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Asthma and the Effects of Steroid Inhalers on the Voice
Journal article   Peer reviewed

Asthma and the Effects of Steroid Inhalers on the Voice

Dylan Vance and Robert Sataloff
Journal of singing, v 80(2)
01 Nov 2023
DOI: https://doi.org/10.53830/DEGA1125

Abstract

Acoustics Aerosols Asthma Inhalers Respiration Singers Steroids Voice training
In addition to malting it difficult to breathe and feeling increased air resistance, asthma can cause changes in air resistance and impair breath support, impacting phonation and quality of the voice, potentially resulting in breathiness, roughness, strain and asthenia, a term used to denote physical weakness and/or a lack of energy.1 Singers suffering from asthma may have lower lung volumes directly impacting strength of voice.2 Asthmatics tend to have restricted expiration, increase in abdominal wall muscle contraction to compensate for restricted breathing, lung hyperinflation with lowering of the diaphragm, and fluctuations in intra-thoracic and intra-abdominal pressures. The authors found that values FO, jitter, and shimmer were very similar in the two groups, but there were statistically significant differences in values for voice harshness, hoarseness, normalized noise energy, S/Z ratio and breathiness.5 While one of the most common treatments for asthma is inhaled corticosteroids (ICS), there have been very few studies looking into the impact of inhaled corticosteroids on the voice. The dysphonia symptoms described by the authors included hoarseness and reduced voice power, throat clearing and irritation, and steroid inhalerinduced cough.11 A 2009 study from Liverpool examined the voice acoustic impacts of regular use of ICS. Roland et al. noted that laryngeal effects among asthmatic patients using inhaled steroids included hoarseness and pharyngeal discomfort, as well as others mentioned above.15 In a study of 178 patients from Michigan looking at both asthma and allergy, 44% of patients with asthma listed dysphonia as a concern when defined as "hoarseness of voice" or "reduced voice power."

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