Anatomy and neuro-pathophysiology of the cough reflex arc

Recent advances in cough research suggest a more widespread use of cough-provocation tests to demonstrate the hypersensitivity of the cough reflex arc. Cough-provocation tests with capsaicin or acidic aerosols have been used for decades in scientific studies. Several factors have hindered their use in everyday clinical work: i.e. lack of standardisation, the need for special equipment and the limited clinical importance of the response. Cough-provocation tests with hypertonic aerosols (CPTHAs) involve provocations with hypertonic saline, hypertonic histamine, mannitol and hyperpnoea. They probably act via different mechanisms than capsaicin and acidic aerosols. They are safe and well tolerated and the response is repeatable. CPTHAs can assess not only the sensitivity of the cough reflex arc but also the tendency of the airway smooth muscles to constrict (airway hyper-responsiveness). They can differentiate between subjects with asthma or chronic cough and healthy subjects. The responsiveness to CPTHAs correlates with the cough-related quality of life among asthmatic subjects. Furthermore, the responsiveness to them decreases during treatment of chronic cough. A severe response to CPTHAs may indicate poor long-term prognosis in chronic cough. The mannitol test has been stringently standardised, is easy to administer with simple equipment, and has regulatory approval for the assessment of airway hyper-responsiveness. Manual counting of coughs during a mannitol challenge would allow the measurement of the function of the cough reflex arc as a part of clinical routine.

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Anatomy and neuro-pathophysiology of the cough reflex arc

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2012.592 ◽

2012 ◽

Vol 7 ◽

Author(s):

Mario Polverino ◽

Francesca Polverino ◽

Marco Fasolino ◽

Filippo Andò ◽

Antonio Alfieri ◽

...

Keyword(s):

General Practitioner ◽

Cough Reflex ◽

Defensive Reflex ◽

Reflex Arc ◽

Stimulation Of

Coughing is an important defensive reflex that occurs through the stimulation of a complex reflex arc. It accounts for a significant number of consultations both at the level of general practitioner and of respiratory specialists. In this review we first analyze the cough reflex under normal conditions; then we analyze the anatomy and the neuro-pathophysiology of the cough reflex arc. The aim of this review is to provide the anatomic and pathophysiologic elements of evaluation of the complex and multiple etiologies of cough.

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Responses of the habituated vestibulo-ocular reflex arc to drug stress.

PsycEXTRA Dataset ◽

10.1037/e458702004-001 ◽

1965 ◽

Author(s):

Patrick J. Dowd

Keyword(s):

Ocular Reflex ◽

Reflex Arc ◽

Vestibulo Ocular Reflex

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On Dewey’s Psychology: His Criticism on ‘Reflex Arc’ and Its Educational Implications

The Korean Journal of Philosophy of Education ◽

10.15754/jkpe.2019.41.3.003 ◽

2019 ◽

Vol 41 (3) ◽

pp. 41-65

Author(s):

Moo-Gil Kim

Keyword(s):

Educational Implications ◽

Reflex Arc

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Effect of Neuromuscular Electrical Stimulation on Swallowing Process in Stroke Patient with Neurogenic Dysphagia

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v1i1.191 ◽

1970 ◽

Vol 1 (1) ◽

pp. 44-53

Author(s):

Ruth Ariyani ◽

Widjajalaksmi ◽

Luh K Wahyuni ◽

Susyana Tamin ◽

Saptawati Bardosono

Keyword(s):

Electrical Stimulation ◽

Voice Quality ◽

Neuromuscular Electrical Stimulation ◽

Neurogenic Dysphagia ◽

Stroke Patients ◽

Cough Reflex ◽

Voluntary Cough ◽

Pharyngeal Phase ◽

Significant Difference ◽

Quasi Experimental

Objective: The aim of this study to determine the therapeutic effect of Neuromuscular Electrical Stimulation (NMES) on pharyngeal phase of swallowing for stroke patients with neurogenic dysphagia,and to see the effect of NMES in reducing the incidence of standing secretion, residue, penetration and aspiration.Methods: It is a quasi-experimental study design. 10 stroke patients with neurogenic dysphagia in Cipto Mangunkusumo hospital, Jakarta, 40-80 years old with hemodynamically stable, cooperative and will be get NMES therapy for 4 weeks. Pre and Post treatment assessment caompared using a modified MASA test (The Mann Assessment of Swallowing Ability) and FEES examination (Flexible Endoscophic Evaluation of Swallowing). Analysis of change scores using Wilcoxon test.Results:The obtain average age of patients 59.80+9.705 years. Significant difference seen in the pharyngeal phase of swallowing increased score of gag reflex, velum elevation, cough reflex, voluntary cough, voice quality, pharynx response, pharyngeal constrictor contraction and vocal cord adduction (p<0.005).Also seen significant reduction in the incidence of standing secretion, residue and penetration (p<0.005), but not significantly in the incidence of aspiration (p=0083).Conclusions: NMES increased the pharyngeal phase of swallowing, reduced the incidence of standing secretion, residue and penetration of stroke patients with neurogenic dysphagia, but have not able to reduced aspiration.Keywords :Neuromuscular Electrical Stimulation (NEMS), neurogenic dysphagia, MASA test (The Mann Assessment of Swallow ing Ability), FEES examination (Flexible Endoscophic Evaluation of Swallowing), swallowing process.

