Side Effects of Inhaled Steroids

Adverse Reactions from Inhaled Corticosteroids

Side effects of Inhalers
There are a number of possible side effects from inhaled steroids. George Doyle Collection/Stockbyte/Getty Images

Side Effects of Inhaled Steroids

The word “steroid” conjures up all sorts of different images in a person’s head: “Will these medications make me look like a body-builder?” Or, “Will they make me gain a lot of weight or have a large effect on the growth of my child?" The truth about the side effects of inhaled steroids is that none of these things are true. Inhaled steroids do cause side effects, however, and it is important for anyone taking these medications to be aware of them.


People of all ages who take inhaled steroids are at risk for thrush, a yeast infection in the mouth. Thrush can cause symptoms of mouth or tongue irritation, a sore throat, and in some people, no symptoms at all. There are frequently small white specks or bumps on the roof of the mouth or back of the throat in a person with thrush. Thrush is treated with anti-fungal mouth rinses such as nystatin, and in severe or troublesome cases, with fluconazole (Diflucan) pills.

Thrush can be prevented by thoroughly rinsing the mouth and/or brushing the teeth after using an inhaled steroid. In my practice, I recommend the daily use of an alcohol-based mouth rinse (such as Listerine) to prevent thrush in people who are prone to this condition.


Some people experience a hoarse voice after using inhaled steroids. This may be related to the effects of the steroids on the vocal cords as the medicine passes from the mouth into the lungs.

While the symptoms of hoarseness may come and go while a person is taking an inhaled steroid, metered dose inhaled forms (such as Flovent, QVAR and Azmacort) along with a spacer may cause less hoarseness than a dry-powder inhaler such as Pulmicort, Asmanex or Advair.

Inhaled Steroid Side Effects in Children

In addition to the possibility of developing thrush, a child’s rate of growth can be affected by inhaled steroids.

While the vertical growth does not stop on inhaled steroids, it does slow down. A child’s height difference on an inhaled steroid (compared to if they didn’t use this medication), is about 1 centimeter, and occurs mostly on the first years of treatment. However, studies show that children using inhaled steroids will go through a “catch-up phase” with their growth, and their final adult height will be unchanged (as if they never were taking the inhaled steroid).

While the decrease in growth rate sounds concerning, this is the lesser of two evils: If a child’s asthma is not controlled, their growth rate will be permanently affected, and they will never reach their expected adult height.

Osteoporosis (Thinning of the Bones)

Inhaled steroids are known to place adults at risk for developing osteoporosis. While this effect is far worse with taking oral steroids, inhaled steroids, particularly at high doses, can also lead to thinning of the bones in adults. Prevention of this effect of inhaled steroids occurs with supplemental calcium in the diet (3 servings of dairy foods a day or 1,500mg of calcium daily), weight bearing exercises (such as walking), and minimizing the dose of inhaled steroids needed.

Studies have not shown that children are at risk for osteoporosis as a result of taking inhaled steroids.

Cataracts and Glaucoma

Inhaled steroids may cause an increase in the formation of cataracts and glaucoma in the elderly, while this effect seems to be rare in children. The consideration should be made for routine annual eye exams by a qualified optometrist or ophthalmologist for people with chronically use inhaled steroids, particularly at high doses.

Other Side Effects

Less common side effects associated with inhaled steroids include Cushing syndrome, mood changes and weight gain. While these effects are extremely rare, occasionally I see a patient in my clinic experiencing these symptoms, particularly in young children.

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Schleimer RP, Spahn JD, Covar R, Szefler SJ. Glucocorticoids. In: Adkinson NF, Yunginger JW, Busse WW, et al, eds. Middleton’s Allergy Principles and Practice. 6th edition. Philadelphia: Mosby Publishing; 2003:870-914.

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