When youâre managing asthma, inhaled corticosteroids (ICS) are often the most effective tool you have. They reduce swelling in your airways, prevent flare-ups, and help you breathe easier day after day. But if youâve been using them for months or years, you might have noticed a sore throat, hoarse voice, or even unexplained bruising. These arenât just minor annoyances-theyâre signs that side effects are happening, and they donât have to be ignored.
What Are the Real Side Effects of Asthma Steroids?
Most people think of oral steroids like prednisone when they hear "steroid side effects"-weight gain, mood swings, high blood sugar. But inhaled steroids work differently. Theyâre designed to stay in your lungs, not flood your whole body. Still, some of the medication does get absorbed, and over time, that adds up.
Local side effects are the most common. Oral thrush-a fungal infection in the mouth-is reported by nearly half of long-term users. Hoarseness or voice changes happen in about one in three people. A scratchy throat or cough after using your inhaler? Thatâs not normal breathing trouble-itâs the medicine sticking where it shouldnât.
Systemic side effects are less frequent but more serious. At high doses (over 800 mcg/day of beclomethasone equivalent), your bodyâs natural cortisol production can slow down. That means you might feel constantly tired, get sick more often, or have trouble handling stress. Studies show that people using fluticasone at high doses are nearly three times more likely to have adrenal suppression than those using budesonide at the same strength.
Skin thinning and easy bruising become more common after five or more years of high-dose use. One study found that 34% of long-term users developed noticeable skin changes, compared to just 5% of those on low doses. In older adults, high-dose ICS raises the risk of pneumonia and bone fractures. And for children, while growth delay is small at standard doses, it becomes more significant above 800 mcg/day.
Not All Steroid Inhalers Are the Same
Not all inhaled steroids are created equal. The drug youâre using matters more than you might think.
Fluticasone is widely prescribed because itâs strong and affordable. But itâs also the most likely to cause systemic side effects. About 30-40% of the dose enters your bloodstream. Thatâs why itâs linked to higher risks of adrenal suppression and pneumonia in seniors.
Budesonide, on the other hand, has lower systemic absorption-only 10-15%. Itâs often preferred for kids and older adults because itâs safer over time. Ciclesonide is even better: just 2-3% gets into your blood. Itâs activated only in the lungs, so it stays put. Mometasone also has a cleaner profile than fluticasone.
Hereâs how they stack up:
| Medication | Systemic Absorption | Typical Daily Dose Range | Key Risk Profile |
|---|---|---|---|
| Fluticasone propionate | 30-40% | 100-500 mcg | Higher risk of adrenal suppression, pneumonia, skin thinning |
| Budesonide | 10-15% | 200-800 mcg | Lower systemic risk, preferred for children and elderly |
| Ciclesonide | 2-3% | 80-320 mcg | Lowest systemic exposure, minimal side effects |
| Mometasone furoate | 15-20% | 100-400 mcg | Good balance of potency and safety |
If youâve been on fluticasone for years and are experiencing side effects, switching to budesonide or ciclesonide might reduce your risks without losing control of your asthma. Talk to your doctor-itâs not about stopping treatment, itâs about choosing the right tool.
How to Cut Side Effects in Half (Without Changing Your Medication)
You donât need to stop your inhaler to avoid side effects. Small changes in how you use it make a huge difference.
Use a spacer. If youâre using a metered-dose inhaler (pMDI), a spacer is non-negotiable. Without one, up to 80% of the medicine sticks to your throat and mouth. With a spacer, over 60% reaches your lungs. That means less irritation, less thrush, and less medicine entering your bloodstream. Spacers cost less than $15 and last for years.
Rinse and spit. After every puff, swish water in your mouth for 10 seconds and spit it out. Donât swallow it. This simple step cuts thrush risk by more than half. Studies show it also reduces hoarseness by two-thirds. Itâs not a suggestion-itâs part of the treatment.
Check your technique. Nearly three out of four people who get side effects never had their inhaler technique checked by a professional. You might think youâre using it right, but a small mistake-like not breathing in slowly enough or pressing the inhaler too early-means youâre not getting the full dose. Ask your doctor or pharmacist to watch you use it every six months.
