Steroid inhalers are preventers. They reduce inflammation in the airways over time rather than relieving symptoms immediately, which is why they are taken every day even when you feel well.
An important reassurance: inhaled steroids are not the same as steroid tablets. The dose is far smaller and delivered to the airways rather than throughout the body, so the effects associated with tablets such as prednisone largely do not apply. Most inhaler side effects are local, in the mouth and throat, and are preventable.
Common side effects during long-term use
- Oral thrush, showing as white patches in the mouth or throat, soreness, or an altered taste. See steroid inhalers and thrush.
- A hoarse voice or weakened voice, which matters more if you use your voice for work
- Sore throat or mild cough after inhaling
These are largely preventable, and the two measures that prevent them are worth doing properly:
- Rinse your mouth and spit out after every dose. Not swallow, spit.
- Use a spacer with a metered dose inhaler. It gets more medicine to the lungs and less to the mouth and throat, which improves both effect and side effects at once.
If thrush or hoarseness keeps recurring despite this, ask for your technique to be checked. Poor inhaler technique is common and is usually the explanation.
Serious or persistent symptoms to discuss with a clinician
Get emergency help if breathing worsens rather than improves immediately after using an inhaler, or if you cannot speak in full sentences, your lips look blue or grey, or your reliever is not working.
At higher doses over long periods, some steroid can be absorbed into the body. This is uncommon at usual doses but is why high-dose treatment is reviewed rather than left indefinitely. Considerations include effects on bone density over years, growth monitoring in children, and rarely adrenal suppression. Report unusual tiredness, dizziness or weight loss on long-term high-dose treatment.
Children on inhaled steroids should have their growth monitored. This is routine rather than a sign of concern, and untreated asthma also affects growth.
Dose changes, missed doses and monitoring tests
Do not stop your preventer because you feel well. Feeling well is usually evidence it is working. Stopping allows inflammation to return over days to weeks, and the deterioration is often not noticed until symptoms are back.
Equally, needing your reliever more often than usual is a signal the preventer is not doing enough, and needs review rather than simply more reliever. See Ventolin side effects.
Ask for a written asthma action plan, an annual review, and an inhaler technique check at each review.
Interactions with OTC medicines and supplements
- Some antifungal and antibiotic medicines can raise levels of certain inhaled steroids. Mention your inhaler whenever either is prescribed.
- Anti-inflammatories such as ibuprofen and aspirin trigger symptoms in a minority of people with asthma. See NSAID side effects.
- Beta blockers can worsen asthma. Make sure any prescriber knows.
What to ask your doctor before changing treatment
- Can you check my inhaler technique?
- Would a spacer help me?
- Am I on the lowest dose that keeps me well?
- What should I do if I keep getting thrush or hoarseness?
- How often should I need my reliever, and when should I contact you?
Related chronic medication guides
- Inhaler side effects and asthma pump side effects
- Asthma medication side effects
- Corticosteroid side effects, for the tablet form
- Chronic medication side effects
- Report a side effect in South Africa
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.