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Cough

David E. Leith, James P. Butler, Steven L. Sneddon, Joseph D. Brain

10.1002/cphy.cp030320

Source: Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing

Originally published: 1986

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 General Considerations
2 Cough Description
2.1 Inspiration
2.2 Compression
2.3 Expiration
2.4 Cessation
3 Airflow
3.1 Forced Expiration
3.2 Flow Limitation
3.3 Flow Velocities
3.4 Flow Transients
4 Two‐Phase Cocurrent Flow
4.1 Mucus Properties
4.2 Two‐Phase Flow Regimes
4.3 Transient and Steady Flow
4.4 Particle Generation
4.5 Airway Deformation
4.6 Particle Deposition in Expiration
5 Conclusions
Figure 1. Figure 1.

Flow at airway opening (flow rate), spirometric volume change (air volume), subglottic pressure, and sound level during two representative coughs (top and bottom). Recordings on left are diagrammed on right. Positive flow phase is divided into increasing (A), constant (B), and decreasing (C) phases.

From Yanagihara et al. 164
Figure 2. Figure 2.

Flow () at airway opening (B) and esophageal pressure (A) during single cough in normal subject (left) and in subject with emphysema (right). Peak time derivative of pressure is ∼1,200 and 500 cmH2O/s for on and off transients, respectively, in normal subject but is less in emphysematous subject. In latter, esophageal pressure stays high throughout series of maneuvers that appears to include 6 or 7 glottis closures and reopenings. EXP, expiration; INSP, inspiration.

From Whittenberger and Mead 156
Figure 3. Figure 3.

progressive decreases in pressure at the downstream end of an excised dog trachea result in increasing flows only to critical condition. Dotted line connects open circles that show time‐dependent effects of stress relaxation (increased compressibility) of tracheal wall.

further increases in driving pressure (i.e., decreases in downstream pressure) do not increase flow or change pressure‐distance profile upstream of choke point but do decrease pressures (and cause decreases in cross‐sectional area) downstream from choke point (note downstream pressure recovery). Numbered points in A correspond to numbered lines in B. LPS, liters per second. [From Elliott and Dawson 38.]
Figure 4. Figure 4.

airway pressure (PLAT) vs. position during graded expiratory efforts in a normal subject at ∼50% vital capacity. Dashed lines, unknown pressure‐distance function from alveoli to first measured data points (note break in position axis).

difference between stagnation pressure (PTOT) and PLAT vs. position during same maneuvers. PTOT − PLAT, pressure associated with convective acceleration; alv, alveolus. [From Hoppin et al. 50.]
Figure 5. Figure 5.

Flow‐time plots for 3 maneuvers at same lung volume (A), coughs (B), and forced expirations (C) initiated at different lung volumes. Flow‐volume plots for maneuvers in B and C are superimposed on maximal expiratory flow‐volume curves. Same subject provided all data shown.

From Knudson et al. 72
Figure 6. Figure 6.

Five triggered transients initiated at different lung volumes (Vol), superimposed on subject's maximal expiratory flow‐volume curve. Amplitude of the supramaximal flow transient decreases less with lung volume than does maximal flow. RV, residual volume; TLC, total lung capacity, , flow.

From Knudson et al. 72
Figure 7. Figure 7.

Volume displaced from collapsing central airways is represented by total area under flow‐time curve () for supramaximal transient, less the area that represents volume coming from parenchyma during same time. Magnitude of latter is uncertain, however, because time course of rise in parenchymal flow to maximum flow () is uncertain (e.g., as shown by dashed and dotted lines). Stippled area shows probable minimum value of change in airway volume.

From Knudson et al. 72
Figure 8. Figure 8.

Sequential measurements on mucus sample, showing complex shear stress‐shear strain behavior, including shear thinning (decrease in viscosity with increasing shear rate) and shear destruction (changes in behavior after first exposure to high shear rates). For comparison, mucus shear rates are <10 s−1 during ciliary transport and may range well over 1,000 s−1 during cough.

From Lopez‐Vidriero et al. 84, by courtesy of Marcel Dekker, Inc
Figure 9. Figure 9.

Four basic regimes in two‐phase cocurrent flow. Range of associated gas velocities taken from engineering literature 119 for large rigid conduits and ordinary Newtonian liquids. There is reason to think that lower velocities apply in the lung. Arrows, direction of flow.

