Chest
SupplementDiagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice GuidelinesAnatomy and Neurophysiology of the Cough Reflex: ACCP Evidence-Based Clinical Practice Guidelines
Section snippets
Rapidly Adapting Receptors
The anatomy of rapidly adapting receptor (RAR) terminations in the airway wall is unknown. Functional studies11, 12, 13, 14, 15, 16, 17 of RARs suggest that they terminate within or beneath the epithelium of both intrapulmonary and extrapulmonary airways, but primarily the intrapulmonary airways. RARs are differentiated from other airway afferents by their rapid adaptation (ie, 1 to 2 s) to sustained lung inflations (Fig 2).13, 14, 15, 16, 17, 18, 19 Other distinguishing properties of RARs
Peripheral Interactions
Activated C-fibers can release the neuropeptides substance P, neurokinin A, and calcitonin gene-related peptide from their peripheral nerve terminals without involvement of the CNS, and even without action potential formation.59 This process is called the axon reflex, and has been well-described in human skin and in the viscera of many species. Axon reflexes in the airways and lungs of guinea pigs result in bronchospasm, mucus secretion, vasodilatation, edema, leukocyte recruitment, altered
Cough Evoked From the Ear (Arnold Reflex)
Afferent nerves carried by the auricular branch of the vagus nerve (ie, the Arnold nerve) innervate the external auditory meatus.114 In a small subset of patients (< 5%), several visceral reflexes, including cough, may be evoked by the mechanical stimulation of the ear. Tracing studies115 in cats have shown that afferent neurons carried by the Arnold nerve have their cell bodies in the superior vagal (jugular) ganglia, and terminate in several areas throughout the brainstem, including the
CONCLUDING REMARKS
Studies carried out in animals have provided clear evidence that vagal afferent nerves regulate coughing. It remains unclear, however, what relative role the identified afferent nerve subtypes play in mediating cough. Evidence both for and against the role of C-fibers and RARs has been reported. These conflicting data suggest that the activation of both afferent nerve subtypes may be required to induce coughing, or that a previously unrecognized airway afferent nerve subtype subserves a primary
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