A model of the central regulatory system for cough reflex.

Cough is an important defensive reflex that eliminates particles and secretions from the airways and protects the lower airways from the aspiration of foreign materials. Although the classical cough center is thought to be situated in or around the nucleus tractus solitarius (NTS) of the brainstem, our understanding of its profile is still incomplete. Accumulating evidence suggests a new concept of the central regulatory system for cough reflex. The cough pattern generator in the brainstem appears to be identical to the respiratory pattern generator and to function by reshaping of the discharge pattern of respiratory neurons. The generated cough motor task is transmitted to spinal motoneurons through the descending respiratory pathways. The cough-gating mechanism receives the peripheral tussigenic information through the relay neurons in the NTS and activates such a functionally flexible pattern generator by producing triggering signals. This review focuses on the cough-gating neurons that constitute the gating mechanism and play a crucial role in the generation of cough reflex.