Systemic adverse effects of long term inhaled steroids are evident only at doses more than -

Ans. is 'c' i.e., 600 mcg/day Adverse effects of inhaled steroids* 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.* There is no evidence of mucosal damage or increased incidence of chest infections, even on prolonged use.* Systemic effects of long-term inhaled glucocorticoids are clinically relevant only at doses > 600 mg/day. The significant ones are--mood changes, osteoporosis, growth retardation in children, bruising, petechiae, hyperglycaemia and pituitary-adrenal suppression; several reports of adrenal crisis have appeared, especially in children, during stress (of an infection, etc).* Inhaled steroids are safe during pregnancy.