth after each use.
Always work with your doctor to start with the lowest effective dose and adjust slowly. A proper device and method lower risks like respiratory infections, oral thrush, and withdrawal symptoms. You need regular check-ups to ensure your treatment remains safe and effective. The focus is on maintaining a healthy lifestyle, which includes a balanced diet and exercise.
Frequently Asked Questions
Who can use ICS?
Most people with asthma can use them. They may also help some people with COPD. Your doctor decides if they are right for you.
How should I use my ICS?
Follow your doctor’s instructions exactly. You may take 1-2 puffs twice a day. Always check your inhaler technique.
What should I do if I miss a dose?
Take your missed dose as soon as you remember. But if it is nearly time for your next dose, skip it. Never double your dose.
What is a corticosteroid safety card?
It is a card that shows you use ICS. It tells doctors or dentists about your treatment. Keep it handy for emergencies.
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