Anatomy and neuro-pathophysiology of the cough reflex arc

Polverino, Mario; Polverino, Francesca; Fasolino, Marco; Andò, Filippo; Alfieri, A; Blasio, Francesco De

doi:10.1186/2049-6958-7-5

Cited by 123 publications

(103 citation statements)

References 39 publications

(30 reference statements)

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“…Os receptores sensíveis à estímulos mecânicos (mecanorreceptores) estão presentes no estômago, pericárdio, pleura, diafragma, faringe, seios paranasais, tímpanos e meato acústico externo. Eles são ativados pelo tato e distensão 8 . Os impulsos oriundos desses receptores atingem o centro da tosse na medula através do nervo vago.…”

Section: Fisiopatologiaunclassified

“…Grupos de risco com reflexo da tosse comprometido (idosos, tabagistas, transplantados de pulmão, recém-nascidos) são altamente suscetíveis a infecções pulmonares e pneumonia aspirativa. Entretanto, quando persistente, a tosse afeta a qualidade de vida do paciente e pode agravar hérnias, incontinência urinária e ser potencialmente danosa a mucosa das vias aéreas 8 . Aproximadamente 50% dos pacientes com tosse crônica apresentam distúrbios de sono 9 .…”

Section: Introductionunclassified

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Aspectos fisiopatológicos do reflexo da tosse: uma revisão de literatura

Rodrigues

Galvão

2017

Rev. Med. (São Paulo)

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RESUMO:A tosse é um reflexo de defesa da via aérea em condições fisiológicas. Entretanto, ela compõe o quadro clínico de diversas doenças pulmonares, cardíacas e gastrintestinais. A persistência desse sintoma afeta a qualidade de vida do paciente e acomete 3 a 40% da população geral. Embora possua uma prevalência alta, a fisiopatologia desse sintoma ainda não é bem esclarecida. Nesse sentido, anualmente, são publicados novos achados sobre a fisiopatologia desse sintoma. Assim, o objetivo desse trabalho é realizar uma revisão de literatura sobre a fisiopatologia da tosse. Essa revisão utilizou quarenta publicações presentes nas seguintes bases de dados: Scholar Google, SciELO, Pubmed Central® (PMC), National Center for Biotechnology Information (NCBI) e Medline. A fisiopatologia da tosse está intimamente ligada à estimulação química das fibras-C e à ativação por estímulos mecânicos dos receptores de adaptação rápida (RARs) e dos receptores de estiramento de adaptação lenta (SARs). O conhecimento desses mecanismos fisiopatológicos é importante para o manejo clínico de pacientes com esse sintoma e contribui para o entendimento do mecanismo de ação de antitussígenos que agem sobre esses receptores.Descritores: Tosse/fisiopatologia; Tosse/diagnóstico; Reflexo; Antitussígenos. ABSTRACT:Cough is a reflex of airway defense under physiological conditions. However, it composes the clinical condition of several pulmonary, cardiac and gastrointestinal deseases. The persistence of the symptom affects the welfare of the patient and affects 3 to 40% of the general population. Although it has an important prevalence, the pathophysiology of the symptom is still not clear. In this sense, new symptom findings are published annually. Thus, the objective of the study is to perform a review of the pathophysiology of cough. This review used forty recent publications in the following databases: Scholar Google, SciELO, Pubmed Central® (PMC), National Center for Biotechnology Information (NCBI) and Medline. The pathophysiology of cough is closely linked to the chemical stimulation of C-fibers and to activation by mechanical stimuli of the rapid adaptation receptors (RARs) and the slow adaptating stretch receptors (SARs). The knowledge of these pathophysiological mechanisms is important for the clinical management of patients with this symptom and contributes to the understanding of the mechanism of action of antitussives that act on these receptors.

