Cough Reflex in Pregnancy

Mechanism of Cough Induction

Mechanical stimulation of cough receptors in the hypopharynx and larynx by secretions from the nose and sinuses can trigger the cough reflex in pregnant women with upper respiratory tract infections, according to the American College of Chest Physicians 1, 2
Upper airway inflammation can sensitize the cough reflex, lowering the threshold for cough initiation even with minimal stimulation, as noted by the American College of Chest Physicians 1, 2
Fluid infusion into the pharynx or mechanical stimulation with postnasal drip can evoke vigorous coughing through vagal, glossopharyngeal, or trigeminal nerve pathways, as reported in studies published in Chest 4, 5

Upper Airway Cough Syndrome (UACS) is the most common cause of both acute and chronic cough in pregnant women with upper respiratory infections, as stated by the American College of Chest Physicians 1, 6, 7
Approximately 20% of patients with UACS-induced cough are unaware of postnasal drainage or its connection to their cough, highlighting the importance of clinical diagnosis, according to the American College of Chest Physicians 1, 2, 3

Symptoms such as sensation of throat drainage, frequent throat clearing, throat tickle, nasal congestion, nasal discharge, or hoarseness can indicate UACS, as noted in studies published in Chest 1, 3
Physical examination findings like mucoid or mucopurulent secretions in the posterior pharynx or oropharynx, and cobblestone appearance of oropharyngeal mucosa can support the diagnosis of UACS, as reported in Chest 1, 6
The diagnosis of UACS is clinical and ultimately confirmed by response to empiric therapy, as stated by the American College of Chest Physicians 1, 2, 6

Nasal saline irrigation/washings are a safe and recommended initial approach for symptomatic management of UACS in pregnancy, providing relief without medication exposure, as suggested by the American College of Chest Physicians 1, 2
Acetaminophen or ibuprofen (in the second trimester, avoiding the third trimester) can be used for associated pain, fever, and inflammation in pregnant women with UACS, as recommended by the American College of Obstetricians and Gynecologists 8
Oral decongestants may provide symptomatic relief if there are no contraindications, such as hypertension or preeclampsia risk, and should be used cautiously in pregnancy, as advised by the American College of Obstetricians and Gynecologists 8
Topical nasal decongestants can provide temporary relief but should be limited to 3-5 days to avoid rebound congestion, as warned by the American Academy of Allergy, Asthma, and Immunology 8
Dextromethorphan can be prescribed for dry, bothersome cough in pregnant women, while codeine is generally avoided, as recommended by the American College of Obstetricians and Gynecologists 8

Discolored nasal discharge does not necessarily indicate bacterial sinusitis, and antibiotics are not indicated for viral upper respiratory tract infections, as stated by the Infectious Diseases Society of America 8
Bacterial sinusitis should be considered if symptoms persist beyond 3 weeks, fever exceeds 4 days, or clinical deterioration occurs, requiring antibiotics, as recommended by the Infectious Diseases Society of America 8
The American College of Chest Physicians now recommends the term "Upper Airway Cough Syndrome" instead of "postnasal drip syndrome" to reflect the uncertainty of the mechanism, highlighting the importance of accurate diagnosis and treatment 1, 6, 7