Dysphonia in asthmatic women using inhaled corticosteroids: It is not only a laryngeal inflammation

Background: It is usual to incriminate inhaled corticosteroids in the occurrence of dysphonia in asthmatics. For a long time, local adverse effects of inhaled corticosteroid therapy have been supposed to be the cause of dysphonia. We hypothesized that dysphonia in asthmatics were mostly functional and not based on organic lesions. Aims: To investigate, prospectively, what could be the cause of dysphonia occurring in women with a persistent asthma treated with inhaled corticosteroids. Methods: Women9s outpatients with persistent asthma, aged 18-65 years, treated with inhaled corticosteroids were recruited at the chest diseases department, and compared with controls without asthma. Subjects with higher smoking 5 pack-years, symptomatic gastroesophageal reflux, obesity, laryngeal surgery history and an organic abnormal vocal cord unattributed to a vocal forcing were excluded. Tests to assess a vocal dysfunction were performed : Vocal Handicap Index, GRBAS scale, phonation quotient, fundamental laryngeal tests and laryngeal stroboscopic video. A functional dysphonia was defined as having one of these tests anormal. Results: 68 asthmatics, 51 controls were selected. In the asthmatic group 87.3% had dysphonia vs 12.7% (p=10 -4 ). Among the dysphonic asthmatic patients 80% had a functional dysphonia (IC : 67-90). Laryngeal organic lesions were not seen in the asthmatic group and only one in the control group. No asthmatic patient had a laryngeal mycosis. Conclusion: For the 1st time we have demonstrated that dysphonia occurring in asthmatic women who used inhaled corticosteroids was mostly due to a functional mechanism and not as a consequence of organic lesions (like inflammation or mycosis).