How can you reduce the side effects of inhaled corticosteroids?

Many people who use inhaled corticosteroids to manage asthma or COPD struggle with side effects. These side effects might affect your bones, lungs, eyes, or even your voice.

You might ask yourself, “Is there a way to keep the benefits while avoiding the bad parts?”

Yes, there is. You can lower these risks with proper technique, mindful habits, and the right medical advice.

What problems can inhaled corticosteroids cause?

Inhaled corticosteroids, especially at higher or long-term doses, can weaken bones, increase respiratory infections, raise cataract risk, cause withdrawal symptoms if stopped abruptly, lead to oral thrush, and irritate the vocal cords, resulting in a hoarse voice.

It can affect your bones

When used in high doses, inhaled corticosteroids can reduce bone mineral density. Over time, this weakens your bones and makes them easier to break.

For example, one Swedish study in COPD patients found that 19.9% had an osteoporosis-related event compared to 12.9% in people not using corticosteroids. Those who took high doses had a 52% higher risk.

Another study showed that doubling the total dose lowered bone mineral density in the lower spine. This means that even if your breathing improves, your bones can silently grow weaker.

So, what should you do?

You should talk to your doctor about the lowest effective dose and ways to protect your bone strength, like adding calcium or vitamin D.

It can make you catch respiratory infections

Higher doses may weaken your lung’s defense system. This makes it easier for germs to cause respiratory infections.

In one study, people with COPD using even low doses had a greater chance of infection from Moraxella catarrhalis. Another study found that those on the highest corticosteroid doses were twice as likely to develop pneumonia or lower lung infections compared to non-users.

As the dose increases, your lungs lose more of their natural ability to fight bacteria. So, you need to use the smallest amount that keeps your breathing stable. This helps your lungs stay strong against infections.

It can harm your eyes

Long-term, high-dose use can lead to cataracts. This happens when the lens of your eye becomes cloudy, which blurs your vision.

Studies found that people using these medications had 1.5 times more nuclear cataracts and nearly twice as many posterior subcapsular cataracts as those who did not use them. Among patients with over 2000 mg of lifetime exposure to beclomethasone, 27% developed cataracts compared to only 5% in nonusers.

This shows that eye protection matters just as much as lung health. Regular eye exams can catch early changes and help prevent vision problems.

Withdrawal symptoms

When you stop corticosteroids all at once, your body reacts. You may feel extreme fatigue, nausea, dizziness, or joint pain. Your adrenal glands might struggle to balance your hormones, which can cause low blood pressure or dehydration.

This is why your doctor always recommends tapering off slowly. Gradual adjustment gives your body time to recover and stay stable.

Your mouth sometimes hurts after using an inhaler

If you forget to rinse your mouth, leftover medicine stays on your tongue and cheeks. This residue can cause yeast to grow, leading to oral thrush. It looks like white patches that may feel sore.

Research shows that inhaled corticosteroids nearly triple your risk of thrush. People using metered-dose inhalers were about five times more likely to develop it, while dry powder inhalers increased risk about threefold.

Rinsing right after each use clears the medication residue and protects your mouth from these painful spots.

It can change your voice

This side effect is called dysphonia, which means a hoarse or weak voice. When medicine builds up in your mouth instead of reaching your lungs, it can irritate your vocal cords.

The National Asthma Council Australia has explained that poor inhaler technique often causes this issue. That’s why practicing correct technique is essential not only for effective treatment but also for keeping your voice healthy.

How can you prevent or reduce these side effects?

You can prevent or reduce these side effects by using proper inhaler technique, rinsing after each use, sticking to the lowest effective dose, choosing the most suitable corticosteroid and device, and supporting your overall health with good lifestyle habits.

Ensure proper inhaler technique

If you use your inhaler incorrectly, medicine stays in your mouth instead of reaching your lungs. This can cause thrush, voice problems, or even make your treatment less effective.

