Lung

, Volume 190, Issue 1, pp 29–33 | Cite as

Effect of Aging on Cough and Swallowing Reflexes: Implications for Preventing Aspiration Pneumonia

Article

Abstract

The impairment of airway protective reflexes, i.e., swallowing and cough reflexes, is thought to be one of the major causes for aspiration pneumonia in older people. Restoration of cough and swallowing reflexes in the elderly is key to preventing aspiration pneumonia in the elderly. Although, the medical literature has asserted that cough and swallowing are controlled primarily by the brainstem, recent advances in human brain imaging has provided evidence that cortical and subcortical structures play critical roles in cough and swallowing control. Because of their nature, reflexive cough and swallowing activate both sensory and motor areas in the cortex. In both protective reflexes, the sensory component, including sensory cortex in reflexive circuits, seems to be more vulnerable to aging than the motor component, including the motor cortex. Therefore, the strategy to restore cough and swallowing reflexes should be focused on compensations of sensory components in these reflexive circuits. Remedies to enhance sensory nerve terminals and sensory cortical areas related to these reflexes might be useful to prevent aspiration pneumonia in the elderly.

Keywords

Cough reflex Swallowing reflex Capsaicin TRPV1 

References

  1. 1.
    Marik PE (2011) Pulmonary aspiration syndromes. Curr Opin Pulm Med 17:148–154PubMedCrossRefGoogle Scholar
  2. 2.
    Ely EW, Haponik EF (1911) Pneumonia in the elderly. J Thorac Imaging 6:45–61CrossRefGoogle Scholar
  3. 3.
    Pennington JE (1984) Respiratory tract infections: intrinsic risk factors. Am J Med 76:34–41PubMedCrossRefGoogle Scholar
  4. 4.
    Pontoppidan H, Beecher HK (1960) Progressive loss of protective reflexes in the airway with the advance of age. JAMA 174:2209–2213PubMedCrossRefGoogle Scholar
  5. 5.
    Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T (2008) Japanese study group on aspiration pulmonary disease high incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 56:577–579PubMedCrossRefGoogle Scholar
  6. 6.
    Sekizawa K, Ujiie Y, Itabashi S, Sasaki H, Takishima T (1990) Lack of cough reflex in aspiration pneumonia. Lancet 355:1228–1229CrossRefGoogle Scholar
  7. 7.
    Nakazawa H, Sekizawa K, Ujiie Y, Sasaki H, Takishima T (1993) Risk of aspiration pneumonia in the elderly. Chest 103:1636–1637PubMedCrossRefGoogle Scholar
  8. 8.
    Pinto A, Yanai M, Nakagawa T, Sekizawa K, Sasaki H (1994) Swallowing reflex in the night. Lancet 344:820–821PubMedCrossRefGoogle Scholar
  9. 9.
    Katsumata U, Sekizawa K, Ebihara T, Sasaki H (1995) Aging effects on cough reflex. Chest 107:290–291PubMedCrossRefGoogle Scholar
  10. 10.
    Kobayashi H, Sekizawa K, Sasaki H (1997) Aging effects on swallowing reflex. Chest 111:1466PubMedCrossRefGoogle Scholar
  11. 11.
    Sheth N, Diner WC (1988) Swallowing problems in the elderly. Dysphagia 2:209–215PubMedCrossRefGoogle Scholar
  12. 12.
    Mazzone SB, McLennan L, McGovern AE, Egan GF, Farrell MJ (2007) Representation of capsaicin-evoked urge-to-cough in the human brain using functional magnetic resonance imaging. Am J Respir Crit Care Med 176:327–332PubMedCrossRefGoogle Scholar
  13. 13.
    Widdicombe J, Eccles R, Fontana G (2006) Supramedullary influences on cough. Respir Physiol Neurobiol 152:320–328PubMedCrossRefGoogle Scholar
  14. 14.
    Hamdy S, Rothwell JC, Aziz Q, Singh KD, Thompson DG (1998) Long-term reorganization of human motor cortex driven by short-term sensory stimulation. Nat Neurosci 1:64–68PubMedCrossRefGoogle Scholar
  15. 15.
    Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, Tallis RC, Thompson DG (1996) The cortical topography of human swallowing musculature in health and disease. Nat Med 2:1217–1224PubMedCrossRefGoogle Scholar
