Evaluation of Inhaled Corticosteroids use and Associated Local Adverse Reactions in Respiratory Disease Patients at a Tertiary Care Teaching Hospital in Nepal

Background: Bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD) are major respiratory diseases in Nepal, with an increasing prevalence. Inhaled corticosteroids (ICS) are the cornerstone of treatment, reducing exacerbations and mortality. However, local adverse reactions such as oropharyngeal candidiasis, dysphonia, and throat irritation can impact medication adherence and patient quality of life. Materials and Methods: This cross-sectional descriptive study was conducted at a tertiary care teaching hospital in Nepal over a period of six months. Patients diagnosed with asthma or COPD and prescribed inhaled corticosteroids were included. Data on demographic characteristics, ICS usage, their dosage duration and severity of adverse drug reactions were collected through structured questionnaires. Those adverse drug reactions were observed and preventive measures taken by patients to counteract adverse drug reactions were included. Statistical analysis was performed using SPSS version 22, with chi-square tests applied to assess associations between variables. Results: Among 138 patients, 81 (58.7%) reported at least one ICS-related adverse reaction, with a higher prevalence in females (p<0.001) and illiterate patients (p<0.001). The most commonly used Inhaled Corticosteroids was fluticasone (33.3%), and frequently reported adverse effects included tooth decay (35.8%), throat irritation (20.99%), and tongue abrasion (19.75%). Higher Inhaled corticosteroids dosages (200 mcg) and twice-daily regimens were significantly associated with increased adverse reactions (p<0.001). Self- management strategies included salt and water gargling (30.9%), use of antifungal cream (22.2%), and mouthwash use (21%). Conclusion: ICS-related local adverse effects are common and influenced by demographic and drug related factors. Proper inhaler techniques, patient education, and preventive measures can help mitigate those effects and enhance treatment adherence. Key words: Inhaled corticosteroids, adverse drug reactions, oral candidiasis, dysphonia