As a community pharmacist I often saw patients repeatedly ordering their blue inhalers to relieve symptoms of asthma because they were scared that the brown preventer inhalers contained steroid and would make them look like body builders. This is, of course not going to happen using inhalers correctly. Oral thrush can be common if inhaler technique is poor but simple things like rinsing the mouth after use or using a spacer can help. Talk to your specialist asthma nurse if you are struggling with symptoms.
If we add in breastfeeding it is no surprise that mothers are concerned about their medication use to control asthma but without cause. Inhalers and steroids are compatible with breastfeeding. Not only that but breastfeeding helps to minimise the risk of your baby developing asthma in the future according to new research.
The symptoms of asthma being high because of very high pollen counts coupled with the risk of thunderstorms which can be a bad combination.
I hope this factsheet taken largely from Breastfeeding and Chronic Medical Conditions helps
“My asthma actually improves when feeding and I had a big decline when I weaned my 2-year-old twins. The symptoms have gone again now I’m breastfeeding my 3-month-old.”
Breastfeeding protects against asthma in children up to the age of 6. Shorter duration and non-exclusivity of breastfeeding were associated with increased risks of asthma-related symptoms in pre-school children (Mukherjee 2016). Thus, mothers with asthma may be keen to breastfeed exclusively to protect their baby. In a study of 366 pregnancies, symptoms worsened in 36% of women (Schatz 1988). Further studies by Schatz (1995) and Wendel (1996) in the United States suggest that 11–18% of pregnant women with asthma will have at least one emergency department visit for acute asthma and, of these, 62% will require hospitalisation.
Wilson et al (2022) studied 2021 mother-child dyads. Women reported the duration of any and exclusive breastfeeding and child asthma outcomes during follow-up at child aged 4 to 6 years. Outcomes included current wheeze (previous 12 months), ever asthma, current asthma (having ≥2 of current wheeze, ever asthma, medication use in past 12-24 months), and strict current asthma (ever asthma with either or both current wheeze and medication use in past 12-24 months). They showed that longer duration of exclusive breastfeeding had a protective association with child asthma.
Asthma can be controlled during breastfeeding with:
- inhalers (short and long-acting beta 2 agonists to relieve symptoms
- bronchodilators to prevent symptoms
- compound inhalers,
- Leukotriene receptor antagonists.
Beta-adrenoreceptor agonists relieve symptoms of asthma attack such as breathlessness: E.g., Salbutamol, Bambuterol , Formoterol, Salmeterol, Terbutaline.The inhalers act locally in the lungs and limited transfer into blood let alone milk –
Oral Corticosteroids : Prednisolone – limited transfer at 40mg/day, higher doses short term. Very high doses or long term wait 4 hours after administration to breastfeed (but rarely necessary in my experience)
Inhaled Corticosteroid Inhalers prevent asthma symptoms and are used when regular use of preventer inhalers is necessary: E.g., Beclometasone, Budesonide, Fluticasone, Mometasone. Inhalers act locally in lungs and limited transfer into blood let alone milk
Leukotrine Receptor antagonists: Montelukast – relative infant dose 0.68%. Used in children so compatible with breastfeeding. However, in September 2019 the MHRA added a caution to use in children so individual mothers may need to decide for themselves if they wish to take this drug whilst breastfeeding.
“Healthcare professionals are advised to be alert for neuropsychiatric reactions, including speech impairment and obsessive-compulsive symptoms, in adults, adolescents, and children taking montelukast. The risks and benefits of continuing treatment should be evaluated if these reactions occur. Patients should be advised to read the list of neuropsychiatric reactions in the information leaflet and seek immediate medical attention if they occur.”
Zafirlukast– relative infant dose 0.7%. Absorption slowed with food. Used in children > 12 years so compatible with breastfeeding assumed.
Theophylline/ Aminophylline – prolonged half-life in neonates (babies < 6 weeks). One reported case of irritability. Avoid if possible, especially with young babies .
There are many options of inhalers and asthma specialist should be able to make symptoms changing life a rare rather than common event. Many athletes have asthma and are able to control symptoms with the right balance of medication. For some symptoms are worse with respiratory infections, for others season affects are greater e.g., moulds, pollen from different plant affecting different times of the year.
- Mukherjee M, Stoddart A, Gupta RP, Nwaru BI, Farr A, Heaven M, Fitzsimmons D, Bandyopadhyay A, Aftab C, Simpson CR, Lyons RA, Fischbacher C, Dibben C, Shields MD, Phillips CJ, Strachan DP, Davies GA, McKinstry B, Sheikh A, The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases, BMC Medicine, 2016;14:113–128.
- Schatz M, Harden K, Forsythe A, Chilingar L, Hoffman C, Sperling W, Zeiger RS, The course of asthma during pregnancy, post-partum, and with successive pregnancies: a prospective analysis, J Allergy Clin Immunol, 1988;81:509–17.
- Schatz M, Zeiger RS, Hoffman CP, Harden K, Forsythe A, Chilingar L, Saunders B, Porreco R, Sperling W, Kagnoff M, Perinatal outcomes in the pregnancies of asthmatic women: a prospective controlled analysis, Am J Respir Crit Care Med, 1995;151:1170–4.
- Wendel PJ, Ramin SM, Barnett-Hamm C, Rowe TF, Cunningham FG, Asthma treatment in pregnancy: a randomized controlled study, Am J Obstet Gynecol, 1996;175:150–4.
- Wilson K, Gebretsadik T, Adgent MA, et al. The association between duration of breastfeeding and childhood asthma outcomes. Annals of Allergy, Asthma & Immunology. (https://www.annallergy.org/article/S1081-1206(22)00400-8/fulltext)
Asthma UK https://www.asthma.org.uk/