Central Neural Circuits for Coordination of Swallowing, Breathing, and Coughing

Bolser, Donald C.; Gestreau, Christian; Morris, Kendall F.; Davenport, Paul W.; Pitts, Teresa

doi:10.1016/j.otc.2013.09.013

Cited by 33 publications

(43 citation statements)

References 27 publications

(45 reference statements)

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“…PD is known to affect the respiratory system [22], and because cough is an overlaid respiratory function, it is not surprising to find changes to the coordination of a sequential cough task in this cohort of PD participants. Recent reports by Pitts et al [23] and Bolser et al [24] assert that cough and swallowing central pattern generators are intricately connected within brainstem centers. Davenport et al [25] hypothesized that brainstem respiratory centers are actually reconfigured to produce cough and swallow behaviors.…”

Section: Discussionmentioning

confidence: 99%

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Wheeler-Hegland

Okun

Troche

2014

Lung

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Background Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson’s disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia. Methods Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration–aspiration score observed was used to determine whether the patient had dysphagia. Results There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia. Conclusions The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.

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Section: Discussionmentioning

confidence: 99%

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Wheeler-Hegland

Okun

Troche

2014

Lung

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“…Additional behaviors, such as laryngeal adduction and apnea, also participate in the prevention of aspiration. If aspiration occurs, cough corrects this problem by the production of high velocity airflows that create shear forces to dislodge and eject material from the airway [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

“…The NTS circuit has been informed by the activity patterns of neurons recorded in the region of the NTS during cough and swallow and simulations of the proposed swallow oscillator (Fig. 2)[27, 58]. This proposed circuit represents the simplest modeling that is consistent with the data but not been informed by specific knowledge of functional relationships with other elements of the network.…”

Section: Introductionmentioning

confidence: 99%

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Role of the dorsal medulla in the neurogenesis of airway protection

Bolser

Pitts

Davenport

et al. 2015

Pulmonary Pharmacology & Therapeutics

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The dorsal medulla encompassing the nucleus of the tractus solitarius (NTS) and surrounding reticular formation (RF) has an important role in processing sensory information from the upper and lower airways for the generation and control of airway protective behaviors. These behaviors, such as cough and swallow, historically have been studied in isolation. However, recent information indicates that these and other airway protective behaviors are coordinated to minimize risk of aspiration. The dorsal medullary neural circuits that include the NTS are responsible for rhythmogenesis for repetitive swallowing, but previous models have assigned a role for this portion of the network for coughing that is restricted to monosynaptic sensory processing. We propose a more complex NTS/RF circuit that controls expression of swallowing and coughing and the coordination of these behaviors. The proposed circuit is supported by recordings of activity patterns of selected neural elements in vivo and simulations of a computational model of the brainstem circuit for breathing, coughing, and swallowing. This circuit includes separate rhythmic sub-circuits for all three behaviors. The revised NTS/RF circuit can account for the mode of action of antitussive drugs on the cough motor pattern, as well as the unique coordination of cough and swallow by a meta-behavioral control system for airway protection.

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“…Central networks and mechanisms that regulate cough are beyond the scope of this review [95*, 96, 97*, 98, 99], but it is clear that cough mediated by nodose Aδ fibers and jugular C fibers are differentially sensitive to anesthesia, thus suggesting major differences. Nevertheless, activation of airway jugular C fibers (with capsaicin or bradykinin) augments Aδ fiber-mediated cough in anesthetized animals [50, 100].…”

Section: Cough Afferent Interactionsmentioning

confidence: 99%

Peripheral neural circuitry in cough

Taylor‐Clark¹

2015

Current Opinion in Pharmacology

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Cough is a reflex that serves to protect the airways. Excessive or chronic coughing is a major health issue that is poorly controlled by current therapeutics. Significant effort has been made to understand the mechanisms underlying the cough reflex. The focus of this review is the evidence supporting the role of specific airway sensory nerve (afferent) populations in the initiation and modulation of the cough reflex in health and disease.

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Central Neural Circuits for Coordination of Swallowing, Breathing, and Coughing

Cited by 33 publications

References 27 publications

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Role of the dorsal medulla in the neurogenesis of airway protection

Peripheral neural circuitry in cough

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