Restoration of cough reflex in lung transplant recipients

Alexander Duarte, Luigi Terminella, Jason T. Smith, Allen C. Myers, Gerald Campbell, Scott Lick

Research output: Contribution to journalArticle

21 Citations (Scopus)

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. Conclusion: In human lung transplant recipients, recovery of the cough reflex was noted 12 months after lung transplantation.

Original languageEnglish (US)
Pages (from-to)310-316
Number of pages7
JournalChest
Volume134
Issue number2
DOIs
StatePublished - Aug 2008

Fingerprint

Cough
Reflex
Lung
Lung Transplantation
Transplant Recipients
Conscious Sedation
Nerve Growth Factor Receptors
TRPV Cation Channels
Bronchoscopes
Abdominal Muscles
Bronchoscopy
Electromyography
Denervation
Muscle Contraction
Surgical Instruments
Mucous Membrane
Extremities
Anesthesia
Transplantation
Staining and Labeling

Keywords

  • Cough
  • Denervation
  • Innervation
  • Lung transplantation
  • Neurobiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Duarte, A., Terminella, L., Smith, J. T., Myers, A. C., Campbell, G., & Lick, S. (2008). Restoration of cough reflex in lung transplant recipients. Chest, 134(2), 310-316. https://doi.org/10.1378/chest.07-2934

Restoration of cough reflex in lung transplant recipients. / Duarte, Alexander; Terminella, Luigi; Smith, Jason T.; Myers, Allen C.; Campbell, Gerald; Lick, Scott.

In: Chest, Vol. 134, No. 2, 08.2008, p. 310-316.

Research output: Contribution to journalArticle

Duarte, A, Terminella, L, Smith, JT, Myers, AC, Campbell, G & Lick, S 2008, 'Restoration of cough reflex in lung transplant recipients', Chest, vol. 134, no. 2, pp. 310-316. https://doi.org/10.1378/chest.07-2934
Duarte, Alexander ; Terminella, Luigi ; Smith, Jason T. ; Myers, Allen C. ; Campbell, Gerald ; Lick, Scott. / Restoration of cough reflex in lung transplant recipients. In: Chest. 2008 ; Vol. 134, No. 2. pp. 310-316.
@article{e9b7fe8f29ce4a688438591ad04fd20d,
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. Conclusion: In human lung transplant recipients, recovery of the cough reflex was noted 12 months after lung transplantation.",
keywords = "Cough, Denervation, Innervation, Lung transplantation, Neurobiology",
author = "Alexander Duarte and Luigi Terminella and Smith, {Jason T.} and Myers, {Allen C.} and Gerald Campbell and Scott Lick",
year = "2008",
month = "8",
doi = "10.1378/chest.07-2934",
language = "English (US)",
volume = "134",
pages = "310--316",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

}

TY - JOUR

T1 - Restoration of cough reflex in lung transplant recipients

AU - Duarte, Alexander

AU - Terminella, Luigi

AU - Smith, Jason T.

AU - Myers, Allen C.

AU - Campbell, Gerald

AU - Lick, Scott

PY - 2008/8

Y1 - 2008/8

N2 - 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. Conclusion: In human lung transplant recipients, recovery of the cough reflex was noted 12 months after lung transplantation.

AB - 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. Conclusion: In human lung transplant recipients, recovery of the cough reflex was noted 12 months after lung transplantation.

KW - Cough

KW - Denervation

KW - Innervation

KW - Lung transplantation

KW - Neurobiology

UR - http://www.scopus.com/inward/record.url?scp=49449084648&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49449084648&partnerID=8YFLogxK

U2 - 10.1378/chest.07-2934

DO - 10.1378/chest.07-2934

M3 - Article

VL - 134

SP - 310

EP - 316

JO - Chest

JF - Chest

SN - 0012-3692

IS - 2

ER -