Inhaled steroids (IS) for the treatment of asthma have become a standard in the U.S. and many countries around the world. They are an essential cornerstone in the management of persistent asthma. Adverse effects of IS are minimal, but a small percentage of patients may experience dysphonia (hoarseness, weakness or loss of voice), throat irritation, cough or candida overgrowth (oral thrush).
Many patients who have hoarseness related to IS describe a subtle onset which began months or years after starting the inhaler. There is increased risk of voice change with higher doses or strengths of inhaled steroid. It’s often very frustrating when you have established a good routine of daily inhalations and have reaped the rewards of good asthma control, but later learn the wonder drug is weakening your voice.
Studies have reported between 10-50% of patients on IS experience hoarseness, although package inserts only reflect a range of 1-8%. In my practice it always seems to be a singer,...
Many cases of asthma do not present with the typical recognizable symptoms. So you may not initially think asthma. You might think you have allergies or some other exposure to a substance or product in the environment, at home or in the work place, that’s instigating symptoms. You may also not think it’s asthma because the symptoms present at peculiar times and you don’t respond to traditional asthma therapy when it’s dispensed. You or your doctor, in that case, may even decide to increase dosages or add medications, and yet, you still don’t respond. What gives?
The more you look at external causes, the farther you may get from diagnosing the real inner cause: gastric reflux. It’s probably hard to imagine that acid produced by the stomach can cause shortness of breath. The fact is that gastric reflux is one of the most common causes of chronic cough.
How Acid Reflux works
The stomach produces acid i...
My doctor has recommended that I have my hiatal hernia repaired. I am waiting to see a surgeon. Is this a good idea, and what should I ask the surgeon?
Although rarely necessary, at times, surgical repair of a hiatal hernia is the right choice in patients with gastroesophageal reflux disease . There are two types of hiatal hernia. In the much more common, sliding hernia, in which the stomach slides below the esophagus into the chest, medical therapy usually is very effective. The paraesophageal hernia, in which the stomach herniates next to the esophagus, is usually managed surgery. This is because of the potentially life-threatening complication of strangulation. When surgery is considered, it is best to see a surgeon that performs the procedure laparoscopically, if it is possible. Laparoscopic anti-reflux surgery involves reinforcing the valve between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus. Using on...
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