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Review
. 2014 Jul-Aug;22(4):251-60.
doi: 10.1590/1678-775720140132.

A framework for understanding shared substrates of airway protection

Michelle Shevon Troche  1 , Alexandra Essman Brandimore  1 , Juliana Godoy  2 , Karen Wheeler Hegland  1
Affiliations
Review

A framework for understanding shared substrates of airway protection

Michelle Shevon Troche et al. J Appl Oral Sci. 2014 Jul-Aug.

Abstract

Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough (2009) by Hegland, et al. (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

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Figures

Figure 1
Figure 1
Continuum of airway protective behaviors
Figure 2
Figure 2
Proposed framework of airway protection. Cough and swallowing share afferents (a) that are essential to the initiation and modification of the behaviors. This afferent (a) information is then sent to the sensory nuclei (b) located in the brainstem. There, the behavioral control assembly (BCA) (c) will receive the afferent information and exert control over the swallowing and cough central pattern generators (CPGs) (d & e) in order to generate the appropriate airway protective behavior. Information fed into the motor nuclei (f) is then sent to the efferent (g) nerves. Information from the brainstem sensory nuclei (b) travels through ascending pathways to the cortex via the thalamus, allowing for somatosensation (h) of the stimulus. Preceding the motor output there is an urge to act (i) on the stimulus. This will enable suppression or up-regulation of the airway protective behavior through volitional control (j). Both cough and swallowing can be initiated through volitional control (k), or on command. This neural information then travels through descending pathways to the brainstem and then through efferents (g) to the periphery
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References

    1. Arnfred SM, Eder DN, Hemmingsen RP, Glenthøj BY, Chen AC. Gating of the vertex somatosensory and auditory evoked potential P50 and the correlation to skin conductance orienting response in healthy men. Psychiatry Res. 2001;101(3):221–235. - PubMed
    1. Augustine JR. Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Brain Res Rev. 1996;22(3):229–244. - PubMed
    1. Barros MJ, Zammattio SJ, Rees PJ. Importance of inspiratory flow rate in the cough response to citric acid inhalation in normal subjects. Clinical Sci (Lond) 1990;78(5):521–525. - PubMed
    1. Barros MJ, Zammattio SL, Rees PJ. Effect of changes in inspiratory flow rate on cough responses to inhaled capsaicin. Clinical Sci (Lond) 1991;81(4):539–542. - PubMed
    1. Bolser DC, Davenport PW. Codeine and cough: an ineffective gold standard. Curr Opn Allergy Clin Immunol. 2007;7(1):32–36. - PMC - PubMed

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