Lung

, Volume 192, Issue 1, pp 27–31 | Cite as

Airway Protective Mechanisms

Article

Abstract

Cough and swallow are highly coordinated reflex behaviors whose common purpose is to protect the airway. The pharynx is the common tube for air and food/liquid movement from the mouth into the thorax, has been largely overlooked, and is potentially seen as just a passive space. The thyropharyngeus muscle responds to cough inducing stimuli to prepare a transient holding area for material that has been removed from the subglottic airway. The cricopharyngeus muscle participates with the larynx to ensure regulation of pressure when a bolus/air is moving from the upper airway through to the thorax (i.e., inspiration or swallow) or the reverse (i.e., expiration reflex or vomiting). These vital mechanisms have not been evaluated in clinical conditions but could be impaired in many neurodegenerative diseases, leading to aspiration pneumonia. These newly described airway protective mechanisms need further study, especially in healthy and pathologic human populations.

Keywords

Pharynx Cricopharyngeus Thyropharyngeus Cough Swallow 

References

  1. 1.
    Canning BJ (2006) Anatomy and neurophysiology of the cough reflex. Chest 129(1 Suppl):33SCrossRefPubMedGoogle Scholar
  2. 2.
    Canning BJ (2007) Encoding of the cough reflex. Pulm Pharmacol Ther 20(4):396–401PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Pantaleo T, Bongianni F, Mutolo D (2002) Central nervous mechanisms of cough. Pulm Pharmacol Ther 15(3):227–233CrossRefPubMedGoogle Scholar
  4. 4.
    Shannon R, Baekey D, Morris K, Lindsey B (1996) Brainstem respiratory networks and cough. Pulm Pharmacol 9(5–6):343–347CrossRefPubMedGoogle Scholar
  5. 5.
    Shannon R, Baekey D, Morris K, Nuding S, Segers L, Lindsey B (2004) Production of reflex cough by brainstem respiratory networks. Pulm Pharmacol Ther 17(6):369–376CrossRefPubMedGoogle Scholar
  6. 6.
    Fontana GA, Lavorini F (2006) Cough motor mechanisms. Respir Physiol Neurobiol 152(3):266–281CrossRefPubMedGoogle Scholar
  7. 7.
    Fontana GA, Pantaleo T, Lavorini F, Benvenuti F, Gangemi S (1998) Defective motor control of coughing in Parkinson’s disease. Am J Respir Crit Care Med 158(2):458–464CrossRefPubMedGoogle Scholar
  8. 8.
    Smith Hammond CA, Goldstein LB, Zajac DJ, Gray L, Davenport PW, Bolser DC (2001) Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology 56(4):502–506CrossRefPubMedGoogle Scholar
  9. 9.
    Smith Hammond CA, Goldstein LB, Horner RD, Ying J, Gray L, Gonzalez-Rothi L, Bolser DC (2009) Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest 135(3):769–777CrossRefPubMedGoogle Scholar
  10. 10.
    Pitts T, Bolser D, Rosenbek J, Troche M, Sapienza C (2008) Voluntary cough production and swallow dysfunction in Parkinson’s disease. Dysphagia 23(3):297–301PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Pitts T, Troche MS, Carnaby-Mann G, Rosenbek JC, Okun MS, Sapienza CM (2010) Utilizing voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in Parkinson’s disease. Chest. doi:10.1378/chest.10-0342 PubMedGoogle Scholar
  12. 12.
    Tsujimura T, Udemgba C, Inoue M, Canning BJ (2013) Laryngeal and tracheal afferent nerve stimulation evokes swallowing in anaesthetized guinea pigs. J Physiol. doi:10.1113/jphysiol.2013.256024 PubMedCentralPubMedGoogle Scholar
  13. 13.
    Pitts T, Rose MJ, Mortensen AN, Poliacek I, Sapienza CM, Lindsey BG, Morris KF, Davenport PW, Bolser DC (2013) Coordination of cough and swallow: a meta-behavioral response to aspiration. Respir Physiol Neurobiol. doi:10.1016/j.resp.2013.08.009 PubMedCentralPubMedGoogle Scholar
  14. 14.
    Falk D (1975) Comparative anatomy of the larynx in man and the chimpanzee: implications for language in Neanderthal. Am J Phys Anthropol 43(1):123–132CrossRefPubMedGoogle Scholar
  15. 15.
    Lieberman P, Laitman JT, Reidenberg JS, Gannon PJ (1992) The anatomy, physiology, acoustics and perception of speech: essential elements in analysis of the evolution of human speech. J Hum Evol 23(6):447–467CrossRefGoogle Scholar
  16. 16.