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Supraspinal inhibition of a cutaneous vascular reflex in the cat

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1964.207.2.303 ◽

1964 ◽

Vol 207 (2) ◽

pp. 303-307 ◽

Cited By ~ 8

Author(s):

B. J. Prout ◽

J. H. Coote ◽

C. B. B. Downman

Keyword(s):

Carotid Sinus ◽

Spinal Reflexes ◽

Descending Pathways ◽

Skin Response ◽

Reflex Arc ◽

Vascular Reflex ◽

Carotid Sinus Nerve Stimulation ◽

Sympathetic Discharge ◽

Stimulation Of ◽

Cerebellar Stimulation

In cats anesthetized with chloralose-urethane mixture, stimulation of an afferent nerve evoked a vasoconstrictor reflex (VCR) and a galvanic skin response (GSR) in the pads of the feet. Stimulation of the ventromedial medullary reticular substance at the level of the obex abolished the VCR and the GSR. VCR could also be reduced by occlusion during prolonged stimulation of another spinal or visceral afferent pathway. Medulla stimulation was effective without itself causing a sympathetic discharge to the paw, showing that inhibition rather than occlusion was operative. Anterior cerebellar stimulation also inhibited the VCR. Carotid sinus nerve stimulation did not abolish the VCR. It is concluded that the effective mechanism includes a bulbospinal inhibitory path projecting on a spinal vasoconstrictor reflex arc. This arrangement is similar to the descending pathways inhibiting other spinal reflexes but the VCR-inhibitory path can be activated independently of them.

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Effect of sulindac on the cough reflex of healthy subjects.

British Journal of Clinical Pharmacology ◽

10.1111/j.1365-2125.1991.tb05518.x ◽

1991 ◽

Vol 31 (2) ◽

pp. 207-208 ◽

Cited By ~ 8

Author(s):

G. Foster ◽

WW Yeo ◽

LE Ramsay

Keyword(s):

Healthy Subjects ◽

Cough Reflex

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Intragastric administration of capsiate, a transient receptor potential channel agonist, triggers thermogenic sympathetic responses

Journal of Applied Physiology ◽

10.1152/japplphysiol.00128.2010 ◽

2011 ◽

Vol 110 (3) ◽

pp. 789-798 ◽

Cited By ~ 68

Author(s):

Kaori Ono ◽

Masako Tsukamoto-Yasui ◽

Yoshiko Hara-Kimura ◽

Naohiko Inoue ◽

Yoshihito Nogusa ◽

...

Keyword(s):

Sympathetic Nerve ◽

Transient Receptor Potential ◽

Trp Channels ◽

Low Frequency ◽

Receptor Potential ◽

Transient Receptor Potential Channel ◽

Intragastric Administration ◽

Brown Adipose ◽

Reflex Arc ◽

Transient Receptor

The sympathetic thermoregulatory system controls the magnitude of adaptive thermogenesis in correspondence with the environmental temperature or the state of energy intake and plays a key role in determining the resultant energy storage. However, the nature of the trigger initiating this reflex arc remains to be determined. Here, using capsiate, a digestion-vulnerable capsaicin analog, we examined the involvement of specific activation of transient receptor potential (TRP) channels within the gastrointestinal tract in the thermogenic sympathetic system by measuring the efferent activity of the postganglionic sympathetic nerve innervating brown adipose tissue (BAT) in anesthetized rats. Intragastric administration of capsiate resulted in a time- and dose-dependent increase in integrated BAT sympathetic nerve activity (SNA) over 180 min, which was characterized by an emergence of sporadic high-activity phases composed of low-frequency bursts. This increase in BAT SNA was abolished by blockade of TRP channels as well as of sympathetic ganglionic transmission and was inhibited by ablation of the gastrointestinal vagus nerve. The activation of SNA was delimited to BAT and did not occur in the heart or pancreas. These results point to a neural pathway enabling the selective activation of the central network regulating the BAT SNA in response to a specific stimulation of gastrointestinal TRP channels and offer important implications for understanding the dietary-dependent regulation of energy metabolism and control of obesity.

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