Gender and age risks for hoarseness and dysphonia with use of a dry powder fluticasone propionate inhaler in asthma.
Dry powder inhalers (DPIs) of fluticasone propionate (FP) are the most commonly prescribed inhaled glucocorticosteroid (ICS) devices in Japan because of their ease of use. FP has the strongest anti-inflammatory effects in vitro among ICS, and it has few systemic adverse effects because of its <1% oral bioavailability. However, local adverse effects, especially hoarseness or dysphonia (hoarseness/dysphonia), appear to be frequent. We investigated hoarseness/dysphonia in 313 patients with bronchial asthma who were using or had used the FP-DPI. Overall, 20.4% of FP-DPI users complained of hoarseness/dysphonia, with women and elderly patients complaining of it more frequently; 35.8% of female FP-DPI users > or =65 years of age complained of hoarseness/dysphonia. The prevalence of hoarseness/dysphonia was dose dependent in patients <65 years old but not in patients > or =65 years of age. Inspiratory flow rates adjusted by resistance of the DPIs were not related to the prevalence of hoarseness/dysphonia. In patients using ICS, especially in women and the elderly patients, who develop hoarseness/dysphonia, it is important to select the most suitable device so that patients can continue ICS therapy comfortably.
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan. tamotsui@showa.gunma-u.ac.jp
Tamotsu
T
Ishizuka
Takeshi
T
Hisada
Haruka
H
Aoki
Noriko
N
Yanagitani
Kyoichi
K
Kaira
Mitsuyoshi
M
Utsugi
Yasuo
Y
Shimizu
Noriaki
N
Sunaga
Kunio
K
Dobashi
Masatomo
M
Mori
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000009:adverse effects*; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D000068298:Fluticasone; D006685:Hoarseness / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders; D012129:Respiratory Function Tests; D012307:Risk Factors; D012737:Sex Factors; D014832:Voice Disorders / Q000209:etiology*
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D011208:Powders; D000068298:Fluticasone