Cough

What is a cough?

Coughing is the sudden expulsion of air from the lungs in a manner that creates a sound. It is the result of a reflex that occurs when irritant receptors (cough receptors) in the lining (epithelium) of the airways are stimulated, either mechanically, or chemically. This can happen from the presence of even tiny amounts of foreign matter irritating the airways at any level. This can happen once in a while from normal activity, such as swallowing saliva, but coughing is more frequent when part of a chronic disease such as asthma, an infection such as the common cold, or more serious respiratory infections.

How common is coughing during pregnancy?

Coughing due to the common cold may occur frequently during pregnancy because the typical adult gets 2 3 colds per year.

How is a cough diagnosed?

Cough is not a diagnosis, but rather a symptom that can be assessed together with other symptoms and signs to diagnose a condition, such as a cold, influenza, asthma, tuberculosis, or pneumonia. Thus, the workup for a diagnosis will be dictated by the index of suspicion for possible conditions based on your history and physical exam. One extremely important factor in your history is how long you have been coughing. If you have been coughing for a few days without thick mucus, for example, and have no more than a low-grade fever, or no fever, a common cold will be high on the differential diagnosis, and its likely that the doctor will not even order any laboratory tests. On the other hand, if your coughing is severe, has been occurring for several weeks, and there is blood coming out when you cough, this raises the possibility that you could have tuberculosis, in which case you will need a Mendel-Mantoux skin test, an interferon-gamma release assay, a chest X-ray, and tests on sputum samples.

Does a cough cause problems during pregnancy?

Medical conditions underlying a cough can cause trouble during pregnancy. If the condition causes a fever, for instance, this can lead to dehydration, and problems, sometimes long-term problems, in various organ systems. Certain disease-causing organisms, the bacterial species that causes tuberculosis, for instance, can damage organs directly. As for a cough specifically, even when associated with just a minor condition, such as the common cold, a cough can be more than a nuisance because it can keep you from sleeping soundly. At the severe end of the spectrum, infection with the bacterial species Bordetella pertussis causes whooping cough, in which coughing can be so powerful and so continuous as to cause bleeding from blood vessels in the brain and retina of the eye.

Does a cough during pregnancy cause problems for the baby?

As noted above, the type of problems and the severity level of problems depend on the condition that is the underlying reason for the cough. Cough itself does not cause trouble for the developing baby.

What to consider about taking medications when you are pregnant:

• The risks to yourself and your baby if you do not treat the cough
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat cough during pregnancy?

Drugs found in cough syrups commonly have narcotic properties, meaning that they bind to and activate some of the same cell receptors in the nervous system, called opioid receptors, which are bound by the drug morphine. Opioid receptors are involved in stopping both pain and the cough reflex, but narcotic drugs vary in their antitussive (cough-stopping) and analgesic (anti-pain) effects. Dextromethorphan is the antitussive drug that you typically find in over-the-counter cough syrups, whereas prescription cough syrups often contain stronger narcotic drugs, such as codeine and hydrocodone. Some of these syrups also have an antihistamine medication called promethazine. Controversy surrounds the use of narcotics such as codeine and hydrocodone during pregnancy. On one hand, studies have not provided much evidence of danger from limited use of these drugs against cough. On the other hand, these drugs have a high potential for abuse, similar to other opioid (narcotic) drugs that are well-known problems, such as morphine and oxycodone. As for dextromethorphan, various studies have been carried out on humans and they have not provided strong evidence that the drug could cause birth defects. At the same time, dextromethorphan does not have the same level of abuse potential as the stronger narcotics. It thus is probably not particularly dangerous, so you might consider using it, if it makes the difference between whether or not you are able to sleep.

Who should NOT stop taking medication for a cough during pregnancy?

A cough is a symptom, not a condition, so anyone can stop taking a cough suppressant. You may find that you can tolerate your cough, or that it only bothers you at certain times of the day, or under certain conditions, such as when you get cold or drink cold drinks. On the other hand, in weighing the benefits against the risk, you may find that it is worthwhile to keep taking a cough suppressant if it gets your cough under control.

What should I know about choosing a medication for my cough during pregnancy?

You may find Pregistrys expert reports about the individual medications to treat cold symptoms here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my cough when I am breastfeeding?

If taken for short periods (a single dose here or there), dextromethorphan and codeine are considered safe in breastfeeding mothers.

What alternative therapies besides medications can I use to treat my cough during pregnancy?

Inhalation of steam from the shower or from a hot drink can have a very temporary, but effective, effect on suppressing your cough. Drinking hot drinks and soup also can provide temporary relief. Lozenges can help too. These include lozenges that are medicated with dextromethorphan, but also lozenges containing only menthol.

What can I do for myself and my baby when I have a cough during pregnancy?

Get plenty of rest, treat your cough as needed, but have your doctor assess whether there could be an underlying condition more serious than a cold.

Resources for common cough in pregnancy:

For more information about cough during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

• Mayo Clinic:  Cough and Cold Medications
• Cleveland Clinic: Medication in Pregnancy