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Cough due to vagal stimulation

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cough reflex vagal afferent stimulation physiology

Cough due to vagal stimulation occurs when irritant-sensitive sensory fibers of the vagus nerve are activated.
Reflex arc
  1. Stimulus: mucus, smoke, cold air, infection, acid reflux, aspiration, or mechanical irritation.
  2. Afferent limb: vagal sensory fibers from the larynx, trachea, carina, and bronchi transmit impulses to the medullary cough center.
  3. Central processing: nucleus tractus solitarius and related brainstem pathways coordinate the response.
  4. Efferent limb: vagus, phrenic, and spinal motor nerves activate the laryngeal, diaphragmatic, intercostal, and abdominal muscles.
  5. Response: deep inspiration, glottic closure, forceful expiration, then glottic opening produces cough.
The larynx and tracheobronchial tree, particularly the carina and bronchial branching points, are highly cough-sensitive because of their dense vagal sensory innervation. - Murray & Nadel's Textbook of Respiratory Medicine, sensory receptors for the cough reflex
A common clinical example is GERD-related cough: esophageal irritation may trigger an esophago-vagal reflex, causing bronchoconstriction and cough even without aspiration. Vagal stimulation during coughing can also increase vagal tone and occasionally contribute to bradycardia or cough syncope.
For background, this review of cough afferents describes the vagal sensory mechanisms of the cough reflex.
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