Discuss whether a change in controller medication or decrease in the dose or strength of the inhalant would be an option. Some health experts have reported a reduction in hoarseness after backing down the dose, but this is not always effective. There is a particular inhaled steroid which is inactive until it reaches the surface of the lung (after inhalation). It seems to be an ideal inhalant for people who have adverse effects which are localized to the throat or tongue. The brand name of this unique inhaled steroid is Alvesco. It is only available by prescription. Unfortunately no currently available steroid based inhaler, (including Alvesco) eliminates the risk of dysphonia. One study referenced below suggested reduced risk with some dry powder inhalers.
When used in high doses, a small amount of the medication is absorbed into the bloodstream and some side effects beyond the mouth and throat may develop. The most likely to be encountered are easy bruisability of the skin and suppression of the adrenal glands. The significance of adrenal gland suppression is discussed in further detail in the pamphlet entitled Asthma and Steroids in Tablet Form , prepared by the Partners Asthma Center. The risk from the long-term use of inhaled steroids in terms of hastening thinning of the bones (osteoporosis) is currently being studied. However, it is widely agreed that any risk that may be discovered will be far less than that resulting from use of steroids in tablet form in doses needed to achieve the same control of asthma.