The effect of inhaled steroids on the upper respiratory tract.

The incidence of upper respiratory tract Candidiasis secondary to steroid aerosol treatment is disputed, and varies from series to series. We found a very low incidence of thrush, but a significant number of abnormalities of the upper respiratory tract in a random selection of asthmatics on steroid inhaler. A minority had positive Candida cultures, but 37 per cent had symptoms which were minor and self-limiting, but a complaint of hoarseness in asthmatics on steroid inhalers should be referred to a laryngologist, even if there is no evidence of fungal infection in order to ascertain the nature of the laryngeal abnormality, such as adductor cord paralysis, or even carcinoma. This study also implies that the history from a patient with laryngeal or pharyngeal symptoms is incomplete unless the patient's aerosol medication is also taken into account, as signs and symptoms in this group of patients are usually reversible when alternative treatment for asthma is instituted.