To fix this, ask your healthcare provider to demonstrate the proper method. You can also watch approved video tutorials from health sources like the NHS.

Have you heard of spacers?

A spacer helps more medication reach your lungs and keeps less of it in your mouth. However, not every inhaler works with a spacer. For example, you should not use one with devices like:

• Advair Diskus
• Asmanex Twisthaler
• Pulmicort Flexhaler.

Other inhalers like Flovent Diskus, Arnuity Ellipta, and Spiriva HandiHaler also do not pair with spacers. Always check which one you have before using a spacer. Matching the right device and method is vital for safe, effective treatment. Practice until it feels natural. The more natural it becomes, the better your protection from side effects.

Rinse after every use

It may sound simple, but rinsing your mouth right after you inhale the medication prevents many problems. One Australian study found that nearly a third of patients did not rinse correctly. Those who did were far less likely to experience mouth or throat irritation.

Start by rinsing and spitting out water after every use. If possible, brush your teeth as well. These small steps remove leftover particles that could cause oral thrush or voice changes. Keeping this habit strengthens your oral health and lowers your risk of infections.

Use the lowest effective dose

Taking the smallest dose that still controls your symptoms can greatly reduce side effects. High doses increase risks for bone loss, infections, and cataracts.

For instance, studies show that bone density dropped by 0.35% in patients using budesonide for two years, and up to 0.83% with beclomethasone. Another study found pneumonia risk increased 1.6 times with fluticasone, while cataract risk rose about 5%.

These numbers show how dose matters. Always discuss with your doctor to find the right balance. Regular checkups help track your progress, so you only take what you need. If your asthma remains stable, your doctor may lower your dose over time. This prevents unnecessary exposure and keeps your body safer.

Choose the right inhaled corticosteroids molecule and device

Choosing the right inhaler and corticosteroid type depends on your needs, breathing strength, and coordination. Your doctor can assess these factors to find the best match.

There are many options. For example:

• Beclometasone Dipropionate is found in Clenil Modulite or Qvar (MDI).
• Budesonide is used in Pulmicort or Easyhaler (DPI).
• Fluticasone Propionate is in Flovent HFA or Flovent Diskus.
• Mometasone Furoate is in Asmanex Twisthaler.
• Combination inhalers like Advair Diskus, Symbicort, and Fostair pair corticosteroids with other medications for added control.

If you have trouble taking a deep breath, a soft mist inhaler might suit you better than a dry powder one. Also, some corticosteroids may be gentler on the body. Studies suggest that budesonide might affect your bones and hormones less than fluticasone.

Your doctor will consider factors like age, cost, and other health conditions. The right choice ensures better results and fewer side effects.

Maintain a healthy lifestyle

Healthy habits protect your lungs, bones, and immune system. Quitting smoking is one of the most powerful steps you can take. Research shows that people who stopped smoking for six weeks improved their lung function by about 407 mL and reduced airway inflammation by nearly 30%.

You can also protect your bones by eating foods rich in calcium and vitamin D. Include milk, leafy greens, fish, and fortified cereals in your meals. Doing regular weight-bearing exercises, such as walking or light resistance training, strengthens your bones too.

A Cochrane review found that patients who took calcium and vitamin D for two years gained bone density in both the spine and forearm. This lowers the chance of fractures and long-term bone problems.

Don’t forget that a strong immune system also keeps infections away. A balanced diet and regular exercise make a big difference in how your body handles medication.

Wrap up

• Always use your inhaler the correct way and practice regularly until you master it.
• Rinse and spit after every use to protect your mouth and throat.
• Work with your doctor to find the lowest dose that keeps your symptoms under control.
• Never stop your treatment suddenly. Taper off slowly under supervision.
• Use the inhaler and corticosteroid that best match your breathing ability and medical needs.
• Maintain a healthy lifestyle—quit smoking, eat a balanced diet, and stay active.
• Regular checkups keep your dose safe and prevent long-term damage.