Cough production passes through three harmonized phases: Inspiratory, compression, and expiratory. Cough is a reflex predominantly mediated by control centers in the respiratory areas of the brainstem, modulated by the cerebral cortex (Figure (Figure1). There are three main types of coughs according to the central control mechanisms: Reflex cough (type I), voluntary cough (type II), and evoked cough (type III), which follows the urge to cough.īoth reflex and voluntary cough initiate similar mechanisms of cough motor behavior. It is one of the essential respiratory protective mechanisms, alerting to the presence of a potential or actual respiratory tract lesion, and helps to clear secretions and foreign particles from the airways. Cough is one of the most common complaints driving patients to seek medical advice. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity.Ĭough is a forced expiratory effort against a closed glottis that opens suddenly with the expulsion of secretion and foreign particles out of the airways, producing a distinctive sound. Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. Arnold's nerve ear-cough reflex, syncopal cough, cough headache, opioids-associated cough, and cough-anal reflex are signs that could help diagnose underlying neurological conditions. Meanwhile, cough sensitivity decreases in multiple sclerosis, brain hypoxia, cerebral hemispheric stroke with a brainstem shock, Parkinson's disease, dementia due to Lewy body disease, amyotrophic lateral sclerosis, and peripheral neuropathy as diabetic neuropathy, hereditary sensory and autonomic neuropathy type IV, vitamin B12, and folate deficiency. Cough reflex sensitivity could be increased in many neurological disorders such as brainstem space-occupying lesions, medullary lesions secondary to Chiari type I malformations, tics disorders such as Tourette's syndrome, somatic cough, cerebellar neurodegenerative diseases, and chronic vagal neuropathy due to allergic and non-allergic conditions. ![]() ![]() Cough is a reflex predominantly mediated by control centers in the respiratory areas of the brainstem, modulated by the cerebral cortex. There are three main types of coughs: Reflex cough (type I), voluntary cough (type II), and evoked cough (type III). Besides being a fundamental respiratory sign, it is also a crucial neurological sign. Cough is a common respiratory complaint driving patients to seek medical advice.
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