Adverse Effects of Inhaled Glucocorticoids

Local Adverse Effects

The American Academy of Otolaryngology-Head and Neck Surgery notes that hoarseness is a well-documented adverse effect of inhaled glucocorticoids, caused by local deposition of the medication on the larynx 1, 2
The use of spacers with metered-dose inhalers significantly reduces systemic absorption and associated adverse effects, including hoarseness 3

The American Academy of Otolaryngology-Head and Neck Surgery reports that inhaled glucocorticoids increase the risk of osteoporosis, although with less frequency than systemic corticosteroids 1, 2
Recent (within 12 months) and prolonged (≥90 days) use of glucocorticoids was independently associated with reduced bone mineral density and increased risk of fractures 1, 2
The American Journal of Respiratory and Critical Care Medicine recommends monitoring children and adults treated with inhaled corticosteroids for potential adverse effects, including osteoporosis, high blood pressure, adrenal suppression, and cataracts 3

The American Academy of Otolaryngology-Head and Neck Surgery notes that pancreatitis is a rare but documented adverse effect of glucocorticoids, including inhaled forms 1, 2
Pancreatitis and diabetogenesis are potential adverse effects of glucocorticoids 1

The Mayo Clinic Proceedings states that inhaled glucocorticoids have a significantly better safety profile than systemic corticosteroids, but are not devoid of adverse effects 4
The use of spacers with metered-dose inhalers provides better deposition in small airways and reduces systemic absorption, minimizing adverse effects 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends using the lowest effective dose for the shortest possible period to minimize all systemic adverse effects 1, 2
The American Journal of Respiratory and Critical Care Medicine advises prescribing spacers with metered-dose inhalers to reduce systemic absorption 3, 4
The Journal of Allergy and Clinical Immunology recommends monitoring patients periodically for blood pressure, bone density (with long-term use), adrenal function, cataract development, and blood glucose levels 3, 5

Inhaled corticosteroids can cause tachycardia and anxiety symptoms, particularly at moderate to high doses, though these side effects are less common than with systemic corticosteroids 6

Corticosteroids can directly increase cellular potassium efflux which shortens action potential duration, potentially contributing to tachycardia 6
Corticosteroids can cause mineralocorticoid-like effects leading to elevation of atrial pressures, which may contribute to tachycardia 6

Patients with a history of anxiety disorders or cardiovascular conditions should be monitored more closely when initiating or increasing ICS doses 6
Using spacers with metered dose inhalers can help reduce systemic absorption and associated side effects 7

The American Academy of Otolaryngology-Head and Neck Surgery notes that benefits of ICS therapy in controlling respiratory conditions like asthma generally outweigh the risks of side effects when used appropriately, with sleep disturbances occurring at an incidence of >30% with corticosteroid therapy 8
The American College of Physicians may suggest that patients should not discontinue ICS therapy without medical supervision due to risk of respiratory condition exacerbation, although this specific guideline is not provided 9
While ICS can cause side effects, they occur less frequently than with systemic corticosteroids, with documented cardiovascular effects including hypertension and cardiovascular disease 8, 10, 11