Oral steroids enter the bloodstream to get to the lungs, so they can cause these and other systemic effects, particularly if used frequently or for long periods of time. Other effects include cataracts, increased blood sugar, lack of blood supply to some bones and suppression of the body's own production of steroids needed during stress. Since inhaled steroids reduce the amount of oral steroids that may be needed for asthma, they may be safer than just using as needed mediation in all but the mildest forms of asthma. If your child is given many courses of oral steroids, careful monitoring for some of these side effects may be necessary.
Discuss whether a change in controller medication or decrease in the dose or strength of the inhalant would be an option. Some health experts have reported a reduction in hoarseness after backing down the dose, but this is not always effective. There is a particular inhaled steroid which is inactive until it reaches the surface of the lung (after inhalation). It seems to be an ideal inhalant for people who have adverse effects which are localized to the throat or tongue. The brand name of this unique inhaled steroid is Alvesco. It is only available by prescription. Unfortunately no currently available steroid based inhaler, (including Alvesco) eliminates the risk of dysphonia. One study referenced below suggested reduced risk with some dry powder inhalers.