endobj (29). Three trials of all tasks were completed. The hypothesis is that those who aspirate several years after treatment completion would demonstrate reduced airflows for all cough parameters compared to those recently status post treatment completion given the known progressive deterioration associated with radiotherapy. It was hypothesized that the reflex cough response would be volitionally modified in a manner quantifiable with increases and decreases in specific expiratory airflow and muscle EMG parameters, depending on the cough modification task. Twenty adults (1840 yr, 4 men) volunteered for study participation and gave verbal and written informed consent. - Because although the steps happen in order (like a reflex), the swallow itself is modulated by taste, temperature, texture, and volume - Gag and swallow have 2 different neuronal pathways - There is no structure in the mouth that can elicit a swallow. Independent variables were task (baseline, short, long) and cough# (Cr1 and Cr2). Vovk et al. 6 0 obj Our data suggests the cortex participates in reflex cough not only in terms of detecting a sensory stimulus (as in the case of type III evoked cough) and selecting a response (cough/no cough) but also in terms of the nonsuppressible reflex cough response. of Physiological Sciences, Univ. The nebulizer was a DeVilbiss T-piece (DeVilbiss Healthcare) connected to a dosimeter (Koko Dosimeter) that delivered aerosolized solution during inspiration with a delivery duration of 2 s. Participants were administered single inhalations of aerosolized 200 M capsaicin dissolved in a vehicle solution consisting of 80% physiological saline, 10% Tween 20, and 10% ethanol. http://dx.doi.org/10.1016/j.pupt.2011.01.007 << Urge-to-cough: what can it teach us about cough? Using our PPPIA measure as a measure of expired volume, our overall results would indicate the Cr1 accounted for 68% and the Cr2 for 32% of the total air expired. Baseline trials were always completed first, and the order of the capsaicin and control solutions was randomized across participants. True All participants who coughed (17 of 18) exhibited at least one additional behavior to cough; on average, participants exhibited two additional behaviors. Unlike previous studies, the present study investigated the cortical control of reflex cough in a nonbinary manner. The capsaicin or control solution was automatically administered on inspiration. Cough reflex testing is a validated tool for identifying patients at risk of silent aspiration. If not able to be suppressed, the type of cough would fall into the reflex cough category, and presumably the cortex does not play a role in the generation of that cough response (5). No interaction was found between cough# and trial; thus the reported results for cough# reflect all data averaged across baseline, long, and short conditions. The three experimental tasks were then completed only if the participant exhibited a minimum of a two-cough (Cr2) response to the capsaicin and/or control solution during all three baseline trials. /MediaBox [0.0 0.0 595.0 842.0] Epub 2022 Apr 16. Only a very slight trend was seen for a decrease in expiratory sEMG duration of small cough vs. baseline cough, even with a significant decrease in PPPD duration. << /Rotate 0 CG) a\ @0AF32z>, Voluntary and Reflex Cough: Similarities and Differences, Pulmonary Pharmacology & Therapeutics, doi:10.1016/j.pupt.2011.01.007. Initially, 30 s of quiet breathing were recorded in order for participants to acclimate to the facemask. elsevier.com The site is secure. 22, No. Hutchings HA, Eccles R, Smith AP, Jawad MS. /ElsevierWebPDFSpecifications (6.1) The results of the present study confirmed the hypothesis that healthy human participants can volitionally modify their cough response to capsaicin at a concentration where complete suppression of cough is not possible. World J Crit Care Med. /Parent 2 0 R Although there was not a statistical difference detected in expiratory muscle activation for long cough vs. baseline or small cough, examination of Table 1 reveals a trend toward increased RA and IC8 activation that may indicate muscle modulation for airway compression during the long cough task. Spontaneous swallow (SS) is the result of accumulated saliva and/or food remnants in the mouth. 