  16. 16.
    Michou E, Hamdy S (2009) Cortical input in control of swallowing. Curr Opin Otolaryngol Head Neck Surg 17:166–171PubMedCrossRefGoogle Scholar
  17. 17.
    Humbert IA, Robbins J (2007) Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia 22:266–275PubMedCrossRefGoogle Scholar
  18. 18.
    Mazzone SB, McLennan L, McGovern AE, Egan GF, Farrell MJ (2007) Representation of capsaicin-evoked urge-to-cough in the human brain using functional magnetic resonance imaging. Am J Respir Crit Care Med 176:327–332PubMedCrossRefGoogle Scholar
  19. 19.
    Mazzone SB, Cole LJ, Ando A, Egan GF, Farrell MJ (2011) Investigation of the neural control of cough and cough suppression in humans using functional brain imaging. J Neurosci 31:2948–2958PubMedCrossRefGoogle Scholar
  20. 20.
    Malandraki GA, Perlman AL, Karampinos DC, Sutton BP (2011) Reduced somatosensory activations in swallowing with age. Hum Brain Mapp 32:730–743PubMedCrossRefGoogle Scholar
  21. 21.
    Ebihara S, Ebihara T, Kanezaki M, Gui P, Yamasaki M, Arai H, Kohzuki M (2011) Aging deteriorated perception of urge-to-cough without changing cough reflex threshold to citric acid in female never-smokers. Cough 7:3PubMedCrossRefGoogle Scholar
  22. 22.
    Watando A, Ebihara S, Ebihara T, Okazaki T, Takahashi H, Asada M, Sasaki H (2004) Effect of temperature on swallowing reflex in elderly patients with aspiration pneumonia. J Am Geriatr Soc 52:2143–2144PubMedCrossRefGoogle Scholar
  23. 23.
    Ebihara T, Sekizawa K, Nakazawa H, Sasaki H (1993) Capsaicin and swallowing reflex. Lancet 341:432PubMedCrossRefGoogle Scholar
  24. 24.
    Ebihara T, Ebihara S, Watando A, Okazaki T, Asada M, Ohrui T, Yamaya M, Sasaki H (2006) Effects of menthol on the triggering of the swallowing reflex in elderly patients with dysphagia. Br J Clin Pharmacol 62:369–371PubMedCrossRefGoogle Scholar
  25. 25.
    Ebihara T, Takahashi H, Ebihara S, Okazaki T, Sasaki T, Watando A, Sasaki H (2005) Capsaicin troche for swallowing dysfunction in older people. J Am Geriatr Soc 53:824–828PubMedCrossRefGoogle Scholar
  26. 26.
    Romanovsky AA (2007) Thermoregulation: some concepts have changed. Functional architecture of the thermoregulatory system. Am J Physiol Regul Integr Comp Physiol 292:R37–R46PubMedCrossRefGoogle Scholar
  27. 27.
    Yamasaki M, Ebihara S, Ebihara T, Freeman S, Yamanda S, Asada M, Yoshida M, Arai H (2007) Cough reflex and oral chemesthesis induced by capsaicin and capsiate in healthy never-smokers. Cough 3:9PubMedCrossRefGoogle Scholar
  28. 28.
    Yamasaki M, Ebihara S, Ebihara T, Yamanda S, Arai H, Kohzuki M (2010) Effects of capsiate on the triggering of the swallowing reflex in elderly patients with aspiration pneumonia. Geriatr Gerontol Int 10:107–109PubMedCrossRefGoogle Scholar
  29. 29.
    Ebihara S, Maruyama Y, Ebihara T, Oshiro T, Kohzuki M (2010) Red wine polyphenols and swallowing reflex in dysphagia. Geriatr Gerontol Int 10:329–330PubMedCrossRefGoogle Scholar
  30. 30.
    Ebihara S, Kohzuki M, Sumi Y, Ebihara T (2011) Sensory stimulation to improve swallowing reflex and prevent aspiration pneumonia in elderly dysphagic people. J Pharmacol Sci 115:99–104PubMedCrossRefGoogle Scholar
  31. 31.
    Ebihara T, Ebihara S, Yamazaki M, Asada M, Yamanda S, Arai H (2010) Intensive stepwise method for oral intake using a combination of transient receptor potential stimulation and olfactory stimulation inhibits the incidence of pneumonia in dysphagic older adults. J Am Geriatr Soc 58:196–198PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Satoru Ebihara
    • 1
  • Takae Ebihara
    • 2
  • Masahiro Kohzuki
    • 1
  1. 1.Department of Internal Medicine and Rehabilitation ScienceTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of Geriatrics and GerontologyInstitute of Development, Aging and Cancer, Tohoku UniversitySendaiJapan

Personalised recommendations