High dose and long term use of medications in the steroid family may affect bone growth, the density or strength of bones, and promote the growth of cataracts. Patients on high doses of ICS should have their growth monitored (for children), as well as bone density testing and eye exams periodically. For the overwhelming majority of children who are on inhaled corticosteroids for asthma and/or nasal steroids for rhinitis, or nasal disease, height will not be affected. There is some evidence that children on inhaled corticosteroids may actually have some decrease in growth velocity in the first year of treatment. However, other studies of large numbers of children have shown that with years of inhaled corticosteroid use, expected final adult height was attained.
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.
Family history is a risk factor for asthma, with many different genes being implicated.  If one identical twin is affected, the probability of the other having the disease is approximately 25%.  By the end of 2005, 25 genes had been associated with asthma in six or more separate populations, including GSTM1 , IL10 , CTLA-4 , SPINK5 , LTC4S , IL4R and ADAM33 , among others.  Many of these genes are related to the immune system or modulating inflammation. Even among this list of genes supported by highly replicated studies, results have not been consistent among all populations tested.  In 2006 over 100 genes were associated with asthma in one genetic association study alone;  more continue to be found.