2, American Journal of Respiratory and Critical Care Medicine, Vol. 205, Respiratory Physiology & Neurobiology, Vol. government site. 5). 2016 Jun;24(3):191-6. doi: 10.1097/MOO.0000000000000256. Nguyen NP, Moltz CC, Frank C, Millar C, Smith HJ, Dutta S, Nguyen PD, Nguyen LM, Lemanski C, Ludin A, Jo BH, Sallah S. Lung. (The remaining participant expressed other expiratory behaviors but not cough in the response.) prepared figures; K.W.H. Multiple studies suggest a role for the cerebral cortex in the generation of reflex cough in awake humans. Error bars are standard error. Imaging analysis of a suppressed cough support this hypothesis, showing diffuse cortical activation of many of the same regions activated with evoked cough, with the addition of pre-SMA and basal ganglia activation unique to cough suppression (18). approved the final version of the manuscript. >> HHS Vulnerability Disclosure, Help Cough airflow parameters are illustrated in Fig. Cough airflow waveform with associated surface EMG (sEMG) from a representative baseline capsaicin trial. Elisa Chellini This revised model supports cough as a complex sensorimotor behavior and helps to explain why differences in both reflex and voluntary cough appear with neuropathologies primarily affecting the cortex. As well, in patients with Parkinson's disease, decreases in peak expiratory airflow and prolonged CPD are seen for voluntary cough production (21). 2 and include the duration of activation and maximum and RMS values from the integrated sEMG signals from the RA and IC8. /CropBox [0.0 0.0 595.0 842.0] Mlotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Dysphagia. In the present study, all participants were given 200 M concentration, and 17 of 18 could not suppress the cough response. 2007;20(4):423-32. doi: 10.1016/j.pupt.2006.11.006. Therefore, we chose to include one abdominal (RA) and one thoracic placement (IC8). Independent variables were task (baseline, short, long) and cough# (Cr1 and Cr2). drafted the manuscript; K.W.H., D.C.B., and P.W.D. 2012 Jul 1; 113(1): 3946. These muscles were selected based on the findings of Vovk et al. 97, No. a, Expiratory, Results of post hoc statistical analysis for the effect of trial (baseline, small,, Results of post hoc statistical analysis for the effect of cough (Cr1, Cr2), Revised model for the neural control of cough, based on the model proposed, MeSH interpreted results of experiments; K.W.H. The ePub format is best viewed in the iBooks reader. Does diurnal variation in cough reflex testing exist in healthy young adults? Measurement of Cough Aerodynamics in Healthy Adults, Vagal Afferent Innervation of the Airways in Health and Disease, Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients, Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease, Comparison of Two Methods for Inducing Reflex Cough in Patients With Parkinsons Disease, With and Without Dysphagia, Preliminary Evidence of Reduced Urge to Cough and Cough Response in Four Individuals following Remote Traumatic Brain Injury with Tracheostomy, Respiratory kinematic and airflow differences between reflex and voluntary cough in healthy young adults, Abraham Guz memorial: Still unresolved hypotheses: Lung reflexes and perceptions of breathing, Endogenous central suppressive mechanisms regulating cough as potential targets for novel antitussive therapies, The impact of harmfulness information on citric acid induced cough and urge-to-cough, Interactions of mechanically induced coughing and sneezing in cat, Sensations and regional brain responses evoked by tussive stimulation of the airways, Functionally connected brain regions in the network activated during capsaicin inhalation. /MediaBox [0.0 0.0 612.0 709.0] Participants were seated and outfitted with a facemask and pneumotacograph, and two surface EMG electrodes were positioned over expiratory muscles. /Contents 52 0 R Hegland KW, Troche MS, Brandimore A, Okun MS, Davenport PW. 126, No. /Parent 2 0 R /Type /Page /Contents 46 0 R Epub 2007 Oct 22. study found no CPD differences. It was hypothesized that the reflex cough response would be volitionally modified in a manner quantifiable with increases and decreases in specific expiratory airflow and muscle EMG parameters, depending on the cough modification task. Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors. /Resources 43 0 R endobj Reflex cough is preceded by detection of an urge to cough; strokes specifically within the cerebral cortex can affect parameters of reflex cough, and reflex cough can be voluntarily suppressed. Like other functions with brain stem control centers (for example, respiration and the pharyngeal phase of swallowing), it may be possible to generate a cough in the absence of cortical input; however, it likely will not result in normal task execution. Significant difference: Fig. This allowed for determination of those specific aspects of reflex cough that can be volitionally modulated. Volume 293, November 2021, 103702 Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status AmyFullertona YuhanMoub NatalieSilverc Neil N.Chhedad Kathryn Hitchcocke KarenHeglandf https://doi.org/10.1016/j.resp.2021.103702 Get rights and content Keywords Dysphagia Methods: /CropBox [0.0 0.0 595.0 842.0] Participants were not told which solution was being presented. Elsevier /Length 1607 endobj Therefore, if an individual participant had a Cr5, for example, the total expired volume and consequent percentage allocation among all responses would change. 31, No. One additional participant reported no additional urge to cough from capsaicin as the experimental tasks were initiated; this participant then admitted to regularly smoking cigarettes (although had denied smoking in the last 5 yr upon initial study screening) and was subsequently withdrawn from the study. For the suppressed cough condition, a binary system (yes or no) was used to identify whether participants were able to suppress the cough response. /AuthoritativeDomain#5B2#5D (sciencedirect.com) and P.W.D. Results of post hoc statistical analysis for the effect of cough (Cr1, Cr2) on airflow and sEMG parameters. >> Table 4. Evoked cough via inhalation of capsaicin is associated with activation of many of the same structures, including primary motor and somatosensory cortices, SMA, operculum, anterior and posterior mid-cingulate cortex, insula, thalamus, brain stem, and cerebellum (18). Online ahead of print. Cough airflow waveform with associated surface EMG (sEMG) from a representative baseline capsaicin, Cough and sEMG parameters for data analysis. Author contributions: K.W.H., D.C.B., and P.W.D. /Type /Page In the present study, no differences were found for sEMG amplitude for RA or IC8 muscles. See this image and copyright information in PMC. Thus they termed the non-suppressed (cough if you need to) stimulus threshold the natural cough threshold and the suppressed stimulus threshold the suppressed threshold. These differences between natural and suppressed cough thresholds reflect a degree of suprapontine modulation over the brain stem control center for cough. Without being able to identify specific neural structures involved in reflex cough based on the present study results, it is hypothesized that reflex cough neural control in healthy awake humans includes a cortical pathway that can exert excitatory and/or inhibitory influence on brain stem cough control centers. The trend for the small cough task is a decrease in PEFR and increase in PEFRT, whereas the trend for long cough is an increase in PEFR and decrease in PEFRT. Vovk A, Bolser DC, Hey JA, Danzig M, Vickroy T, Berry R, Martin AD, Davenport PW. As well, in patients with Parkinson's disease, decreases in peak expiratory airflow and prolonged CPD are seen for voluntary cough production (21). Cough and sEMG parameters for data analysis. Multiple studies suggest a role for the cerebral cortex in the generation of reflex cough in awake humans. 10 0 obj The mean values of measures for Cr1 and Cr2 (cough#) were calculated across the three trials completed for the baseline, small, and long cough tasks. /Parent 2 0 R << /AuthoritativeDomain#5B1#5D (elsevier.com) /Contents 30 0 R /Length 5808 That is, a relatively weak stimulus evokes an urge to cough that may be followed by an evoked cough (3, 9). /Subtype /XML 2 and include the duration of activation and maximum and RMS values from the integrated sEMG signals from the RA and IC8. Knudson et al. Voluntary cough is associated with activation of primary motor and somatosensory cortices, supplementary motor area (SMA), operculum, anterior and posterior mid-cingulate cortex (19, 24), insula, thalamus, basal ganglia, precuneus, inferior temporal gyri, amygdala, brain stem, and cerebellum (24). No conflicts of interest, financial or otherwise, are declared by the author(s). Electrodes remained in place for the duration of the study. In humans, three types of cough have been classified based on their hypothesized central control mechanisms. /Metadata 5 0 R Again, the concentration level of the stimulus (for the Lasserson study, L-tartaric acid) was not tested at a suppressed vs. supramaximal (reflex) threshold, so it remains a possibility that the type of cough elicited leads to observed differences in CPD and sEMG muscle activation patterns. 