Hello Everyone at LACTNET,

This is my first post. I am an RN (currently disabled--worked respiratory
and geriatrics), new WIC BF Peer Counselor, LLL member, wife and mother.  My
boss at WIC is an IBCLC and hooked me up with LACTNET.  I am very grateful
for all that I learn as I try to keep up with reading!

I think Dr. Newman may best be able to answer this question, but I am very
open to any information anyone would like to share.

I have checked the archives and have not been able to find any information
about the drug I am asking about (mentioned only once last year in nasal
form).  I do not presently have access to Hale's book.

I am writing today to see if anyone has any information about the Pulmicort
Turbuhaler (budesonide inhalation powder).  I have a client whose primary
care would like her to begin the drug (oral--not nasal)to gain better
control of her asthma.  She BF her seven month old daughter four-five times
a day.  The package insert says for nursing mothers:  "Corticosteroids are
secreted in human milk.  Because of the potential for adverse reactions in
nursing infants from any corticosteroid, a decision should be made whether
to discontinue nursing or discontinue the drug, taking into account the
importance of the drug to the mother.  Actual data for budesonide are
lacking."

I have worked in a respiratory hospital and my experience tells me Astra
(the drug company that makes the Turbuhaler) seems to be taking a
particularly conservative approach...e.g., many patients of mine have been
unduly concerned about taking corticosteroids because of the word "steroid"
in the name and there fears after having taken  them orally (prednisone).

I have not thought corticosteroids, when administered by inhalation nasally
or orally, were of too much concern for side effects, though I am aware that
certain drugs can be stronger than others.  Is budesonide one of the
"stronger" ones?  Might this patient be advised another oral corticosteroid
that is considered safer for nursing mothers?  (I have no clinical
experience with nursing mothers--my patients were nearly all elderly).
Might my client's primary care physician be less knowledgeable about this
having given the drug to the client, assuring her it was safe for use in
nursing (then the client read the insert when she got home).

My client will not take the drug unless she can receive some information
that it is safe, either from me through all of you, or perhaps from a
consult she needs to book with a respiratory physician in the near future.
Of course, her asthma is not under good control now, and so information
sooner rather than later is preferable.

Thank you very much for your time and consideration regarding this matter.
(And Happy Holidays!)

Sincerely,
Wendy Lemire, RN, BS

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html