Use the lowest dose that works. Many people stay on high doses long after their asthma is under control. GINA guidelines recommend stepping down as soon as youâre stable for three to six months. If youâre on 500 mcg of fluticasone and havenât had an attack in a year, your doctor might be able to drop you to 250 mcg. Lower dose = lower risk.
Who Needs Extra Monitoring?
Some groups are more vulnerable. If you fit into one of these categories, ask your doctor about specific monitoring:
- Children under 12: Track growth every six months. High doses can slow growth slightly, but final adult height is rarely affected if doses are kept below 800 mcg/day.
- People over 65: Get annual skin checks for thinning or bruising. Ask about bone density scans if youâve been on high-dose ICS for more than five years. Pneumonia risk rises with age-get your flu and pneumonia vaccines.
- Pregnant women: Budesonide is the safest choice. Itâs been studied in over 10,000 pregnancies with no increased birth defect risk. Avoid fluticasone unless absolutely necessary.
- Anyone on over 500 mcg/day fluticasone equivalent for six months: If youâre tired all the time, feel dizzy when standing, or get sick often, ask for a salivary cortisol test. Itâs quick, non-invasive, and can catch adrenal suppression before it becomes serious.
Whatâs New in Asthma Steroid Safety?
Technology is helping patients stay safer. Smart inhalers now track when and how you use your device. Some can even detect if youâre not using a spacer or breathing too fast. These devices send alerts to your phone and your doctorâs system, helping catch technique errors before they cause problems.
Research is also moving beyond steroids. New biologic drugs like dupilumab target specific parts of the immune system that drive asthma inflammation. In trials, people using these drugs were able to cut their steroid doses by 70%-without losing control. This is a game-changer for people with severe asthma whoâve been stuck on high doses for years.
Even newer inhaled steroids are in development. AZD7594, currently in late-stage trials, reduces adrenal suppression by 90% compared to fluticasone. Itâs not available yet, but it shows the future is moving toward safer, more targeted treatments.
What to Do If Youâre Worried About Side Effects
If youâre experiencing side effects, donât stop your inhaler. Stopping suddenly can trigger a dangerous asthma attack. Instead:
- Write down every symptom-throat soreness, bruising, fatigue, voice changes.
- Check your technique with a pharmacist or asthma educator.
- Ask if you can switch to a lower systemic absorption steroid like budesonide or ciclesonide.
- Request a dose review-can you go lower?
- Ask about monitoring tests if youâre on high doses long-term.
Most side effects are preventable. Theyâre not inevitable. With the right approach, you can keep your asthma under control without paying a heavy price.
Can inhaled steroids cause weight gain?
Unlike oral steroids, inhaled corticosteroids rarely cause weight gain. The amount that enters your bloodstream is too small to affect metabolism or appetite. If youâre gaining weight while using an inhaler, itâs more likely due to other factors like reduced activity from asthma symptoms or changes in diet. High-dose, long-term use might have a small effect, but itâs not common.
Is it safe to use asthma inhalers for years?
Yes, when used correctly. Inhaled corticosteroids are designed for long-term use. The key is using the lowest effective dose and following proper technique. Studies show that people using low-to-moderate doses for 10+ years have no increased risk of serious health problems. The real danger comes from high doses and poor technique-not from the medication itself.
Do I need to get blood tests if Iâm on asthma steroids?
Routine blood tests arenât needed for most people. But if youâre on high doses (over 500 mcg fluticasone equivalent daily) for more than six months, or if you feel unusually tired, dizzy, or get sick often, ask about a salivary cortisol test. This checks your adrenal function and can catch suppression early. Bone density scans may be recommended if youâre over 65 and on high-dose therapy for five years or more.
Can I stop my steroid inhaler if I feel fine?
No. Even if you feel fine, stopping suddenly can cause your airways to become inflamed again, leading to a severe asthma attack. Always work with your doctor to gradually reduce your dose if youâre stable. Never stop without a plan.