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Section: Fisiopatologiaunclassified

Section: Introductionunclassified

Aspectos fisiopatológicos do reflexo da tosse: uma revisão de literatura

Rodrigues

Galvão

2017

Rev. Med. (São Paulo)

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“…Este proceso se inicia por la irritación de receptores que en su mayoría corresponden a fibras C. Aquellos que se encuentran distribuidos en el epitelio de la tráquea, carina y laringe pueden responder a estímulos químicos, como la acidez, calor, frío, capsaicina (se encuentra en pimientos picantes), bradicinina, solución salina hipertónica, y también a estímulos mecánicos. Existen receptores de la tos localizados en el canal auditivo externo (CAE), tímpano, senos paranasales, faringe, diafragma, pleura, pericardio y estómago, que probablemente solo respondan a estímulos mecánicos, como el tacto o desplazamiento 1 .…”

Section: Fisiología De La Tosunclassified

“…El centro de la tos genera una señal eferente que viaja por el nervio vago, frénico y nervios espinales motores, hacia la musculatura espiratoria y laringe 1 . El centro de la tos, está bajo el control de regiones corticales superiores, por lo que puede manifestarse o inhibirse voluntariamente y asociarse a componentes afectivos 3,5 .…”

Section: Fisiología De La Tosunclassified

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Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

Jofré

García

2017

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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RESUMEN La tos ocurre por la compleja acción del arco de la tos. En condiciones normales es ABSTRACT Cough occurs due to the complex action of the coughing arch. Under normal conditions it is essential to protect the airway. It is a very frequent symptom with a large of possible etiologies.The diagnosis process of patients with chronic cough can be a challenge. The most prevalent pathologies must be considered. Thus includes pharyngolaryngeal reflux and posterior discharge: both conditions that are part of the otorhinolaryngolocical area.In the present article review, we pretend to provide an updated approach and management to this condition, in order to asses relevant information to daily clinical practice.

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Atypical Activation of Laryngeal Somatosensory-Motor Cortex During Vocalization in People With Unexplained Chronic Cough

Misono,

Xu,

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceUnexplained chronic cough is common and has substantial negative quality-of-life implications, yet its causes are not well understood. A better understanding of how peripheral and central neural processes contribute to chronic cough is essential for treatment design.ObjectiveTo determine if people with chronic cough exhibit signs of abnormal neural processing over laryngeal sensorimotor cortex during voluntary laryngeal motor activity such as vocalization.Design, Setting, and ParticipantsThis was a cross-sectional study of a convenience sample of participants with chronic cough and healthy participants. Testing was performed in an acoustically and electromagnetically shielded chamber. In a single visit, electroencephalographic (EEG) signals were recorded from participants with chronic cough and healthy participants during voice production. The chronic cough group participants presented with unexplained cough of 8 weeks or longer duration with prior medical evaluation including negative results of chest imaging. None of the participants had a history of any neurologic disease known to impair vocalization or swallowing. Data collection for the healthy control group occurred from February 2 to June 28, 2018, and for the chronic cough group, from November 22, 2021, to June 21, 2022. Data analysis was performed from May 1 to October 30, 2022.ExposureParticipants with or without chronic cough.Main Outcome MeasuresEvent-related spectral perturbation over the laryngeal area of somatosensory-motor cortex from 0 to 30 Hz (ie, θ, α, and β bands) and event-related coherence as a measure of synchronous activity between somatosensory and motor cortical regions.ResultsThe chronic cough group comprised 13 participants with chronic cough (mean [SD] age, 63.5 [7.8] years; 9 women and 4 men) and the control group, 10 healthy age-matched individuals (mean [SD] age, 60.3 [13.9] years; 6 women and 4 men). In the chronic cough group, the typical movement-related desynchronization over somatosensory-motor cortex during vocalization was significantly reduced across θ, α, and β frequency bands when compared with the control group.Conclusions and RelevanceThis cross-sectional study found that the typical movement-related suppression of brain oscillatory activity during vocalization is weak or absent in people with chronic cough. Thus, chronic cough affects sensorimotor cortical activity during the asymptomatic voluntary activation of laryngeal muscles.

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Anatomy and neuro-pathophysiology of the cough reflex arc

Cited by 123 publications

References 39 publications

Aspectos fisiopatológicos do reflexo da tosse: uma revisão de literatura

Aspectos fisiopatológicos do reflexo da tosse: uma revisão de literatura

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

Atypical Activation of Laryngeal Somatosensory-Motor Cortex During Vocalization in People With Unexplained Chronic Cough

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