Urge to cough with voluntary suppression following mechanical pharyngeal stimulation.

OBJECTIVE The goal of this project was to determine if mechanical stimulation to the posterolateral oropharynx would elicit the urge-to-cough and/or cough. BACKGROUND Inhaled agents, such as capsaicin and citric acid, readily produce coughing and the sensation of urge-to-cough. Areas below the glottis are thought to be the primary sensory mediators of these responses, however it is unknown if there are specific areas in the oropharynx or laryngopharynx that are important for the sensation and production of coughing. METHODS Paired-pulse air puffs were delivered to the posterolateral oropharyngeal walls of 11 healthy adults (5 men, 6 women) between the ages of 18 and 30 years. Air puffs were delivered via custom mouthpiece in 4 trials, 50 sets per trial. Instances of cough were recorded, and a modified Borg scale was used to gauge urge-to-cough throughout each trial. RESULTS Instances of cough were recorded in 12/37 trials, and the sensation of an urge-to-cough was present in 25/37 trials. No motor cough response was elicited with an urge-to-cough rating less than 2.4 on the modified Borg scale. A trend towards higher urge-to-cough was noted for later (3rd and 4th) trials. CONCLUSIONS Oropharyngeal mechanical stimulation elicits urge-to-cough and cough in healthy young adults. Like other methods to elicit coughing, the motor and sensory thresholds are different using the oropharyngeal air-puff stimuli. Further, it appears there is a sensitization to the air puff stimuli with later trials associated with stronger urge-to-cough and higher likelihood of coughing versus the first and second trial (Tab. 1, Fig. 5, Ref. 21).