This chapter is most relevant to Section F10(v) from the 2017 CICM Primary Syllabus, which expects the exam candidates to be able to "explain the pathways and importance of the cough reflex". This topic has appeared in Question 13 from the first paper of 2014 and Question 8 from the second paper of 2020. It is therefore explored here because it may one day bedevil an unprepared exam candidate. The second time it came up, the pass rate was still only 62%.
Polverino et al (2012) give an excellent brief overview of this reflex without overflowing with unnecessary detail. If unnecessary detail becomes necessary for whatever reason, the review by Canning (2006) offers an abundance of it. Given the relative lack of interest regarding this tpic from the CICM examiners, only a brief summary is offered here, resembling an answer to a hypotherical SAQ which asks the candidates to "explain the pathways and importance of the cough reflex".
In summary:
Stimulus for cough:
Purpose and importance of cough reflex:
Afferent pathway of the cough reflex arc: Three main classes of receptor:
These receptors connect to the medullary control centre by vagus nerve fibres:
Central integrated control of cough:
Efferent pathway of the cough reflex arc:
Process of cough:
In the event that one needs to read more about the actual procedure of coughing, one may wish to explore the excellent article by Stuart Brooks (2011) in which the author for some reason uses his spouse as a model for what happens during a cough: "...now, her face is cerulean-colored as she forcibly emits a staccato-like exhalation...".
Polverino, Mario, et al. "Anatomy and neuro-pathophysiology of the cough reflex arc." Multidisciplinary respiratory medicine 7.1 (2012): 5.
Brooks, Stuart M. "Perspective on the human cough reflex." Cough 7.1 (2011): 10.