Strategies for the Integration of Cough and Swallow to Maintain Airway Protection in Humans
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Airway protective behaviors, like cough and swallow, deteriorate in many populations suffering from neurologic disorders. While coordination of these behaviors has been investigated in an animal model, it has not been tested in humans.
We used a novel protocol, adapted from previous work in the cat, to assess cough and swallow independently and their coordination strategies in seven healthy males (26 ± 6 years). Surface electromyograms of the submental complex and external oblique complex, spirometry, and thoracic and abdominal wall kinematics, were used to evaluate the timing of swallow, cough, and breathing as well as lung volume (LV) during these behaviors.
Unlike the cat, there was significant variability in the cough-swallow phase preference; however, there was a targeted LV range in which swallow occurred.
These results give insight into the differences between the cat and human models in airway protective strategies related to the coordination of cough and swallow behaviors, allowing for better understanding of dystussia and dysphagia.
KeywordsApnea duration Lung volume Airflow Surface electromyography Volume related feedback
This work was supported by Leona M. and Harry B. Helmsley Charitable Trust, R00- HL 111215, The Kentucky Spinal Cord and Head injury Trust, The Commonwealth of Kentucky Challenge for Excellence.
AH assisted in running the experiment, coordinated the experiment, analyzed data, and prepared the manuscript. MDR assisted in manuscript preparation. BKS assisted in manuscript preparation. EHB assisted in running the experiment and was the coordinator of the experiment. AVO assisted in experimental design and data acquisition. TP assisted in experimental design and assisted in manuscript preparation. The manuscript draft was critically revised by all authors.
This study was funded by the following: Leona M. and Harry B. Helmsley Charitable Trust, R00- HL 111215, The Kentucky Spinal Cord and Head injury Trust, The Commonwealth of Kentucky Challenge for Excellence.
Compliance with Ethical Standards
Conflict of interest
There are no conflict of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of University of Louisville Institutional Review Board.
- 4.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):769–777. https://doi.org/10.1378/chest.08-1122 CrossRefPubMedGoogle Scholar
- 21.Poliacek I, Simera M, Veternik M, Kotmanova Z, Pitts T, Hanacek J, Plevkova J, Machac P, Visnovcova N, Misek J, Jakus J (2016) The course of lung inflation alters the central pattern of tracheobronchial cough in cat-The evidence for volume feedback during cough. Respir Physiol Neurobiol 229:43–50. https://doi.org/10.1016/j.resp.2016.04.008 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Coleridge HM JCGC (1986) Reflexes evoked from the tracheobronchial tree and lungs. In: Fishman AP (ed) Handbook of physiology: the respiratory system; control of breathing, vol II. American Physiology Society, Bethesda, pp 395–429Google Scholar
- 26.Karczewski W (1962) Effects of afferent vagal activity recorded on magnetic tape on the respiration of vagotomised animals. Bull Pol Acad Sci (10):499–500Google Scholar
- 27.Widdicombe JG (1964) Respiratory reflexes. In: Fenn WO, Rahn R (eds) Handbook of physiology: section 3. Respiration, vol I. American Physiological Society, Washington, DC, pp 585–630Google Scholar
- 32.Brodsky MB, McFarland DH, Dozier TS, Blair J, Ayers C, Michel Y, Gillespie MB, Day TA, Martin-Harris B (2010) Respiratory-swallow phase patterns and their relationship to swallowing impairment in patients treated for oropharyngeal cancer. Head Neck 32(4):481–489. https://doi.org/10.1002/hed.21209 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Clark GA (1920) Deglutition apnoea. J Physiol 54:59Google Scholar
- 42.Hardemark Cedborg AI, Sundman E, Boden K, Hedstrom HW, Kuylenstierna R, Ekberg O, Eriksson LI (2009) Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans. Exp Physiol 94(4):459–468. https://doi.org/10.1113/expphysiol.2008.045724 CrossRefPubMedGoogle Scholar