title: Coordination of cough and swallow: a meta-behavioral response to aspiration.
abstract: Airway protections is the prevention and/or removal of material by behaviors such as cough and swallow. We hypothesized these behaviors are coordinated to respond to aspiration. Anesthetized animals were challenged with simulated aspiration that induced both coughing and swallowing. Electromyograms of upper airway and respiratory muscles together with esophageal pressure were recorded to identify and evaluate cough and swallow. During simulated aspiration, both cough and swallow intensity increased and swallow duration decreased consistent with rapid pharyngeal clearance. Phase restriction between cough and swallow was observed; swallow was restricted to the E2 phase of cough. These results support three main conclusions: 1) the cough and swallow pattern generators are tightly coordinated so as to generate a protective meta-behavior; 2) the trachea provides feedback on swallow quality, informing the brainstem about aspiration incidences; and 3) the larynx and upper esophageal sphincter act as two separate valves controlling the direction of positive and negative pressures from the upper airway into the thorax.
authors.affiliation: Department of Physiological Sciences, University of Florida, Gainesville, FL, United States. Electronic address: tepitts@ufl.edu.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pitts
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Rose
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Mortensen
authors.forename: Ivan
authors.initials: I
authors.lastname: Poliacek
authors.forename: Christine M
authors.initials: CM
authors.lastname: Sapienza
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Lindsey
authors.forename: Kendall F
authors.initials: KF
authors.lastname: Morris
authors.forename: Paul W
authors.initials: PW
authors.lastname: Davenport
authors.forename: Donald C
authors.initials: DC
authors.lastname: Bolser
mesh_terms: D000818:Animals; D002415:Cats; D003371:Cough / Q000150:complications* / Q000209:etiology / Q000473:pathology; D003679:Deglutition / Q000502:physiology*; D004576:Electromyography; D008297:Male; D010812:Physical Stimulation / Q000009:adverse effects; D012132:Respiratory Muscles / Q000503:physiopathology; D012137:Respiratory System / Q000503:physiopathology*
keywords: Airway protection; Dysphagia; Dystussia; EMG; Pharyngeal clearance; Pharynx