1). Participants were given instructions for the cough tasks, including baseline (cough if you need to), and three experimental tasks: 1) small cough (cough smaller or softer than normal), 2) long cough (cough longer or louder than normal), and 3) suppress cough (do not cough). 2017 Jul 1;123(1):19-26. doi: 10.1152/japplphysiol.00612.2016. This indicates that, under normal physiological conditions, cough production reflects an interaction between multiple control sites along the neuraxis resulting in mechanical differences reflective of both laryngeal and respiratory muscle modulation. healthy participants can exert volitional control over reflex cough. Identification of specific components of cough expiratory airflow (which is essential to clearing material from the airway) that can be modified provides a basis for development of behaviorally based treatments that may lead to effective cough rehabilitation. According to Eccles' model, the former would represent an evoked cough (type III) and the latter a reflex cough (type I). As such, multiple reaccelerations were considered in the data analysis in the former study compared with just the first cough (Cr1) and first reacceleration (Cr2) in the present study. cough is an airway defense mechanism that acts to expel material from the airway. Author contributions: K.W.H., D.C.B., and P.W.D. However, even though it is not possible to completely suppress a cough, it may be possible to volitionally attenuate or enhance the reflex cough response. 22 0 obj The eighth rib was palpated, and the IC8 electrode was placed 2 cm lateral to the costal margin, 1 cm medial to the anterior axillary line. /CreationDate (D:20221102223103-00'00') Only a very slight trend was seen for a decrease in expiratory sEMG duration of small cough vs. baseline cough, even with a significant decrease in PPPD duration. In addition, Mazzone and colleagues (18) found that evoked cough uniquely activates the rostral and caudal medulla. /CropBox [0.0 0.0 595.0 842.0] electromyography 4 and 5). Values are means (SE) data for dependent variables according to task and cough number. These expiratory airflow parameters are related to subglottal pressure generation (CPD), rapid expiratory airflow acceleration (PEFR, PEFRT, CVA), and the sustained expiratory airflow plateau phase, which is a function of the airflow velocity (PPPD, PPPIA). The neural structures involved in voluntary cough and evoked cough have been studied in humans using functional magnetic resonance imaging (fMRI). (26) report degradation in the velocity and volume of expiratory airflow in reflexive and voluntary cough, respectively, in stroke patients. Epub 2006 Dec 12. R33 HL089104/HL/NHLBI NIH HHS/United States. Error bars are standard error. A trend was seen for long cough for increased PPPD and PPPIA vs. baseline. (29) that showed measuring EMG activity in any of these muscle groups (IC8, RA, or external obliques) is adequate in assessing strength of airway defensive responses in humans. It may be that with the small cough task participants relied on active laryngeal adductor muscles to stop the flow of air to attenuate the length of the cough, thereby maintaining the duration of sEMG activation against a closed glottis. Cough hypersensitivity and chronic cough. Dysphagia following chemoradiation for locally advanced head and neck cancer. Capsaicin (200M) was delivered via dosimeter attached to the facemask. >> 188, No. /MediaBox [0.0 0.0 595.28 841.89] expiration reflex From those responses, both airflow and surface EMG (sEMG) parameters were derived. 11, Journal of Applied Oral Science, Vol. << Magni C, Chellini E, Lavorini F, Fontana GA, Widdicombe J. 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