title: Voice Assessment After Treatment of Subacute and Chronic Cough With Inhaled Steroids.
abstract: BACKGROUND
  Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Furthermore, the efficacy of inhaled steroids on cough was investigated, as well.
  
  
  METHODS
  This study included 46 patients (27 females and 19 males) with a persistent cough lasting at least 3 weeks and treated with inhaled steroids. All patients were examined by a pulmonologist and lung auscultation where a posteroanterior chest X-ray and spirometry were performed. The patients were also examined by an otolaryngologist. Anterior rhinoscopy, flexible fiberoptic nasopharyngoscopy, and laryngostroboscopy were performed. Also, the patients' acoustic voice analyses were performed and recorded using a multidimensional voice program. Cough symptom index (CSI) scores were used to evaluate the response to treatment. Patients with an underlying disease that was unresponsive to inhaled steroids were excluded from study. The 46 patients were administered inhaled budesonide 400 mcg twice a day, for 1 month, and their acoustic voice analyses were performed again at the end of the treatment. In addition, CSI scores were determined after stopping medication.
  
  
  RESULTS
  When pretreatment and posttreatment acoustic voice analysis parameters (Fo, Jita, Jitt, Shim, APQ, vAm, and NHR) were compared, statistically significant differences were detected for vAm (P = 0.001) and F0 (P0.003). After treatment with inhaled steroids, the CSI score reduced from 3 to 1 (median), and the difference was statistically significant.
  
  
  CONCLUSIONS
  Inhaled budesonide treatment in the proper dose seems to be an effective treatment for persistent cough, in the selected patient group. In addition, short-term budesonide application did not cause any negative effects on the voice parameters in these patients. These findings may be related to the steroid formulation used, the application method, and the duration of treatment. Further studies are needed on a larger group of patients with different formulations of inhaled steroids to clarify aforementioned issues.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. Electronic address: arzualanya@yahoo.com.
authors.forename: Arzu
authors.initials: A
authors.lastname: Tuzuner
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Demirci
authors.affiliation: Department of Pulmonology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Gulden
authors.initials: G
authors.lastname: Bilgin
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Islahiye State Hospital, Gaziantep, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Cagli
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Aydogan
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Kursat Murat
authors.initials: KM
authors.lastname: Ozcan
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Etem Erdal
authors.initials: EE
authors.lastname: Samim
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects*; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014831:Voice / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide
keywords: Cough; Inhaled budesonide; Laryngostroboscopy; Multidimentional voice program