<prompt> Systemic adverse effects of long term inhaled steroids are evident only at doses more than -200 mcgday400 mcgday600 mcgday800 mcgday  <response>: Ans. is c i.e., 600 mcgday Adverse effects of inhaled steroids Hoarseness of voice, dysphonia, sore throat, asymptomatic or symptomatic oropharyngeal candidiasis are the most common side effects. These can be minimized by the use of a spacer, gargling after every dose to wash off the drug deposited on oral and pharyngeal mucosa and prevented as well as treated by topical nystatinclotrimazole. There is no evidence of mucosal damage or increased incidence of chest infections, even on prolonged use. Systemic effects of long-term inhaled glucocorticoids are clinically relevant only at doses 600 mgday. The significant ones are--mood changes, osteoporosis, growth retardation in children, bruising, petechiae, hyperglycaemia and pituitary-adrenal suppression; several reports of adrenal crisis have appeared, especially in children, during stress of an infection, etc. Inhaled steroids are safe during pregnancy. 