Complications of inhalational steroids use include

Adverse effects Hoarseness of voice, dysphonia, sore throat, asymptomatic or symptomatic oropharyngeal candidiasis are the most common side effects. These can be minimized by the use of a spacer, gargling after every dose (to wash off the drug deposited on oral and pharyngeal mucosa) and prevented as well as treated by topical nystatin/clotrimazole. Patients who are to be switched over from oral steroid should receive inhaled steroid in addition for 1-2 weeks before oral steroid is tapered (Peak effect of inhaled steroid is seen after 4-7 days of instituting inhaled steroids and benefit persists for a few weeks after discontinuation), Otherwise steroid with-drawal may manifest (precipitation of asthma, muscular pain, lassitude, depression, hypotension). This confirms lack of systemic activity of inhaled steroids (at doses < 600 ug/day). Systemic effects of long-term inhaled glucocoicoids are clinically relevant only at doses > 600 ug/day. The significant ones are--mood changes, osteoporosis, growth retardation in children, bruising, petechiae, hyperglycaemia and pituitary-adrenal suppression; several repos of adrenal crisis have appeared, especially in children, during stress. Ref:- kd tripathi; pg num:-230,231