    Leder SB, Karas DE (2000) Fiberoptic endoscopic evaluation of swallowing in the pediatric population. Laryngoscope 110(7):1132–1136CrossRefPubMedGoogle Scholar
  17. 17.
    Miller (2008) The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev 14(2):77–86CrossRefPubMedGoogle Scholar
  18. 18.
    Logemann JA, Rademaker AW, Pauloski BR, Ohmae Y, Kahrilas PJ (1998) Normal swallowing physiology as viewed by videofluoroscopy and videoendoscopy. Folia Phoniatr Logop 50(6):311–319CrossRefPubMedGoogle Scholar
  19. 19.
    Logemann (1998) Evaluation and treatment of swallowing disorders. ProEd, AustinGoogle Scholar
  20. 20.
    Bosma JF (1957) Deglutition: pharyngeal stage. Physiol Rev 37(3):275–300PubMedGoogle Scholar
  21. 21.
    Edgeworth FH (1916) Q J Microsc Sci 6I:383Google Scholar
  22. 22.
    Kitagawa J, Shingai T, Takahashi Y, Yamada Y (2002) Pharyngeal branch of the glossopharyngeal nerve plays a major role in reflex swallowing from the pharynx. Am J Physiol Regul Integr Comp Physiol 282(5):R1342–R1347CrossRefPubMedGoogle Scholar
  23. 23.
    Mu L, Sanders I (2000) Neuromuscular specializations of the pharyngeal dilator muscles: II. Compartmentalization of the canine genioglossus muscle. Anat Rec 260(3):308–325CrossRefPubMedGoogle Scholar
  24. 24.
    Goyal RK, Cobb BW (1981) Motility of the pharynx, esophagus, and esophageal sphincters. Physiol Gastrointest Tract 1:359–391Google Scholar
  25. 25.
    Hyodo M, Aibara R, Kawakita S, Yumoto E (1998) Histochemical study of the canine inferior pharyngeal constrictor muscle: implications for its function. Acta Otolaryngol 118(2):272–279CrossRefPubMedGoogle Scholar
  26. 26.
    Dodds WJ, Logemann JA, Stewart ET (1990) Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 154(5):965–974CrossRefPubMedGoogle Scholar
  27. 27.
    Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH (2000) Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res 43(5):1264CrossRefPubMedGoogle Scholar
  28. 28.
    Dodds WJ, Stewart ET, Logemann JA (1990) Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 154(5):953–963CrossRefPubMedGoogle Scholar
  29. 29.
    Dua K, Surapaneni SN, Kuribayashi S, Hafeezullah M, Shaker R (2011) Pharyngeal airway protective reflexes are triggered before the maximum volume of fluid that the hypopharynx can safely hold is exceeded. Am J Physiol Gastrointest Liver Physiol 301(2):G197–G202PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Batson OV (1960) The Valsalva maneuver and the vertebral vein system. Angiology 11(5):443–447CrossRefPubMedGoogle Scholar
  31. 31.
    Bartlett D (1989) Respiratory functions of the larynx. Physiol Rev 69(1):33–57PubMedGoogle Scholar
  32. 32.
    Merwin GE, Goldstein LP, Rothman HB (1985) A comparison of speech using artificial larynx and tracheoesophageal puncture with valve in the same speaker. Laryngoscope 95(6):730–734CrossRefPubMedGoogle Scholar
  33. 33.
    Morris I (1988) Functional anatomy of the upper airway. Emerg Med Clin N Am 6(4):639Google Scholar
  34. 34.
    Wang AY, Kadkade R, Kahrilas PJ, Hirano I (2005) Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar. Gastrointest Endosc 61(1):148–152CrossRefPubMedGoogle Scholar
  35. 35.
    Goyal RK, Martin SB, Shapiro J, Spechler SJ (1993) The role of cricopharyngeus muscle in pharyngoesophageal disorders. Dysphagia 8(3):252–258CrossRefPubMedGoogle Scholar
  36. 36.
    Fan X, Scott L, Underbrink M, Hersey M (2008) Resolution of cricopharyngeal bar with Botox injection combined with esophageal dilation. Am J Gastroenterol 103:27CrossRefGoogle Scholar
  37. 37.
    Natt R, McCormick M, Clayton J, Ryall C (2010) Percutaneous chemical myotomy using botulinum neurotoxin A under local anaesthesia in the treatment of cricopharyngeal dysphagia following laryngectomy. Auris Nasus Larynx 37(4):500–503CrossRefPubMedGoogle Scholar
  38. 38.
    Williams RB, Wallace KL, Ali GN, Cook IJ (2002) Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Am J Physiol Gastrointest Liver Physiol 283(1):G16–G26CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Physiological Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleUSA

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