Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device

Background: The objective was to investigate the local side-effects of inha led corticosteroids (ICS) in daily life in asthmatic children, particularly the younger ones, by an observational prospective cross-sectional cohort s tudy. Methods: Asthmatic children (n=639, 75.9 +/- 48.9 months, 61.3% boys), trea ted with beclomethasone dipropionate (BDP) (721.0 +/- 287.3 mug per day) or budesonide (BUD) (835.5 +/- 684.9 mug per day) for at least 1 month, were recruited at the time of a scheduled visit. Local side-effects were researc hed by questionnaire (cough during inhalation, hoarseness, dysphonia, and t hirsty feeling) and clinical examination (perioral dermatitis, oral candidi asis, and tongue hypertrophy). Results: Exactly 63.3% of the children aged under 6 years and 59.5% of the older ones reported one local side-effect. Cough (39.7%) was dependent on y oung age, use of BDP, and mainly use of spacer device, with an OR of 4.7 (9 5% CI: 2.7-8.2). Thirsty feeling (21.9%) and hoarseness (14.1%) occurred in children using ICS and long-acting beta (2)-agonists. Dysphonia (11.1%) wa s favored by high doses of BDP and BUD, and by inhalation from spacer devic es or nebulizers. No factor favored oral candidiasis (10.7%). Perioral derm atitis (2.9%) and tongue hypertrophy (0.1%) were associated with nebulizati on. Conclusions: Local side-effects of ICS are common in asthmatic children of all ages, and the device used constitutes the most influential factor.