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Inhaled corticosteroids (ICSs) are important anti-asthmatic drugs that can act directly on the local respiratory and lung tissues. It is a first-line treatment for patients with asthma and COPD because of its rapid onset of action and low systemic adverse reactions.
Local adverse reactions are common adverse reactions after long-term administration. Although they are considered minor problems, they often affect patients’ compliance with treatment.
In severe cases, it affects the progression of the disease, so it still has important clinical significance.

Common local adverse reactions mainly include the following types:

1. Cause the voice hoarse or difficult to pronounce

It is reported that 5%-50% of patients treated with ICSs have difficulty in speech.
Thirty-four percent of patients experienced dose-dependent sonic inhalation of beclomethasone dipropionate or budesonide by pressure metered dose inhaler (pMDI).
In general, this anomaly can be reversed after ICS is deactivated.

2. Oropharyngeal fungal infection

Patients with ICSs often have localized infectious complications, such as oropharyngeal candidiasis, which may be due to reduced oral mucosal surface immunity or elevated levels of glucose in saliva that contribute to the growth of Candida albicans.
It is recommended that patients inhale ICSs and gargle with sodium chloride solution.

3. Reflex cough

Cough is an intrinsic symptom of asthma and COPD and is associated with poorly controlled conditions. More than one-third of children treated with ICSs have a reflex cough that may be caused by non-specific stimulation of the inhaled pMDIs (oleic acid) and ICSs themselves.
An inhalation device may be considered to reduce the likelihood of occurrence and pre-administered beta 2 agonists may also be alleviated.

4. Perioral dermatitis

Perioral dermatitis is mainly caused by the direct local effect of ICSs on the facial skin. It has been reported that budesonide has an effect on the synthesis of collagen in the skin. The incidence of nebulizers with masks (5%) is much lower than with nebulizers without mouthpieces (14%), and erythromycin or metronidazole can be recommended for severe cases.

5. Dry mouth and tongue hypertrophy

More than 20% of children with ICSs have a thirst, which may be caused by ICSs irritations in the throat or oral candidiasis. Tongue hypertrophy is more common in infants and young children inhaled with ICSs. It may be caused by ICSs’ direct tongue muscle hypertrophy and local fat accumulation. Stopping hormone therapy can alleviate this condition.

Prevention of local adverse reactions:

  1. Patients are advised to wash their mouths, rinse their mouths, and wash their face after ICSs are inhaled.
  2. The use of storage tanks can significantly reduce the deposition of inhaled drugs in the throat and reduce the occurrence of local adverse reactions.
  3. If there is a local adverse reaction associated with the inhalation device, consider replacing the inhalation device.

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