Chest
Volume 146, Issue 6, December 2014, Pages 1633-1648
Journal home page for Chest

Evidence-Based Medicine
Anatomy and Neurophysiology of Cough: CHEST Guideline and Expert Panel Report

https://doi.org/10.1378/chest.14-1481Get rights and content

Abstract

Bronchopulmonary C-fibers and a subset of mechanically sensitive, acid-sensitive myelinated sensory nerves play essential roles in regulating cough. These vagal sensory nerves terminate primarily in the larynx, trachea, carina, and large intrapulmonary bronchi. Other bronchopulmonary sensory nerves, sensory nerves innervating other viscera, as well as somatosensory nerves innervating the chest wall, diaphragm, and abdominal musculature regulate cough patterning and cough sensitivity. The responsiveness and morphology of the airway vagal sensory nerve subtypes and the extrapulmonary sensory nerves that regulate coughing are described. The brainstem and higher brain control systems that process this sensory information are complex, but our current understanding of them is considerable and increasing. The relevance of these neural systems to clinical phenomena, such as urge to cough and psychologic methods for treatment of dystussia, is high, and modern imaging methods have revealed potential neural substrates for some features of cough in the human.

ABBREVIATION

ATP
adenosine triphosphate
GERD
gastroesophageal reflux disease
GIT
gastrointestinal tract
nTS
nucleus tractus solitarius
RAR
rapidly adapting receptor
SAR
slowly adapting receptor
TRPA1
transient receptor potential A1
TRPM8
transient receptor potential M8
TRPV1
transient receptor potential vanilloid 1

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FUNDING/SUPPORT:The American College of Chest Physicians was the sole supporter of these guidelines, this article, and the innovations addressed within. Dr Bolser received National Institutes of Health funding [Grant R01 HL104315].

DISCLAIMER:American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1464S1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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