ASSOCIATION BETWEEN INHALED CORTICOSTEROID USE, SALIVARY PH ALTERATIONS AND ORAL LICHEN PLANUS AND ORAL LICHENOID LESIONS IN ASTHMA PATIENTS: A CASE-CONTROL STUDY

Abstract

Background: Inhaled corticosteroids (ICS) are widely used for managing bronchial asthma but may lead to oral mucosal issues like oral lichen planus (OLP) and oral lichenoid reactions (OLR). These changes are possibly linked to ICS-related salivary pH reduction and immune changes, though the exact cause is still not fully understood.

Aim: This study assessed the link between ICS use, salivary pH levels, and asymptomatic OLP/OLR in asthma patients. It also looked at the effect of asthma severity, ICS dose, and smoking.

Materials and Methods: A cross-sectional case-control study was conducted with 140 asthma patients on ICS and 140 matched non-asthmatic controls. Oral examination, unstimulated salivary pH tests, and biopsy of lesions were performed. ICS dosage, usage duration, asthma severity, and smoking history were recorded and analysed.

Results: Higher ICS doses showed a significant association with lower salivary pH (r = –0.247, p = 0.003). Ten cases of OLP/OLR were found in the ICS group, showing hyperkeratosis, inflammatory cells, and basal cell damage on histology. Lower salivary pH was strongly linked to reticular-type lesions (p = 0.00). Smoking, asthma severity, and gender showed no significant effect on lesion development (p > 0.05).

Conclusion: Long-term ICS use is linked to reduced salivary pH and higher chances of asymptomatic OLP/OLR. Regular oral check-ups are advised for asthma patients on ICS to detect and manage early oral changes.