Cough Reflex in Lung Transplant Recipients

Abstract

Lung transplantation has become the standard of care for particular individuals with advanced lung disease. However, this surgical procedure involves interruption of the lower vagal nerve fibers which leads to loss of the protective cough reflex. Injury of the neural pathways involved with the sensory limb of the cough reflex is associated with an increased risk of complications involving the allograft. While loss of the cough reflex was once considered permanent, recent evidence indicates functional and structural restoration is a time-dependent process that occurs 6-12 months after lung transplantation. The implication that the cough reflex may be reestablished in lung transplant recipients provides insight into the dynamic response to airway neural injury that may lead to improvements in allograft tissue repair.

Staphylococcus aureus infections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

“…The respiratory tract is particularly at risk for infection because denervation of the transplanted lung results in impaired coughing and slowing of mucociliary clearance. 17,18 Our most notable findings concerned the outcomes of these infections. Contrary to prior reports of high mortality rates among solid organ transplant recipients with staphylococcal infections, 15,19 we found that the 30-and 90-day mortality rates were only 7% and 12%, respectively.…”

Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions?

“…using a mechanosensory stimulus, and described as normal, attenuated or absent. While there were more observations of absent cough reflex in patients with lower levels of consciousness on the Glasgow Coma Scale, there were also patients in which cough reflex was present at the lowest level of consciousness (37). More recently, this study has been replicated in a larger sample of 208 patients admitted with trauma, poisoning, neurological and cardiorespiratory conditions, etc., and level of consciousness ranging from full (Glasgow Coma Scale score 15) to comatose (Glasgow Coma Scale score ≤8) (39).…”

Epidemiology, clinical manifestations, and outcomes of Scedosporium infections among solid organ transplant recipients

“…It is widely recognized that LTR are at particular risk for respiratory tract infections by environmental molds. This susceptibility is a result of the continuous exposure of the transplanted organ to the external environment, the frequent need for prolonged mechanical ventilation , impaired mucociliary clearance , and profound immune suppression . Moreover, patients awaiting lung transplantation are commonly colonized with fungi as a result of their underlying diseases.…”