- dysphonia (in part from myopathy of small muscles of phonation), oral thrush, and cough
The systemic side effects of inhaled corticosteroids are relatively uncommon but do occur in patients on high-dose therapy, particularly long-term, high-dose therapy. These effects include adrenal suppression, reduced growth velocity in children, weight gain, glaucoma, cataracts, osteopenia, and skin thinning. Therefore, the lowest dose consistent with disease control should always be used. For most end points, the effects of inhaled corticosteroids are relatively flat at high doses. Step-down therapy should be considered at regular intervals, perhaps every 3 months, if the disease is adequately controlled.