Abstract
BackgroundInvoluntary coughing such as that evoked from the larynx, the laryngeal cough reflex (LCR), triggers a coordinated contraction of the thoracic, abdominal and pelvic muscles, which increases intra-abdominal pressure (IAP), displaces the diaphragm upwards and generates the expiratory force for cough and airway clearance. Changes in the IAP during voluntary cough (VC) and the LCR can be measured via a pressure catheter in the bladder. This study evaluated the physiological characteristics of IAP generated during VC and the LCR including peak and mean pressures and calculations of the area under the curve (AUC) values during the time of the cough event or epoch.MethodsEleven female subjects between the ages of 18 and 75 underwent standard urodynamic assessment with placement of an intravesicular catheter with a fiberoptic strain gauge pressure transducer. The bladder was filled with 200 ml of sterile water and IAP recordings were obtained with VC and the induced reflex cough test (RCT) using nebulized inhaled 20% tartaric acid to induce the LCR. IAP values were used to calculate the area under the curve (AUC) by the numerical integration of intravesicular pressure over time (cm H2O·s).ResultsThe mean (± SEM) AUC values for VC and the LCR were 349.6 ± 55.2 and 986.6 ± 116.8 cm H2O·s (p < 0.01). The mean IAP values were 45.6 ± 4.65 and 44.5 ± 9.31 cm H2O (NS = .052), and the peak IAP values were 139.5 ± 14.2 and 164.9 ± 15.8 cm H2O (p = 0.07) for VC and LCR, respectively.ConclusionThe induced LCR is the involuntary rapid and repeated synchronous expiratory muscle activation that causes and sustains an elevated IAP over time, sufficient for airway protection. VC and LCR have different neurophysiological functions. Quantification of the LCR using AUC values and mean or peak IAP values may be useful as a clinical tool for determining neurophysiological airway protection status and provide a quantitative assessment of changes in a patient's functional recovery or decline.
Highlights
Neurophysiological protection of the upper airway is a critical function of the laryngeal cough reflex (LCR)
This study evaluated changes in the intra-abdominal pressure (IAP) during voluntary cough (VC) and the LCR as indicated by the measurements of the mean and peak IAPs, and mathematical calculations of the area under the curve (AUC, pressure·time) values during VC and LCR cough epochs
The number of peak IAPs was greater for the LCR than for VC (6.00 ± 0.94 vs. 1.78 ± 0.28, p < 0.01), as was the episode duration (27.0 ± 0.74 s vs. 10.2 ± 1.36 s, p < 0.01)
Summary
Neurophysiological protection of the upper airway is a critical function of the laryngeal cough reflex (LCR). Reflex cough (RC) caused increased upward displacement of the diaphragm as compared with voluntary cough (VC) [1] This diaphragmatic displacement is a result of the contraction of the external abdominal obliques, intercostals and associated expiratory muscles. The force of these contractions compresses the abdominal viscera and proportionately displaces the diaphragm superiorly, almost to mid-sternal levels in reflex cough, but not for VC These contractions cause an increase in intra-abdominal pressure (IAP), which is synchronized with urethral and rectal closure to prevent incontinence. Involuntary coughing such as that evoked from the larynx, the laryngeal cough reflex (LCR), triggers a coordinated contraction of the thoracic, abdominal and pelvic muscles, which increases intra-abdominal pressure (IAP), displaces the diaphragm upwards and generates the expiratory force for cough and airway clearance. This study evaluated the physiological characteristics of IAP generated during VC and the LCR including peak and mean pressures and calculations of the area under the curve (AUC) values during the time of the cough event or epoch
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