Fisiologi Batuk

Ikhlas Muhammad Jenie

Receptor
Afferent fibers
Central nervous
system
Efferent fibers
Effector
Reflex arc
Physiologic mechanism to maintain the
tracheobronchila tree
1. Respiratory movement (passive or active)
2. The secretion from the bronchial glands
3. The ciliary activity of the epithelium lining
the trachea and bronchi
4. The cough reflex or the act of coughing
Reseptor Batuk
Mekanoreseptor Chemoreseptor
Intrapulmoner Ekstrapulmoner
Slowly adapting receptor
(SAR)
Rapidly adapting receptor
(RAR)
Mekanoreseptor
Low threshold mechanoreceptor
Activated by one or more mechanical stimuli
Generally do not respond directly to chemical
stimuli, unless the stimulus acts upon airway
structural cells to result in mechanical
distortion
SAR and RAR
Originate in the nodose ganglia of the vagus
nerve
Terminate in the intrapulmonary airways and
lung parenchyma
Conduct AP in the A-range (10-20 m/s)
SAR and RAR
Sensitive to:
Lung inflation (changes in lung volumes)
Bronchospasm (contraction of the smooth muscle
cells)
Airway wall oedema
SAR
Display slowly adaptation --- a slow reduction in the
number of action potential
Active during tidal inspiration, peaking just prior to
the initiation of expiration
Involved in the Hering-Breuer reflex, which
terminates inspiration and initiates expiration when
the lungs are adequately inflated
Antagonize cholinergic drive to the airway smooth
muscle, resulting in a reduction in airway tone
RAR
Display rapidly adaptation --- a rapid reduction
in the number of action potential during
sustained lung inflation
Active during both inflation and deflation of
the lungs (including lung collapse)
Evokes tachypnea and airway smooth muscle
contraction (bronchospasm)

Extrapulmonary
low threshold mechanoreceptors
Sensitive to punctate mechanical stimuli (such
as touch)
Insensitive to:
Physiologically-relevant tissue stretching
Changes in luminal pressure
Airway smooth muscle contraction
Slower conduction velocity (5 m/sec) in the
range of A-nerve fiber
Extrapulmonary
low threshold mechanoreceptors
Originate also from the nodose ganglia of the
vagus nerve
Located in the extrapulmonary airways:
Larynx
Trachea
Large bronchi
May not be activated during normal breathing
Chemoreceptors
Generally quiescent in the normal airways,
becoming recruited during airways
inflammation or irritation
Derived from both the nodose and jugular
vagal ganglia, as well as from the dorsal root
ganglia
conduct action potentials in the C and A-fiber
range
Sometime, it is called high threshold
mechanoreceptors
Afferent fibers of coughing reflex
From the receptors in the pharynx, the impulse is
propagated along the afferent fibers of the
glossopharyngeal nerve (the IX
th
cranial nerve)
From the receptors in the larynx, trachea, and larger
bronchi, the impulse is propagated along the
afferent fibers of the vagus (the x
th
cranial nerve)
[and also through n.laryngeus superior]
The ascending impulse is to reach the nucleus of
tractus solitarius (NTS)
Cough Center
Medulla oblongata (brain stem) near the
respiratory center
Receptors in MO:
Opioid receptors
5-hydroxytryptamine receptors (5HT
1A
)
GABA receptors
NMDA antagonist
(N-methyl-D-asparate)
Efferent fibers of coughing reflex
The descending fibers arising from NTS to the
spinal primary motor neurons and n.laryngeus
recurrence.
Effectors
Laryngeal muscles
Diaphragm
The intercostal muscles
The abdominal muscles

The action of cough
The air is inspired (2.5 L)
The epiglottis is closed, and the vocal cords
shut tightly to entrap the air within the lungs
The abdominal muscle contract forcefully,
pushing against the diaphragm, while other
expiratory muscle contract forcefully the
pressure in the lungs > 100 mmHg
The action of cough (2)
The vocal cords and epiglottis suddenly
opened widely, so that the air under pressure
in the lungs explodes outward (velocity 75
100 miles/ hour)
The rapidly moving air usually carries with it
any foreign matter that is present in the
bronchi or trachea
The act of cough
Deep inspiration
Glottis is closed
Forced expiratory effort against
the closed glottis
Raised intrathoracic & intraabdominal
pressure
Glottis is suddenly opened
A drop in intralaryngeal pressure
Increased air flow (axial & radial)
Brief violent rush of air out of trachea
(800 km/h)
Sites for eliciting cough
The origins of cough are part of respiratory tract:
Pharynx
Larynx (the endings of n.laryngeal superior)
Trachea (at the bifurcation or carina)
Segmental bronchi
Others:
External ear
Pleura
Esophagus
Abdominal organs
Stimulus for cough
Abnormal secretion within respiratory tract
Edema or ulceration of respiratory mucous
membrane
Irritation produced by foreign bodies
Pressure from outside of respiratory tract
(mediastinal tumor, aortic aneurysms, Hodgkins
disease)
Pressure upon the recurrent laryngeal nerve
Irritation of the pleural surface (pleurisy,
effusion)
Clinical cough
Acute and chronic non-asthmathic cough
Postnasal drip syndrome
Asthma
Gastro-esophageal reflux
Chronic bronchitis
Angiotensin-converting enzyme inhibitors
(ACE inhibitors)
Clinical cough (2)
Others:
Pharyngitis
Pulmonary congestion
Pulmonary tuberculosis
Intrathoracal malignancies
Pleural effusion
Pleurisy