title: Restoration of cough reflex in lung transplant recipients.
abstract: BACKGROUND
  Lung transplantation involves vagal nerve interruption resulting in sensory airway denervation and impairment of the cough reflex. Following lung transplantation, it is unclear whether functional recovery of the cough reflex occurs over time. Our objective was to evaluate the afferent limb of the cough reflex in lung transplant recipients.
  
  
  METHODS
  The assessment of cough reflex involved upper airway anesthesia, conscious sedation, and fiberoptic bronchoscopy; the biopsy forceps and a 5% dextrose solution were applied through the bronchoscope to the airway mucosa at the main carina, proximal and distal to the anastomosis. A cross-sectional group of seven subjects underwent a single assessment, while eight subjects in a longitudinal group underwent assessment at 1.5 and 12 months. Cough frequency was determined by counting the number of audible coughs and abdominal muscle contractions measured with a surface electromyogram recorder. The airway anastomosis from deceased subjects in the longitudinal group was examined for nerves.
  
  
  RESULTS
  All seven subjects from the cross-sectional group demonstrated a similar cough frequency after mechanical and chemical irritation of all airway sites. All subjects in the longitudinal group who were evaluated at 1.5 weeks had a cough response at all sites except distal to the anastomosis. Twelve months after transplantation, cough was present at all sites. Immunohistochemical staining for protein gene product 9.5, low-affinity neurotrophin, and vanilloid receptors demonstrated nerves in subepithelial regions proximal and distal to the airway anastomosis.
  
  
  CONCLUSIONS
  In human lung transplant recipients, recovery of the cough reflex was noted 12 months after lung transplantation.
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, TX. Electronic address: aduarte@utmb.edu.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Duarte
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, TX.
authors.forename: Luigi
authors.initials: L
authors.lastname: Terminella
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, TX.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Smith
authors.affiliation: Johns Hopkins University, Bayview Hospital, Baltimore, MD.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Myers
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston, TX.
authors.forename: Gerald
authors.initials: G
authors.lastname: Campbell
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX.
authors.forename: Scott
authors.initials: S
authors.lastname: Lick
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000503:physiopathology; D000368:Aged; D001999:Bronchoscopy; D003371:Cough / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000503:physiopathology* / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012018:Reflex / Q000502:physiology*; D013997:Time Factors