title: The inflammation produced by corticosteroid inhalers in the pharynx in asthmatics.
abstract: OBJECTIVE
  To investigate inflammation of the pharyngeal mucosa caused by inhaled corticosteroids.
  
  
  METHODS
  Prospective, cross-sectional, single-blinded study.
  
  
  METHODS
  University Hospital Aintree, Liverpool, UK.
  
  
  METHODS
  Fifty adults were recruited from two local general practices and from general ENT clinics at our University hospital. Patients were allocated to one of four groups according to use of inhaled corticosteroids and the presence of adverse local side effects.
  
  
  METHODS
  Scores achieved on a respiratory symptom questionnaire. Histological markers of inflammation and their correlation with pharyngitis. Statistical modelling included univariate and multivariate analyses, which included multiple linear and logistic regression, and discriminant analysis.
  
  
  RESULTS
  The regular use of inhaled corticosteroids predisposed subjects to hoarseness, weakness of voice, sore throat and throat irritation (P < 0.0001). Pharyngitis was significantly different between the groups (P < 0.0001). Furthermore, those not using an inhaled corticosteroid regularly had little or no clinically apparent pharyngitis, whereas those using an inhaled corticosteroid regularly had significantly higher pharyngitis scores (P = 0.0204). Similarly, weakness of voice (P = 0.0234), hoarseness (P < 0.001) and sore throat (P < 0.001) were also more common in those patients that used an inhaled corticosteroid on a regular basis. To our surprise, however, cellular markers of inflammation did not corroborate the appearances of clinical examination. We found that the five most important discriminators, between those that were using inhaled corticosteroid therapy regularly and those that were not, to be intra-epithelial inflammatory cells (scdf -1.2939); age (scdf 0.8389); use of a spacer device (scdf 0.5456); sore throat (scdf 0.4230) and throat irritation (scdf 0.4015). The groups were significantly different (P < 0.0001). The statistical model used, classified 68% of the cases correctly into their respective groups.
  
  
  CONCLUSIONS
  Inhaled corticosteroids predispose to pharyngitis and an inflammatory infiltrate. However, the clinical diagnosis of pharyngitis does not correlate well with cellular inflammatory infiltrate and is therefore, not a reliable measure of underlying inflammation. We advocate caution in the use of pharyngeal erythema as a measure of underlying inflammation.
authors.affiliation: Department of Otolaryngology/Head & Neck Surgery, University Hospital Aintree, Liverpool, UK. rajiv.bhalla@cmmc.nhs.uk
authors.forename: R K
authors.initials: RK
authors.lastname: Bhalla
authors.forename: W
authors.initials: W
authors.lastname: Taylor
authors.forename: A S
authors.initials: AS
authors.lastname: Jones
authors.forename: N J
authors.initials: NJ
authors.lastname: Roland
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D010612:Pharyngitis / Q000139:chemically induced*; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D005938:Glucocorticoids