, Volume 196, Issue 5, pp 601–608 | Cite as

Strategies for the Integration of Cough and Swallow to Maintain Airway Protection in Humans

  • Alyssa Huff
  • Mitchell D. Reed
  • Barbara K. Smith
  • Edward H. BrownJr.
  • Alexander V. Ovechkin
  • Teresa PittsEmail author



Airway protective behaviors, like cough and swallow, deteriorate in many populations suffering from neurologic disorders. While coordination of these behaviors has been investigated in an animal model, it has not been tested in humans.


We used a novel protocol, adapted from previous work in the cat, to assess cough and swallow independently and their coordination strategies in seven healthy males (26 ± 6 years). Surface electromyograms of the submental complex and external oblique complex, spirometry, and thoracic and abdominal wall kinematics, were used to evaluate the timing of swallow, cough, and breathing as well as lung volume (LV) during these behaviors.


Unlike the cat, there was significant variability in the cough-swallow phase preference; however, there was a targeted LV range in which swallow occurred.


These results give insight into the differences between the cat and human models in airway protective strategies related to the coordination of cough and swallow behaviors, allowing for better understanding of dystussia and dysphagia.


Apnea duration Lung volume Airflow Surface electromyography Volume related feedback 



This work was supported by Leona M. and Harry B. Helmsley Charitable Trust, R00- HL 111215, The Kentucky Spinal Cord and Head injury Trust, The Commonwealth of Kentucky Challenge for Excellence.

Author Contributions

AH assisted in running the experiment, coordinated the experiment, analyzed data, and prepared the manuscript. MDR assisted in manuscript preparation. BKS assisted in manuscript preparation. EHB assisted in running the experiment and was the coordinator of the experiment. AVO assisted in experimental design and data acquisition. TP assisted in experimental design and assisted in manuscript preparation. The manuscript draft was critically revised by all authors.


This study was funded by the following: Leona M. and Harry B. Helmsley Charitable Trust, R00- HL 111215, The Kentucky Spinal Cord and Head injury Trust, The Commonwealth of Kentucky Challenge for Excellence.

Compliance with Ethical Standards

Conflict of interest

There are no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of University of Louisville Institutional Review Board.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PhysiologyUniversity of LouisvilleLouisvilleUSA
  2. 2.Department of Neurological SurgeryUniversity of LouisvilleLouisvilleUSA
  3. 3.Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleUSA
  4. 4.Department of Physical TherapyUniversity of FloridaGainesvilleUSA
  5. 5.Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, School of MedicineUniversity of LouisvilleLouisvilleUSA

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