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The Coordination of Cough and Swallow Behaviors in Humans

It is not currently known if the coordinated motor control of cough and swallow behaviors described in animal models is preserved in humans. We hypothesized that similar relationships exist, namely the increased muscle activation and decreased swallow duration during combined cough and swallow behaviors. Young healthy individuals were recruited, and during the experiments voluntary cough was elicited by asking subjects to cough “like there was something stuck in their throat” and continue until instructed to stop. Swallow was initiated by infusing 3 ml of water into the subject's mouth and instructing them to “swallow whenever you need to.” Cough and swallow were elicited individually as well as together to mimic an “aspiration” response. Cough excitability was measured by recording the airflow taken from the mouth and surface electromyographic (sEMG) activity from the 6th intercostal, rectus abdominus, abdominal obliques, and submental muscles. Swallow excitability was measured by submental sEMG. All subjects produced multiple cough epochs and swallows to the stimuli. In the combined condition swallows occurred during the inter‐bout interval, with increased intercostal and abdominal drive during cough; and an increased submental drive during swallow. These results confirm the theory of a highly cooperative airway protection system in the human. Furthermore, this model could be used as a novel diagnostic tool for dysphagia/dystussia, eliminating the ceiling effect of a single cough trial. Supported by HL 111215, HL 103750, and P30‐GM103507.