Corticosteroids improve voice function in asthmatics

By David Douglas

NEW YORK (Reuters Health) – Treatment with inhaled beclomethasone dipropionate improves certain acoustic parameters in patients with inadequately controlled asthma, according to Canadian researchers.

This is of particular interest, lead investigator Dr. Meyer S. Balter, told Reuters Health, because "patients are sometimes resistant to the thought of taking inhaled steroids, the best disease modifying therapy for asthma, because of a fear of developing hoarseness."

To investigate the possible upper airway side effects of corticosteroid treatment, Dr. Balter, of the University of Toronto, and colleagues studied 87 steroid-naive asthmatics, 10 of whom acted as controls. The findings appeared in the December 2001 issue of Chest.

Four groups were treated with beclomethasone via a metered dose inhaler and were randomized to receive a total of 1000 mcg per day delivered as one puff four times daily or two puffs twice daily using or not using a holding chamber. The controls received "occasional" bronchodilator therapy.

At baseline and at regular intervals for 16 weeks, subjects' voices were recorded for later analysis. They also repeatedly underwent spirometry and methacholine challenge.

At 16 weeks, all beclomethasone groups showed significant improvements in measures including lung function (FEV1) and in the concentration of methacholine required to cause a 20% drop in FEV1.

In addition, mean shimmer scores, a reflection of perturbation in vocal amplitude, fell significantly. These reductions were not significantly different among beclomethasone groups. Shimmer scores did not change in the control group over the course of the study.

"Asthma itself, perhaps by virtue of frequent coughing associated with uncontrolled disease, affects voice function," Dr. Balter added. "Appropriate therapy of asthma with inhaled steroids, " he concluded, "actually improves voice function."

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