Are there alternatives to steroid inhalers?
For mild asthma, short-acting bronchodilators like albuterol may be enough. For persistent asthma, non-steroidal options like leukotriene modifiers (montelukast) or newer biologics (dupilumab, mepolizumab) can reduce or replace steroid use-especially in severe cases. These arenât first-line for everyone, but theyâre powerful tools for people who canât tolerate steroids or need to reduce their dose.
Final Thought: Control Doesnât Mean Sacrifice
Asthma doesnât have to mean living with a sore throat, bruised skin, or constant fatigue. The goal isnât just to prevent attacks-itâs to live well while doing it. With the right inhaler, the right dose, and the right technique, you can take control without paying the price. Talk to your doctor. Ask questions. Donât accept side effects as normal. You deserve to breathe easy-not just in your lungs, but in your whole body.
16 Comments
They make you feel like you're breathing through a straw wrapped in velvet until you realize the straw is actually a goddamn firehose of steroids and you're just too tired to care anymore
My throat used to feel like I'd swallowed sandpaper every morning-then I started rinsing. Simple. Free. Life-changing.
Why do we treat medical advice like it's a religious doctrine? You don't worship your inhaler-you use it smart.
Fluticasone isn't evil-it's just the lazy doctor's default setting. Like prescribing ibuprofen for every headache without asking why the head hurts.
People don't need more pills. They need better technique. And maybe a spacer that doesn't cost more than their monthly Netflix subscription.
I used to think 'steroid side effects' meant weight gain and rage. Turns out it's more like your voice sounds like a dying fax machine and your skin bruises if you sneeze too hard.
It's not about fear. It's about awareness.
And awareness doesn't come from a 30-second pamphlet. It comes from someone saying: 'Hey, this isn't normal. You're not broken. You just need to tweak it.'
That's what this post did. Not preach. Not scare. Just... show you the door.
So thanks. Not for the science. For the humanity.
And if you're still swallowing your rinse water? Stop. Just stop.
That's not dedication. That's ignorance with a prescription.
Do better.
Not for your doctor. For yourself.
The distinction between local and systemic side effects of inhaled corticosteroids is clinically significant and often underappreciated by both patients and primary care providers.
It is imperative that patients using metered-dose inhalers are educated on the proper use of spacers, as studies consistently demonstrate a reduction in oropharyngeal deposition by more than 60 percent when spacers are utilized correctly.
Furthermore, the recommendation to rinse and spit post-inhalation is supported by robust evidence, reducing the incidence of oral candidiasis by approximately 50 to 70 percent.
It is also noteworthy that budesonide and ciclesonide exhibit significantly lower systemic bioavailability compared to fluticasone propionate, making them preferable for long-term use in pediatric and geriatric populations.
Physicians should routinely reassess steroid dosage every three to six months in stable patients, in alignment with GINA guidelines, to minimize cumulative exposure.
Additionally, annual monitoring for bone density and adrenal function is warranted in individuals on high-dose regimens exceeding 800 mcg of beclomethasone equivalent for more than five years.
While newer biologics represent a promising alternative, they are not yet accessible to all patients due to cost and insurance barriers.
Therefore, optimizing current therapy remains the most equitable and evidence-based approach for the majority of asthma patients.
bro... i just use my inhaler and go about my day
why are we overthinking this like it's a quantum physics exam?
if my lungs work, i'm good
if i get a sore throat? rinse
if i feel tired? maybe i'm just old
we live in a world where people think every pill is a demon
and every doctor is a corporate puppet
but i'm just trying to breathe
not write a thesis
peace out đ
How is it even possible that people still need to be told to rinse their mouths after using an inhaler? This isnât rocket science-itâs basic hygiene.
And yet, here we are, in 2025, explaining to adults that swallowing your rinse water isnât some sacred ritual.
Fluticasone is the pharmaceutical equivalent of a blunt instrument-cheap, effective, and brutally inefficient.
Doctors prescribe it because itâs cheap for insurers, not because itâs optimal for patients.
