# The Effect of Inhaled Corticosteroid Therapy on Periodontal Status in Patients with Asthma
## 4 Discussion  
From the perspective of the continuous progress made in the therapy of asthma, which is an increasingly recognized condition in populations of developed countries, the adverse effects of corticosteroids used for this purpose remain a problem [31; 32]. Even though they have a high therapeutic index and their systemic effects are limited, at the same time, about 80% of the fraction of inhaled ICS is deposited in the mouth and throat. Because of the very high local activity of modern inhaled drugs, they can act directly on oral  
\begin{table}
\begin{tabular}{c c c c c c c} \hline  & **PERIO-ASTHMA** & **ASTHMA** & **CONTROL** & \({}^{\star}\) & & **\({}^{\star}\)** \\  & \(n\) = **40** & \(n\) = **40** & \(n\) = **40** & & **I/II** & **I/III** & **II/III** \\ \cline{2-7}  & **Median (IQR)** & **Median (IQR)** & **Median (IQR)** & **\(\alpha\) = 0.05** & **\(\alpha\) = 0.017 (Bonferroni Correction)** \\ \hline CAL & & & & & & \\ W-3 & 0 (\(-\)0.03\(-\)0.04) & 0(0(\(-\)0) & 0(0(\(-\)0) & 0.9231 & \\ W-1 & 0(0\(-\)0) & 0(0\(-\)0) & 0(0(\(-  
tissues, including periodontal tissues [31]. In asthma, periods of long-term remission may occur, but patients should be under constant medical care because its treatment lasts for life [33]. Many papers describe side effects after long-term treatment with ICSs on dental and periodontal status in children [14; 34; 35; 36; 37; 38; 39; 40]. Although the disease occurs in patients of all age groups, only a little of the literature presents the effect of anti-asthmatic drug therapy on oral health in adults, hence the interest of our group in this topic and the attempt to collect the most interesting and detailed publications and compare them with the material of our group. The literature published to date has shown evidence of a relationship between asthma and periodontal disease, but the results are inconclusive. Some authors [41; 42] describe an inverse relationship between periodontitis and the occurrence of asthma, supporting the so-called hygiene hypothesis [43]. Other authors [44; 45] explain the lack of a significant association between asthma and periodontitis. Studies showing more frequent or more severe periodontitis symptoms significantly in asthmatic patients have also been published [46; 47; 48]. Periodontal status was assessed using basic periodontal parameters such as PD and CAL. The analysis of mean PD for the whole oral cavity in the study showed significant differences between all groups. The deepest pockets were noted in group I with a median of 2.58 mm, followed by group II with 2.19 mm, and the shallowest in the control group with 1.87 mm. This compares to the work of [PERSON] [49], who evaluated the effect of inhaled ICS therapy in the course of chronic obstructive pulmonary disease (COPD) in patients with periodontitis and showed a median PD greater than that in group of patients with periodontitis--3.41 mm. Considering the literature on periodontitis, the most similar results to ours were by [PERSON] [50], whose mean PD was 2.87 mm. In other papers, the mean PD ranged from a level of 3.1 mm to 3.66 mm [51]. When divided into shallow (\(\leq\)3 mm), medium (4-5 mm), and deep (\(\geq\)6 mm) pockets, the proportions (mean values) were: shallow: group I--86.02%, medium: group I--11.47%, deep: group I--1.51%. The most similar proportions of pockets in a group of patients with periodontitis were published by [PERSON] et al., respectively: shallow in group II--74%, medium in group II--24%, deep in group II--3% [52]. In contrast, in [PERSON]'s work [53], the proportions were 43%, 48%, and 9%, respectively, significantly indicating more severe periodontal disease. In assessing the loss of connective tissue attachment, the only group we had that had a significantly greater loss for the entire mouth, with a median of 0.97 mm, was group I, which was due to the burden of periodontitis on this group. Additionally, it was found that the percentage of sites with CAL > 4 mm was 2.5%.