Inhaled Corticosteroids

Which inhaled corticosteroid has the highest topical potency and lowest systemic bioavailability due to extensive first-pass hepatic metabolism?

A 52-year-old man with COPD on inhaled beclomethasone dipropionate 200 µg twice daily for 2 years presents with progressive bone pain and a history of multiple fragility fractures. To evaluate the extent of bone loss attributable to chronic ICS use, which investigation is most appropriate?

A 38-year-old woman with moderate persistent asthma has been on inhaled fluticasone propionate 250 µg twice daily for 6 months. She reports hoarseness and oral candidiasis. To assess local adverse effects and guide further management, which investigation is most appropriate?

A 38-year-old woman with persistent asthma has been using inhaled fluticasone propionate 250 µg twice daily for 6 months. She reports a white patch on her palate and mild difficulty swallowing. What is the most common local adverse effect of inhaled corticosteroids responsible for her symptoms?

A 52-year-old man with moderate persistent asthma has been on inhaled beclomethasone dipropionate 200 µg twice daily for 2 years. On routine monitoring, he is found to have a reduction in bone mineral density. Which is the most common systemic adverse effect of long-term inhaled corticosteroid use that accounts for his findings?