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Studying the effect of inhaled corticosteroids on the larynx in bronchial asthma patients using videostroboscopy

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Abstract

Introduction

The frequent use of inhaled corticosteroids (ICS), especially at higher doses, has been accompanied by concern about both systemic and local side effects. The systemic complications of ICS have been extensively studied and are well documented in the literature. There are comparatively few studies reporting on the local complications of ICS. Compared with systemic side effects, the local side effects of ICS are considered to constitute infrequent and minor problems. However, although not usually serious, these local side effects are of clinical importance.

Aim of the work

The aim of this study was to demonstrate the effect of ICS on the larynx using videostroboscopy in patients suffering from bronchial asthma in order to avoid these effects on the patients in further protocols of treatment.

Patients and methods

This study was carried out on 50 patients suffering from bronchial asthma. They were divided into two groups. Group A included 25 patients suffering from bronchial asthma treated using ICS (budesonide) for 1 year at a dose of 1600 μg/day. Group B included 25 patients having bronchial asthma and not receiving ICS. Each patient was subjected to the following protocols of assessment: (i) elementary diagnostic procedures such as (a) patient interviews, (b) auditory perceptual assessment, and (c) laryngeal visualization. (ii) Clinical diagnostic aids: laryngovideostroboscopy was carried out using a digitalized stroboscopy system to examine the vocal fold mobility, congestion, hypertrophy, ventricular folds hypertrophy, glottic gap, and glottic closure. The following acoustic parameters were measured: fundamental frequency, jitter (cycle-to-cycle variation in frequency), shimmer (cycle-to-cycle variation in amplitude), and noise-to-harmonic ratio (N/H). (iii) Additional instrumental diagnostic measures: the acoustic signals were recorded from each patient. The results of this study revealed more laryngeal abnormalities in group A than in group B. Dysphonia was found in 76% of the patients in group A, in which voice was perceived as either strained, leaky, or of rough qualities. The following changes in the glottis were observed in some patients: either localized or diffuse congestion of the vocal folds, hypertrophy in the ventricular bands, incomplete glottic closure, and glottic gap. In addition, there were also decreases in glottic wave and amplitude. Acoustic analysis showed significant increase in the jitter and shimmer values.

References

  1. Snapper JR. Inflammation and airway functions. The asthma syndrome (ed). Am Rev Respir Dis. 1998; 141: 531–533

    Article  Google Scholar 

  2. Barnes PJ. Medical progress: chronic obstructive pulmonary disease. N Engl J Med. 2000; 343: 269–280

    CAS  Article  Google Scholar 

  3. Selroos O, Backman R, Forsén KO, Löfroos AB, Niemistö M, Pietinalho A, et al. Local side-effects during 4-year treatment with inhaled corticosteroids–a comparison between pressurized metered-dose inhalers and Turbuhaler. Allergy. 1994;49:888–890

    CAS  Article  Google Scholar 

  4. Van der Molen T, Willemse BWM, Schokker S, ten Hacken NHT, Postma DS, Juniper EF. Development, validity and responsiveness of the clinical COPD questionnaire. Health Qual Life Outcomes. 2003;1

  5. Dubus JC, Marguet C, Deschildre A, Mely L, Le Roux P, Brouard J, et al. Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age and device. Allergy. 2001; 56: 944–948

    CAS  Article  Google Scholar 

  6. Allen DB, Bielory L, Derendorf H, Dluhy R, Colice GL, Szefler SJ. Inhaled corticosteroids: past lessons and future issues. J Allergy Clin Immunol. 2003; 112: S1–S40

    CAS  Article  Google Scholar 

  7. John AV, Henry G, Aijaz A. Voice disorders team approach to evaluation and management. J Voice. 2003; 16: 202–210

    Google Scholar 

  8. Cerasoli FJ. Developing the ideal inhaled corticosteroid. Chest. 2006;130(1 Suppl):54S–64S

    CAS  Article  Google Scholar 

  9. Crompton G. Asthma: management. In: Seaton A, Seaton D, Leitch AG, editor. Crofton and Douglas’s respiratory diseases. 5th ed. London: Wiley-Blackwell; 2000. pp. 973–997.

    Chapter  Google Scholar 

  10. Kotby MN. Evaluating voice therapy: measuring the effectiveness of treatment. 1st ed. Singular; 1995.

  11. Kotby MN. Voice disorders: recent diagnostic advances. Egypt J Otolaryngol. 1986; 3: 89

    Google Scholar 

  12. Lavy JA, Wood G, Rubin JS, Harries M. Dysphonia associated with inhaled steroids. J Voice. 2000; 14: 581–588

    CAS  Article  Google Scholar 

  13. Dogan M, Eryuksel E, Kocak I, Celikel T, Sehitoglu MA. Subjective and objective evaluation of voice quality in patients with asthma. J Voice. 2007; 21: 224–230

    Article  Google Scholar 

  14. Hanania NA, Chapman KR, Kesten S. Adverse effects of inhaled corticosteroids. Am J Med. 1995; 98: 196–208

    CAS  Article  Google Scholar 

  15. Koike Y, Takahashi H, Calcaterra TC. Acoustic measure for detecting laryngeal pathology. Acta Otolaryngol. 1999; 84: 105–107

    Article  Google Scholar 

  16. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest. 2004; 126: 213–219

    CAS  Article  Google Scholar 

  17. Hone SW, Donnelly MJ, Robertson J, Coakley R, O’Neill S, Walsh MJ. Dysphonia and inhalation of corticoids: a prospective study. Rev Laryngol Otol Rhinol (Bord). 1996; 117: 331–333

    CAS  PubMed  Google Scholar 

  18. Rachelefsky G. Inhaled corticosteroids and the risk of oropharyngeal adverse events: results from a meta-analysis. J Allergy Asthma Immunol. 2006; 117: 358

    Google Scholar 

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Correspondence to Rana Ahmed Khalifa.

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Almaraghy, A.A., Seliem, A. & Khalifa, R.A. Studying the effect of inhaled corticosteroids on the larynx in bronchial asthma patients using videostroboscopy. Egypt J Otolaryngol 28, 270–274 (2012). https://doi.org/10.7123/01.EJO.0000417980.14267.a8

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  • DOI: https://doi.org/10.7123/01.EJO.0000417980.14267.a8

Keywords

  • bronchial asthma
  • inhaled steroids
  • larynx
  • videostroboscopy