If a pregnant woman is troubled by cough, how should she take medicine?

Coughing is a common symptom of respiratory diseases. It is a defensive nerve reflex of the body, which is helpful for clearing respiratory secretions and harmful factors. However, frequent and severe coughing has a serious impact on people's work and life. Coughing during pregnancy is very distressing for pregnant women and obstetricians. If you cough too much or too intensely, the abdominal pressure will increase, which may lead to miscarriage or premature birth. So, how should pregnant women use medicine for cough? Let's find out together.

Basic principles of medication for pregnant women:

1. Medication must have clear indications

2. Avoid taking medication during the first three months of pregnancy

3. Promote single use and reduce combined use of drugs

4. Promote low doses and short courses of treatment, and avoid high doses and long courses of treatment

5. Refer to pregnancy classification and the new pregnancy and lactation labeling rules (PLLR) to choose safer drugs

1. Cough-related medication

♦ Nasal decongestants: Commonly used drugs include pseudoephedrine. Pseudoephedrine is classified as pregnancy category C and is contraindicated in early and mid-pregnancy (before 28 weeks of pregnancy) and in patients with cardiovascular diseases.

♦ First-generation antihistamines: Commonly used drugs include chlorpheniramine and diphenhydramine. Chlorpheniramine is classified as pregnancy category B and should be used with caution during pregnancy; diphenhydramine is classified as pregnancy category B and should not be used during pregnancy.

♦ Second-generation antihistamines: Commonly used drugs include cetirizine and loratadine. Cetirizine is classified as pregnancy category B and should be used with caution during pregnancy; loratadine is classified as pregnancy category B and should not be used within 3 months of pregnancy.

♦ Centrally acting antitussive drugs: Commonly used drugs include codeine and dextromethorphan. Codeine is classified as pregnancy category C and is contraindicated during pregnancy; dextromethorphan is classified as pregnancy category C and is contraindicated within 3 months of pregnancy.

♦ Peripheral antitussive drugs: Commonly used drugs include Noscapine, which is not recommended for use during pregnancy.

♦ Expectorants: Commonly used drugs include carbocysteine, acetylcysteine, guaifenesin, and ambroxol. Carbocysteine ​​should be used with caution during pregnancy and is contraindicated during active peptic ulcers; acetylcysteine ​​is classified as pregnancy category B and should be used with caution during pregnancy and is contraindicated in patients with asthma; guaifenesin is classified as pregnancy category C and is contraindicated within 3 months of pregnancy; ambroxol should be used with caution within 3 months of pregnancy and is contraindicated for pulmonary hemorrhage, nephritis, and acute gastroenteritis.

♦ β2 receptor agonists (bronchodilators): Commonly used drugs include salbutamol and terbutaline, which are administered by inhalation. Salbutamol is classified as pregnancy category C and should be used with caution within 3 months of pregnancy; terbutaline is classified as pregnancy category B and should be used with caution within 3 months of pregnancy.

♦ Nasal inhaled glucocorticoids: Commonly used drugs are budesonide and beclomethasone. Budesonide is classified as pregnancy category B and should be used with caution during pregnancy; beclomethasone is classified as pregnancy category C and should be used with caution during pregnancy. Budesonide and beclomethasone are widely used in pregnant women and have good safety. They are generally one of the first choice drugs for the treatment of asthma in pregnant women.

♦ Leukotriene receptor antagonists: Commonly used drugs include montelukast. Montelukast is classified as pregnancy category B and should be avoided during pregnancy.

Currently, the cough and expectorant drugs available on the market are often compound preparations, such as compound codeine phosphate solution, mefenamic acid solution, compound licorice oral solution, compound methoxyphenamine capsules, etc., which are not recommended for use during pregnancy!

2. Classification of cough

1. Coughing is classified by time

Acute cough : duration < 3 weeks. The most common cause is the common cold. Other causes include acute bronchitis, acute sinusitis, allergic rhinitis, acute exacerbation of chronic bronchitis, asthma, etc.

Subacute cough : lasts for 3 to 8 weeks. The most common causes are cough after a cold (also known as post-infection cough), bacterial sinusitis, asthma, etc.