From Leith 79
Figure 10. Figure 10.

pressure (ΔP)‐flow curves for dry tubes of various radii (r).

pressure‐flow curves for 8.5‐mm‐radius tube with fluid annulus that reduces inner radius to values indicated. Human tracheal radius is similar. [From Clarke et al. 28.]


Figure 1.

Flow at airway opening (flow rate), spirometric volume change (air volume), subglottic pressure, and sound level during two representative coughs (top and bottom). Recordings on left are diagrammed on right. Positive flow phase is divided into increasing (A), constant (B), and decreasing (C) phases.

From Yanagihara et al. 164


Figure 2.

Flow () at airway opening (B) and esophageal pressure (A) during single cough in normal subject (left) and in subject with emphysema (right). Peak time derivative of pressure is ∼1,200 and 500 cmH2O/s for on and off transients, respectively, in normal subject but is less in emphysematous subject. In latter, esophageal pressure stays high throughout series of maneuvers that appears to include 6 or 7 glottis closures and reopenings. EXP, expiration; INSP, inspiration.

From Whittenberger and Mead 156


Figure 3.

progressive decreases in pressure at the downstream end of an excised dog trachea result in increasing flows only to critical condition. Dotted line connects open circles that show time‐dependent effects of stress relaxation (increased compressibility) of tracheal wall.

further increases in driving pressure (i.e., decreases in downstream pressure) do not increase flow or change pressure‐distance profile upstream of choke point but do decrease pressures (and cause decreases in cross‐sectional area) downstream from choke point (note downstream pressure recovery). Numbered points in A correspond to numbered lines in B. LPS, liters per second. [From Elliott and Dawson 38.]



Figure 4.

airway pressure (PLAT) vs. position during graded expiratory efforts in a normal subject at ∼50% vital capacity. Dashed lines, unknown pressure‐distance function from alveoli to first measured data points (note break in position axis).

difference between stagnation pressure (PTOT) and PLAT vs. position during same maneuvers. PTOT − PLAT, pressure associated with convective acceleration; alv, alveolus. [From Hoppin et al. 50.]



Figure 5.

Flow‐time plots for 3 maneuvers at same lung volume (A), coughs (B), and forced expirations (C) initiated at different lung volumes. Flow‐volume plots for maneuvers in B and C are superimposed on maximal expiratory flow‐volume curves. Same subject provided all data shown.

From Knudson et al. 72


Figure 6.

Five triggered transients initiated at different lung volumes (Vol), superimposed on subject's maximal expiratory flow‐volume curve. Amplitude of the supramaximal flow transient decreases less with lung volume than does maximal flow. RV, residual volume; TLC, total lung capacity, , flow.

From Knudson et al. 72


Figure 7.

Volume displaced from collapsing central airways is represented by total area under flow‐time curve () for supramaximal transient, less the area that represents volume coming from parenchyma during same time. Magnitude of latter is uncertain, however, because time course of rise in parenchymal flow to maximum flow () is uncertain (e.g., as shown by dashed and dotted lines). Stippled area shows probable minimum value of change in airway volume.

From Knudson et al. 72


Figure 8.

Sequential measurements on mucus sample, showing complex shear stress‐shear strain behavior, including shear thinning (decrease in viscosity with increasing shear rate) and shear destruction (changes in behavior after first exposure to high shear rates). For comparison, mucus shear rates are <10 s−1 during ciliary transport and may range well over 1,000 s−1 during cough.

From Lopez‐Vidriero et al. 84, by courtesy of Marcel Dekker, Inc


Figure 9.

Four basic regimes in two‐phase cocurrent flow. Range of associated gas velocities taken from engineering literature 119 for large rigid conduits and ordinary Newtonian liquids. There is reason to think that lower velocities apply in the lung. Arrows, direction of flow.

From Leith 79


Figure 10.

pressure (ΔP)‐flow curves for dry tubes of various radii (r).

pressure‐flow curves for 8.5‐mm‐radius tube with fluid annulus that reduces inner radius to values indicated. Human tracheal radius is similar. [From Clarke et al. 28.]

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Article Title: Cough
 

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David E. Leith, James P. Butler, Steven L. Sneddon, Joseph D. Brain. Cough. Compr Physiol 2011, Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing: 315-336. First published in print 1986. doi: 10.1002/cphy.cp030320