Which adverse effect is most characteristic of chronic high-dose inhaled corticosteroid therapy?

Which adverse effect is most characteristic of chronic high-dose inhaled corticosteroid therapy?

• A. Oropharyngeal candidiasis.
• B. Systemic weight gain.
• C. Severe immunosuppression.
• D. Hyperglycemia.

Answer: (B)

Chronic high-dose inhaled corticosteroids mainly cause local effects on the mouth and throat because the drug directly contacts the oropharyngeal mucosa. The most characteristic adverse effect is oropharyngeal candidiasis (thrush), which occurs when local immune defenses are suppressed in that area and Candida can overgrow. This is why patients often notice sore throat or white patches, and why rinsing the mouth after inhalation and using a spacer to reduce deposition in the mouth are effective preventive steps. Systemic weight gain, severe immunosuppression, and hyperglycemia are more typical of systemic corticosteroid use or absorption at very high doses, not the hallmark for inhaled therapy. Some systemic effects can occur with long-term, very high-dose inhaled steroids, but they are far less common than thrush and not the defining adverse effect.

Chronic high-dose inhaled corticosteroids mainly cause local effects on the mouth and throat because the drug directly contacts the oropharyngeal mucosa. The most characteristic adverse effect is oropharyngeal candidiasis (thrush), which occurs when local immune defenses are suppressed in that area and Candida can overgrow. This is why patients often notice sore throat or white patches, and why rinsing the mouth after inhalation and using a spacer to reduce deposition in the mouth are effective preventive steps.

Systemic weight gain, severe immunosuppression, and hyperglycemia are more typical of systemic corticosteroid use or absorption at very high doses, not the hallmark for inhaled therapy. Some systemic effects can occur with long-term, very high-dose inhaled steroids, but they are far less common than thrush and not the defining adverse effect.