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.
If you have a serious asthma attack (exacerbation), your doctor may prescribe a short course of oral c orticosteroids. When used orally for less than two weeks, the side effects of corticosteroids are less likely, but when used for many months, they can have a serious and permanent effect. After the severe symptoms of your asthma attack have been successfully treated and controlled, your doctor will work with you to minimize your need for prednisone in the future. Faithfully taking an inhaled corticosteroid every day is the most commonly successful method to do this.
Although the safety of inhaled corticosteroid therapy has been established, physicians should prescribe the lowest dosage possible. In addition, there may be a need to increase the corticosteroid dosage and add a long-acting beta 2 agonist in patients at high risk for exacerbations, such as those with a history of hospitalizations or emergency department visits because of asthma. 27 , 28 Combination therapy with an inhaled corticosteroid and a long-acting beta 2 agonist is more cost effective than treatment with an inhaled corticosteroid plus a leukotriene modifier. 29