What are common adverse effects associated with long-term systemic corticosteroid therapy and with chronic high-dose inhaled corticosteroids?

• A. Systemic: weight gain, glucose intolerance, osteoporosis, immunosuppression; inhaled: oropharyngeal candidiasis, hoarseness, throat irritation; long-term inhaled therapy may have subtle systemic effects.
• B. Systemic: weight loss and hypoglycemia; inhaled: increased immunity.
• C. Systemic: liver toxicity; inhaled: kidney failure.
• D. Systemic: hair loss; inhaled: improved voice.

Answer: (A)

Long-term corticosteroid use affects multiple body systems. Systemic corticosteroids often cause metabolic and immune-related side effects: weight gain from fat redistribution and fluid retention, glucose intolerance or hyperglycemia due to increased gluconeogenesis and insulin resistance, osteoporosis from decreased calcium absorption and increased bone resorption, and immunosuppression that can raise infection risk. Inhaled corticosteroids, especially at high chronic doses, primarily irritate and suppress the local mucosa in the oropharynx, leading to oropharyngeal candidiasis (thrush), hoarseness, and throat irritation. Although inhaled forms are designed to limit systemic exposure, long-term high-dose inhaled therapy can still produce subtle systemic effects, such as minor suppression of the hypothalamic-pituitary-adrenal axis or small effects on bone density, but the dominant issues are local.

This matches the pattern described: systemic effects include weight gain, glucose intolerance, osteoporosis, and immunosuppression; inhaled effects include oropharyngeal candidiasis, hoarseness, and throat irritation, with possible subtle systemic impact at high doses. Other options list effects that are not typical for corticosteroids, such as weight loss with hypoglycemia, increased immunity, liver toxicity or kidney failure, or hair loss with improved voice, which do not align with the known adverse-effect profile.