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These side effects include: oropharyngeal candidiasis treated with topical clotrimazole (Bhatka & Choo, 2021) dysphonia (horseness) caused by a direct effect on vocal cords can be reduced by gargling water after each inhaled dose (Bhatka & Choo, 2021) hypothalamic pituitary-adrenal axis suppression ranges from 2.4% (low dose) to 21.5% (high dose) (Heffler et al, 2018) reduction in growth velocity (pediatric patients) corticosteroids can interfere with growth hormone secretion, osteoblast activity and other factors that can cause a average growth reduction of ~1 cm (Heffler et al, 2018) osteoporosis high doses of ICS used to treat severe asthma are at higher than normal risk for reduced bone mineral density and osteoporosis (Heffler et al, 2018) increased risk for type 2 diabetes use of ICS has been associated with a dose-dependent increase in risk for diabetes, up to ~34% with high dose use (Heffler et al, 2018) The risk of ICS-related adverse effects, which are most significant in patients with severe asthma who are taking higher doses of ICS may be reduced by judicious use of newer biologic agents which can result in the reduced need use of corticosteroids (Heffler et al, 2018