ICS and voice

Q: Inhaled glucocorticoids (ICS) may cause dysphonia.

A) True

B) False

Answer: A

Unfortunately, dysphonia manifested as a hoarse voice is common among patients who use long-term ICS. It occurs due to laryngeal myopathy, leading to incomplete closure or bowing of the vocal cords during adduction. Other contributing factors are mucosal irritation and frequent laryngeal candidiasis. Fortunately, it is reversible on discontinuation of ICS.

Strategies to keep dysphonia to a minimum are using the lowest ICS dose, using drugs known to cause the least dysphonia, and adjusting technique to decrease laryngeal deposition.

#pulmonary

#pharmacology

References:

1. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest 2004; 126:213.

2. Buhl R. Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma. Allergy 2006; 61:518.

3. Galván CA, Guarderas JC. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc 2012; 87:901.

4. Rachelefsky GS, Liao Y, Faruqi R. Impact of inhaled corticosteroid-induced oropharyngeal adverse events: results from a meta-analysis. Ann Allergy Asthma Immunol 2007; 98:225.