Summary
The impact of sustained inhaled corticosteroid (ICS) therapy on the larynx and pharynx
was assessed using a prospective, cross-sectional, and investigator-blinded study
conducted at the University Hospital Aintree, Liverpool, UK. Forty-six adults recruited
from two local general practices and from general ENT clinics at our University hospital
were investigated for the study. Patients were allocated to three groups according
to ICS use. Laryngeal effects were measured by correlating the results of a vocal
performance questionnaire, a respiratory symptom questionnaire, and measurements obtained
by computerized speech analysis. Sustained vowels and connected speech were analyzed
in normal and asthmatic subjects. Acoustic analysis was correlated with cellular markers
of inflammation after biopsy. Regular ICS users had significantly more pharyngeal
inflammation and throat discomfort (P<0.0001). Vocal performance was also worse in this group (P<0.0001). They were more likely to have hoarseness, weakness of voice, aphonia, sore
throat, throat irritation, and cough (P<0.0001). All these variables were directly related to one another (P<0.0001). Multiple linear regression analysis showed that jitter was a good objective
measure of hoarseness (P<0.05). Regular ICS users were significantly more likely to have abnormal jitter, shimmer,
and closed-phase quotient scores (P<0.0001). There was no difference between the groups in the observed parameters of
inflammation (P>0.01). A higher pharyngitis score did not correlate with any of the histological markers
of inflammation (P>0.01). Local side effects are more common in asthmatics that use ICS regularly. Measures
of laryngeal function are significantly worse in regular ICS users. However, histological
markers and oropharyngeal redness are not reliable measures of inflammation.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The local side effects of inhaled corticosteroids: current understanding and review of the literature.Chest. 2004; 126: 213-219
- Adverse effects of inhaled corticosteroids.Am J Med. 1995; 98: 196-208
- Efficacy and safety of inhaled corticosteroids.Am J Respir Crit Care Med. 1998; 157: S1-S53
- Dysphonia associated with inhaled steroids.J Voice. 2000; 14: 581-588
- Inhaler devices for asthma.Drug Ther Bull. 2000; 38: 9-14
- Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year.Thorax. 1993; 48: 817-823
- High dose fluticasone propionate, 1mg daily, versus fluticasone propionate, 2mg daily, or budesonide, 1.6mg daily, in patients with chronic severe asthma. International Study Group.Eur Respir J. 1995; 8: 579-586
- Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial.Lancet. 2003; 361: 1071-1076
- Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy.Arch Otolaryngol Head Neck Surg. 2002; 128: 677-681
- Laryngeal findings in users of combination corticosteroid and bronchodilator therapy.Laryngoscope. 2004; 114: 1566-1599
- Optimising outcome assessment of voice interventions, I: reliability and validity of three self-reported scales.J Laryngol Otol. 2007; 29: 1-5
- User's Guide: Statistics Version [8.2].5th ed. SAS Institute Inc., Cary, NC1985
- Physiopathology of airway hyperresponsiveness.Curr Allergy Asthma Rep. 2003; 3: 166-171
- The natural history of asthma and early intervention.J Allergy Clin Immunol. 2002; 109: S549-S553
- Inhalation therapy for bronchial asthma: strategies and targets.Curr Opin Pulm Med. 2003; 9: S3-S7
- Does bronchial hyperresponsiveness in asthma matter?.J Asthma. 2004; 41: 247-258
- Understanding asthma pathophysiology.Allergy Asthma Proc. 2003; 24: 79-83
- Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux.Aliment Pharmacol Ther. 2004; 20: 26-38
- Dysphonia produced by corticoid inhalation: truth or myth?.Arch Bronconeumol. 1995; 31: 415-417
- Objective assessment of hoarseness by measuring jitter.Clin Otolaryngol Allied Sci. 2001; 26: 29-32
- The reliability and sensitivity to change of acoustic measures of voice quality.Clin Otolaryngol Allied Sci. 2004; 29: 538-544
- Dysphonia: current methods of evaluation.Ann Otolaryngol Chir Cervicofac. 2005; 122: 163-172
- Dysphonia and inhalation of corticoids: a prospective study.Rev Laryngol Otol Rhinol (Bord). 1996; 117: 331-333
- The reliability of three perceptual evaluation scales for dysphonia.Eur Arch Otorhinolaryngol. 2004; 261: 429-434
- Sentence/vowel correlation in the evaluation of dysphonia.J Voice. 1995; 9: 297-303
- Effect of tape recording on perturbation measures.J Speech Lang Hear Res. 1998; 41: 1031-1041
- Local side effects during 4-year treatment with inhaled corticosteroids—a comparison between pressurised metered-dose inhalers and turbohaler.Allergy. 1994; 49: 888-890
- Investigation of mouth washing by patients after inhaling corticosteroids.Yakugaku Zasshi. 2005; 125: 455-461
- Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering corticosteroids in asthma.Br Med J. 2001; 323: 896-900
- Inhaled mometasone furoate: a review of its use in adults and adolescents with persistent asthma.Drugs. 2001; 61: 1325-1350
Article info
Publication history
Published online: March 17, 2008
Accepted:
November 1,
2007
Identification
Copyright
© 2009 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