Chronic cough : duration>8 weeks, common causes include cough variant asthma, postnasal drip syndrome, eosinophilic bronchitis and gastroesophageal reflux cough, which account for 70%-95% of chronic cough in respiratory outpatient clinics. Other causes include pneumonia, tuberculosis, lung cancer, chronic bronchitis, bronchiectasis, allergic cough, drug-induced cough, psychological cough, etc.

2. Coughs are classified by nature

Dry cough: daily sputum volume <10 ml.

Wet cough: daily sputum volume >10 ml.

3. Treatment of cough

1. Treatment of acute cough

Common cold: The cough of the common cold is often associated with postnasal drip, and routine use of antibacterial drugs is not recommended. The combination of nasal decongestants and first-generation antihistamines can significantly relieve coughs and improve symptoms such as sneezing and nasal congestion. For patients with severe coughs, central cough suppressants can be used if necessary.

Acute tracheobronchitis: Severe dry cough can be treated with antitussive drugs. Expectorants are recommended for sputum that is difficult to cough up. When bacterial infection is confirmed, antibacterial drugs should be added for treatment. When accompanied by cough and asthma, β2 receptor agonists are recommended.

2. Treatment of subacute cough

The most common cause of subacute cough is post-infectious cough, which is often self-limiting and can usually be relieved on its own, but some patients have persistent coughs and even develop chronic coughs. For some patients with severe cough symptoms, short-term use of antitussives, antihistamines and nasal decongestants is recommended. Inhaled glucocorticoids and montelukast sodium are not recommended for the treatment of post-infectious cough. When bacterial infection is confirmed, antibacterial drugs should be added for treatment.

3. Treatment of chronic cough

Postnasal drip syndrome : (1) Non-allergic rhinitis and common cold: Oral first-generation antihistamines and nasal decongestants are recommended as the first choice. (2) Allergic rhinitis: Inhaled nasal corticosteroids and oral second-generation antihistamines are recommended as the first choice. Leukotriene receptor antagonists are effective in treating allergic rhinitis. Chronic sinusitis is often caused by bacterial infection and often requires antibacterial treatment, which can be combined with nasal inhaled corticosteroids. Nasal decongestants can reduce nasal mucosal congestion and edema, facilitate the drainage of secretions, and relieve nasal congestion symptoms, but they should not be used for a long time and you need to be vigilant about the adverse reactions that may cause drug-induced rhinitis.

Cough variant asthma: Inhaled corticosteroids combined with bronchodilators such as β2 receptor agonists or inhaled corticosteroids alone are recommended.

Gastroesophageal reflux cough: (1) Adjusting lifestyle: For patients suspected of having gastroesophageal reflux cough, controlling diet, losing weight, raising the head of the bed, and avoiding eating before going to bed can help relieve symptoms. Avoid overeating, eating acidic, spicy, and greasy foods, drinking coffee, acidic beverages, smoking, and strenuous exercise. 2. Acid-suppressing drugs: The preferred treatment drugs are proton pump inhibitors and potassium ion competitive acid blockers. H2 receptor antagonists can also be used when proton pump inhibitors are not available. Such drugs should be used with caution during pregnancy.

Allergic cough: Treat with inhaled corticosteroids and/or oral antihistamines.

Pregnancy is a special stage. When using medicine for pregnant women, we must consider both mother and baby, weigh the pros and cons, prevent improper use of medicine, and ensure the safety of mother and baby. When pregnant women have a severe cough, they need to see a doctor in time to clarify the cause of the cough, and never take medicine at home on their own.

This article is excerpted from the guidelines and is intended for clinical use to understand the treatment of this disease. If it involves infringement, it will be deleted immediately.

References:

1. Asthma Group, Chinese Society of Respiratory Diseases. Guidelines for the diagnosis and treatment of cough (2021)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 45(1): 13-46.

2. Asthma Group, Chinese Society of Respiratory Medicine. Diagnosis and treatment guidelines for cough (draft)[J]. Chinese Journal of Practical Internal Medicine (Clinical Edition), 2006, 26(13): 977-982.

3. Expert group on the standard use of common cold medication for special populations. 2015 Expert consensus on the standard use of common cold medication for special populations [J]. International Journal of Respiratory Diseases, 2015, 35(1): 1-5.