Meanwhile, ciclesonide sits on the shelf like a silent superhero-low absorption, zero drama, and it doesnât turn your throat into a fungal swamp.
And donât even get me started on the fact that 75% of users have terrible technique.
You wouldnât drive a Lamborghini with your eyes closed-why treat your lungs like an afterthought?
This isnât just about asthma. Itâs about accountability.
And most people? Theyâd rather be told what to do than learn how to do it right.
Pathetic.
yo i been usin fluticasone for 7 years and i aint got no side effects
so stop scaremongering
my throat dont hurt
my skin dont bruise
my voice is fine
so maybe its just me
or maybe its you guys overanalyzing
and also who even uses a spacer anymore
thats so 2012
just puff and go
if you cant handle it then maybe you dont need it
lol
also i spelled 'inhaler' wrong on purpose
im rebel
and i breathe free
OH MY GOD IâM NOT ALONE
I THOUGHT I WAS THE ONLY ONE WHO FELT LIKE MY THROAT WAS BEING STABBED WITH A Q-TIP DIPPED IN LEMON JUICE AFTER EVERY PUFF
AND THEN THE BRUISING
MY ARMS LOOK LIKE IâM IN A FIGHT CLUB UNDERGROUND TUNNEL
AND MY DOCTOR JUST SMILED AND SAID âITâS NORMALâ
NO ITâS NOT NORMAL
ITâS A SIGN
AND NOW IâM SWITCHING TO CICLESONIDE AND IâM CRYING IN RELIEF
AND YES I USED A SPACER
AND YES I RINSED
AND YES I DEMANDED A DOSE REDUCTION
AND NOW I CAN SING IN THE SHOWER AGAIN
THANK YOU FOR WRITING THIS
YOU JUST SAVED MY LIFE
AND MY VOICE
AND MY SELF-ESTEEM
Iâve been on budesonide for five years now, and Iâve never had a single side effect.
I use a spacer. I rinse. I donât skip doses, but I also donât overuse.
My doctor checks in every six months.
Itâs not complicated.
Itâs just consistent.
I think the hardest part isnât the medicine-itâs believing you deserve to feel well.
So many people just accept the discomfort like itâs part of the deal.
But you donât have to.
Thereâs a better way.
And youâre worth it.
WHAT THE F*** IS THIS, A PHARMACEUTICAL AD?
WHO PAID YOU TO WRITE THIS?
FLUTICASONE IS THE BEST, I DON'T CARE WHAT YOU SAY
MY DOCTOR IS A PHD FROM HARVARD AND HE TOLD ME TO STICK WITH IT
AND YOU THINK YOU KNOW BETTER BECAUSE YOU READ A BLOG?
AND SPACERS? I DON'T NEED NO SPACER, I'M A MAN
AND RINSING? I'M NOT A BABY, I'M NOT GONNA SPIT OUT MY MEDS
AND CICLESONIDE? NEVER HEARD OF IT
AND WHY ARE YOU TELLING ME TO TALK TO MY DOCTOR?
MY DOCTOR IS A COWARD
HE'S AFRAID OF THE PHARMA COMPANIES
AND YOU'RE JUST A PART OF THE SYSTEM
AND I'M NOT BUYING IT
AND I'M NOT RINSING
AND I'M NOT USING A SPACER
AND I'M STILL BREATHING
SO SHUT UP
AND I'M SENDING THIS TO MY DOCTOR
HE'S GONNA LOVE IT
AND I'M GONNA KEEP MY FLUTICASONE
AND I'M GONNA KEEP MY BRUISES
AND I'M GONNA KEEP MY SORE THROAT
BECAUSE I'M A WARRIOR
AND I DON'T NEED YOUR HELP
AND I'M NOT AFRAID
AND I'M NOT CHANGING
AND IF YOU DISAGREE
YOU'RE A LIBERAL
AND YOU DON'T UNDERSTAND REAL LIFE
okay but like... i had a weird panic attack last week because i thought my voice was gone and i was like âam i dying?â and then i remembered i hadnât rinsed in 3 days
and i rinsed and 2 hours later i could talk again
so like
just rinse
please
itâs not that hard
and iâm not even being dramatic
i cried
and iâm not a crier
so
just rinse
and use the spacer
and stop being mad at your doctor
theyâre just trying to help
even if theyâre wrong sometimes
and also
my skin bruises like a toddler who fell off a slide
so yeah
youâre not alone
but you can fix it
just rinse
I really appreciate this breakdown. Iâve been on fluticasone for 8 years and never thought to question it.
