Cough pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], M.Umer Tariq [3] Abiodun Akanmode,M.D.[4]


The act of coughing is a vital one that leads to the mucociliary clearance of excess secretions from the airway and other parts of the respiratory tree.Cough occurs via a complex neurophysiologic cough reflex arc.

Cough Reflex

The cough reflex is constituted by three main components ie

  • Central pathway: This is a central area located within the pons and brainstem. It coordinates the cough reflex arc.[1]

The Afferent sensory nerves

There are 3 major classes of afferent sensory nerves,this classification is based on there conduction velocity(A-fiber, > 3 m/s; C-fiber, < 2 m/s),origin ,myelination,neurochemistry etc.

  • Rapidly adapting receptors (RARs)
  • Slowly adapting stretch receptors (SARs)
  • C-fibres.
Cough reflex-Brooks, S.M. Perspective on the human cough reflex.

Cough Mechanics

For an effective cough to be produced, a sequence of timed mechanical events divided into 3 phases has to take place.[2]

Cough Schematics-Milano, Politecnico di and Andrea Aliverti.VOLUNTARY COUGH MECHANICS IN HEALTH AND DUCHENNE MUSCULAR DYSTROPHY.” (2012).


The ability to cough efficiently and effectively cannot be overstated and when patients have impaired ability to cough, they are at an increased risk of atelectasis, pneumonia, and other chronic airways diseases secondary to aspiration and retention of secretions. In patients with chest wall deformities, abdominal wall deformities and other neuromuscular disorders may have problems generating the required flow pressure needed to clear respiratory secretions effectively.[6][7]

Arnold's nerve cough reflex

This is a very rare nerve disorder associated with chronic cough, in patients with this disorder, the stimulation of the external auditory meatus leads to the activation of the auricular branch of the vagus nerve(Arnold's nerve) thus stimulating the cough reflex. Treatment of patients with this condition and other sensory vagal neuropathy with chronic coughis with gabapentin.[8]

During Injections

Coughing during an injection can lessen the pain of the needle stick caused by a sudden, temporary rise in pressure in the chest and spinal canal, inhibiting the pain-conducting structures of the spinal cord.[9]


  1. Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMC 3415124. PMID 22958367.
  2. BUCHER K (1958). "Pathophysiology and pharmacology of cough". Pharmacol Rev. 10 (1): 43–58. PMID 13542168 PMID: 13542168 Check |pmid= value (help).
  3. Harris RS, Lawson TV (1968). "The relative mechanical effectiveness and efficiency of successive voluntary coughs in healthy young adults". Clin Sci. 34 (3): 569–77. PMID 5666883 PMID: 5666883 Check |pmid= value (help).
  4. Yanagihara N, Von Leden H, Werner-Kukuk E (1966). "The physical parameters of cough: the larynx in a normal single cough". Acta Otolaryngol. 61 (6): 495–510. doi:10.3109/00016486609127088. PMID 5963004.
  5. 5.0 5.1 McCool FD (2006). "Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 48S–53S. doi:10.1378/chest.129.1_suppl.48S. PMID 16428691 PMID: 16428691 Check |pmid= value (help).
  6. Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMC 3415124. PMID 22958367 PMID: 22958367 Check |pmid= value (help).
  7. Schramm CM (2000). "Current concepts of respiratory complications of neuromuscular disease in children". Curr Opin Pediatr. 12 (3): 203–7. doi:10.1097/00008480-200006000-00004. PMID 10836153 PMID: 10836153 Check |pmid= value (help).
  8. Ryan NM, Gibson PG, Birring SS (2014). "Arnold's nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy". J Thorac Dis. 6 (Suppl 7): S748–52. doi:10.3978/j.issn.2072-1439.2014.04.22. PMC 4222929. PMID 25383210 PMID: 25383210 Check |pmid= value (help).
  9. Usichenko, TI (2004). "Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study". Anesthesia and Analgesia. 99 (3): 952–3. PMID 14742367. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)

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