Dysphonia, with corticosteroids

Assess the patient for adverse effects, particularly candidiasis and dysphonia associated with inhaled corticosteroids. 

Local adverse effects from ICSs include oropharyngeal candidiasis and dysphonia that are dose-dependent. The dysphonia appears to be due to a local corticosteroid-induced myopathy of the vocal cords. The use of a spacer device can decrease oropharyngeal deposition and thus decrease the incidence and severity of local side effects. In infants who require delivery through a facemask, the parent should clean the nasal-perioral area with a damp cloth following each treatment to prevent topical candidal infections. 

Another meta-analysis compared the efficacy and safefy of mometasone versus other inhaled corticosteroids, in patients with moderate to severe asthma [5 ]. The meta-analysis included 1354 asthmatics across six trials with study durations of at least 4 weeks. Mometasone appeared to have similar incidence in all treatment-related adverse events compared to ICS (OR = 1.06, 95% Cl = 0.74,1.52). No significant difference in the discontinuation rate, the frequency of oral candidiasis, pharyngitis, headache, or dysphonia was found between mometasone to other ICS. 

Studies of oropharyngeal deposition in healthy subjects (30-32), as well as in patients with asthma (33) have shown wide interindividual variations. For instance, deposition in the oropharynx of inhaled 3.6-pm test particles varied between 10 and 70% in asthmatics. This implies that the dose of a therapeutic aerosol in the lungs is difficult to predict and is sometimes suboptimal. Furthermore, adverse effects of inhaled corticosteroids, such as oral candidiasis (34), dysphonia (35), and osteoporosis (36), may arise locally and systematically. It is evidently important to reduce a high oropharyngeal deposition. 

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