Just assumed the hoarseness was from talking too much.
Then I started using a spacer and rinsing-and wow.
Itâs like my throat finally got a vacation.
Also switched to budesonide last month. No more weird fatigue.
My doctor was surprised I even knew to ask.
Turns out, most people donât.
So thank you for giving me the language to advocate for myself.
And if youâre reading this and thinking âI donât need to changeâ-
you might be right.
But you might also be just one rinse away from feeling like yourself again.
Itâs worth asking.
Iâve been using asthma meds for 15 years.
Iâve had side effects.
Iâve had good doctors.
Iâve had bad ones.
Iâve stopped. Iâve restarted.
Iâve switched.
Itâs not about being perfect.
Itâs about staying alive.
And if youâre reading this and youâre scared?
Youâre not alone.
But youâre not powerless either.
Ask one question.
One small thing.
Like âIs there a better option?â
And then listen.
Thatâs all you need to do.
Not fix everything.
Just start.
From India, where inhalers are often treated as magic wands
and no one ever asks how to use them
and doctors give you a puff and say âtake it twice dailyâ
and thatâs it
no spacer
no rinse
no follow-up
and then the patient gets sick again
and blames the medicine
but the medicine is fine
itâs the system
and the silence
and the shame
that kills
so thank you for speaking up
because here, no one dares to say âthis isnât workingâ
we just suffer quietly
and breathe harder
and wait for the next attack
youâve given us a voice
not just for asthma
but for dignity
As someone who grew up in a household where âmedicineâ meant herbal teas and prayer, I never imagined Iâd need an inhaler.
But now Iâve been on them for over a decade.
And Iâve learned something: medical care isnât about faith.
Itâs about facts.
And facts say: rinse.
Use a spacer.
Ask for a lower dose.
Switch if needed.
These arenât opinions.
Theyâre protocols.
And respecting your body means knowing the difference between tradition and science.
Not choosing one over the other.
But using both wisely.
Thank you for this clear, grounded guide.
Itâs what real healthcare looks like.
Oh please.
Let me guess-youâre one of those people who thinks ânatural remediesâ are better than science?
Because this reads like a GQ article written by a yoga instructor who just got off her detox retreat.
Fluticasone works. Itâs been proven.
Switching to âciclesonideâ because youâre scared of your own throat? Thatâs not smart-thatâs fear-based medicine.
And ârinse and spitâ? You think your grandma didnât do that in 1978?
And âdose reductionâ? Youâre not a child-youâre an adult.
Stop treating your lungs like a toddlerâs toy.
And stop pretending every side effect is a crisis.
Some people have asthma.
Some people have side effects.
And some people have too much time on their hands.
Go meditate.
And leave the science to the doctors.
I once had a flare-up so bad I thought I was dying.
Then I got my inhaler.
Then I got my spacer.
Then I got my rinse.
Then I got my life back.
And now I sing in the shower like a drunk opera singer.
And I donât care who hears me.
Because I used to think asthma meant giving up.
Now I know it just means learning how to fight smarter.
So if youâre tired.
If your voice is gone.
If your skin is bruised.
Donât suffer.
Donât accept.
Donât be quiet.
Ask.
Switch.
Rinse.
And then-
take a breath.
And sing.
Because youâre still here.
And thatâs worth fighting for.
And now that Iâve switched to ciclesonide and use a spacer and rinse like my life depends on it (it does)
I donât just breathe easier.
I feel like Iâm not borrowing my lungs from someone else.
Itâs not about being perfect.
Itâs about being present.
And I finally feel present.
So thanks again.
Not for the science.
For the permission.
To care.