Skip to main content
SpringerLink
Log in

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

  • Published:
Lung Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Marik PE (2011) Pulmonary aspiration syndromes. Curr Opin Pulm Med 17:148–154

    Article  PubMed  Google Scholar 

  2. Ely EW, Haponik EF (1911) Pneumonia in the elderly. J Thorac Imaging 6:45–61

    Article  Google Scholar 

  3. Pennington JE (1984) Respiratory tract infections: intrinsic risk factors. Am J Med 76:34–41

    Article  PubMed  CAS  Google Scholar 

  4. Pontoppidan H, Beecher HK (1960) Progressive loss of protective reflexes in the airway with the advance of age. JAMA 174:2209–2213

    Article  PubMed  CAS  Google Scholar 

  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 56:577–579

    Article  PubMed  Google Scholar 

  6. Sekizawa K, Ujiie Y, Itabashi S, Sasaki H, Takishima T (1990) Lack of cough reflex in aspiration pneumonia. Lancet 355:1228–1229

    Article  Google Scholar 

  7. Nakazawa H, Sekizawa K, Ujiie Y, Sasaki H, Takishima T (1993) Risk of aspiration pneumonia in the elderly. Chest 103:1636–1637

    Article  PubMed  CAS  Google Scholar 

  8. Pinto A, Yanai M, Nakagawa T, Sekizawa K, Sasaki H (1994) Swallowing reflex in the night. Lancet 344:820–821

    Article  PubMed  CAS  Google Scholar 

  9. Katsumata U, Sekizawa K, Ebihara T, Sasaki H (1995) Aging effects on cough reflex. Chest 107:290–291

    Article  PubMed  CAS  Google Scholar 

  10. Kobayashi H, Sekizawa K, Sasaki H (1997) Aging effects on swallowing reflex. Chest 111:1466

    Article  PubMed  CAS  Google Scholar 

  11. Sheth N, Diner WC (1988) Swallowing problems in the elderly. Dysphagia 2:209–215

    Article  PubMed  CAS  Google Scholar 

  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 176:327–332

    Article  PubMed  Google Scholar 

  13. Widdicombe J, Eccles R, Fontana G (2006) Supramedullary influences on cough. Respir Physiol Neurobiol 152:320–328

    Article  PubMed  Google Scholar 

  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 1:64–68

    Article  PubMed  CAS  Google Scholar 

  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 2:1217–1224

    Article  PubMed  CAS  Google Scholar 

  16. Michou E, Hamdy S (2009) Cortical input in control of swallowing. Curr Opin Otolaryngol Head Neck Surg 17:166–171

    Article  PubMed  Google Scholar 

  17. Humbert IA, Robbins J (2007) Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia 22:266–275

    Article  PubMed  Google Scholar 

  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 176:327–332

    Article  PubMed  Google Scholar 

  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 31:2948–2958

    Article  PubMed  CAS  Google Scholar 

  20. Malandraki GA, Perlman AL, Karampinos DC, Sutton BP (2011) Reduced somatosensory activations in swallowing with age. Hum Brain Mapp 32:730–743

    Article  PubMed  Google Scholar 

  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 7:3

    Article  PubMed  Google Scholar 

  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 52:2143–2144

    Article  PubMed  Google Scholar 

  23. Ebihara T, Sekizawa K, Nakazawa H, Sasaki H (1993) Capsaicin and swallowing reflex. Lancet 341:432

    Article  PubMed  CAS  Google Scholar 

  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 62:369–371

    Article  PubMed  CAS  Google Scholar 

  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 53:824–828

    Article  PubMed  Google Scholar 

  26. Romanovsky AA (2007) Thermoregulation: some concepts have changed. Functional architecture of the thermoregulatory system. Am J Physiol Regul Integr Comp Physiol 292:R37–R46

    Article  PubMed  CAS  Google Scholar 

  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 3:9

    Article  PubMed  Google Scholar 

  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 10:107–109

    Article  PubMed  Google Scholar 

  29. Ebihara S, Maruyama Y, Ebihara T, Oshiro T, Kohzuki M (2010) Red wine polyphenols and swallowing reflex in dysphagia. Geriatr Gerontol Int 10:329–330

    Article  PubMed  Google Scholar 

  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 115:99–104

    Article  PubMed  CAS  Google Scholar 

  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 58:196–198

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by the Research Funding for Longevity Sciences (22-2) from the National Center for Geriatrics and Gerontology (NCGG), Japan, and the Ministry of Education, Culture, Sports, Science and Technology, Japan (Grants 20590694, 21390219, and 23659375); the Ministry of Health, Labor and Welfare (Grant 19C-2, 20S-1, H21-Choju-Ippan-005, H22-Junkanki-shi-Ippan-001); and the Suzuken Memorial Foundation.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan

    Satoru Ebihara & Masahiro Kohzuki

  2. Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan

    Takae Ebihara

Authors
  1. Satoru Ebihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takae Ebihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masahiro Kohzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Ebihara.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ebihara, S., Ebihara, T. & Kohzuki, M. Effect of Aging on Cough and Swallowing Reflexes: Implications for Preventing Aspiration Pneumonia. Lung 190, 29–33 (2012). https://doi.org/10.1007/s00408-011-9334-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-011-9334-z

Keywords

Search

Navigation