Dear friend, welcome to HCM ! Alvesco can not cause laryngitis. It contains a steroid-ciclesonide. His symbicort also contains a similar steroid- budesonide. Which appears an undue use. Steroids in fact are used to treat laryngitis. Laryngitis is commonly viral and will get better on its own and may produce hoarseness for quite sometime. But if he is not taking proper mouth wash and hygiene care, commonly these people on steroid inhalers are prone to develop candidiasis -fungal throat infections. candidiasis can cause hoarseness. please rule out this condition. ask your prescribing doctor to have a look at the throat/ tongue . you can also see if there are curdy white patches/ spots on the tongue, palate, insides of cheek etc. it is treatable with anti-fungals. ensure he practices oral rinsing after inhaler use. Spiriva can produce oral dryness and ocassionally cause hoarseness- but not very common. I think either Alvesco or symbicort should be the steroid. or a separate LABA alone instead of symbicort (a combination) Take care and please keep me informed of your progress. Good Luck ! I hope to have answered your query satisfactorily. May I request for your rating and review of this answer before you accept the answer and close the query (if there are no more follow up questions)? Thank you !