Fog-induced cough with impaired respiratory sensation in congenital central hypoventilation syndrome.
BACKGROUND
Congenital central hypoventilation syndrome (CCHS) is a genetic disorder mainly characterized by failure of automatic control of breathing, causing alveolar hypoventilation. Little is known regarding cough in CCHS. Parental reports indicate that patients cough normally during airway infections; however, previous studies have demonstrated no cough response to fog inhalation.


OBJECTIVE
To evaluate the sensory and motor components of cough, respiratory sensations, and changes in ventilation evoked by fog inhalation in children with CCHS and in sex- and age-matched control subjects.


METHODS
Cough threshold was measured and cough intensity was indexed in terms of cough peak expiratory flow and integrated abdominal electromyographic activity. The pattern of breathing was recorded by inductive plethysmography. Respiratory sensations were also investigated.


RESULTS
All control subjects and six of seven patients coughed in response to fog inhalation. The seventh coughed with citric acid aerosol inhalation. Cough threshold values were similar in control subjects (range, 0.40-2.22 ml/min) and patients (range, 0.40-3.26 ml/min). Mean values of cough peak expiratory flow and of integrated abdominal electromyographic activity-related variables during coughing were also similar and corresponded to 80% of those recorded during maximum voluntary cough. Cough appearance was preceded by respiratory sensations and increases (P < 0.01) in ventilation in the control subjects but not in the patients.


CONCLUSIONS
Children with CCHS have normal cough threshold and motor responses to fog inhalation. However, the lack of respiratory sensations and the likely related ventilatory changes typically elicited by tussigenic fog concentrations suggest a neural sensory deficit that may increase the risk of respiratory disease in these patients.
Dipartimento di Area Critica Medico Chirurgica, Sezione di Medicina Respiratoria, Università degli Studi di Firenze, Viale G.B. Morgagni, 85-50134 Florence, Italy.
Federico
F
Lavorini
Giovanni A
GA
Fontana
Tito
T
Pantaleo
Pietro
P
Geri
Raffaele
R
Piumelli
Massimo
M
Pistolesi
John
J
Widdicombe
D000009:Abdominal Muscles / Q000502:physiology; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003371:Cough / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012143:Respiratory Physiological Phenomena; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds / Q000502:physiology; D020182:Sleep Apnea, Central / Q000151:congenital* / Q000503:physiopathology; D014939:Work of Breathing / Q000502:physiology