Thrush
Children 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 children, 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 child with thrush. Thrush is treated with anti-fungal mouth rinses such as nystatin, and in severe or troublesome cases, with fluconazole (Diflucan).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 or Scope) to prevent thrush in children who are prone to this condition. Of course, the child should be old enough to understand not to swallow the mouth wash.
Hoarseness
Some children 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 child 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.Growth Suppression
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.
Cataracts and Glaucoma
Inhaled steroids may cause an increase in the formation of cataracts and glaucoma in older adults, 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 children who 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.Want to learn more? Find out about the best medicines for asthma.
Source:
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.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.
