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Effects of cervical spinal cord injury on cough

Action of the diaphragm is necessary for negative force production during breathing and cough. However, the effect of cervical spinal cord injury on action of the diaphragm during cough is not known. It was hypothesized that C2 hemisection would result in a loss of cough excitability and depression of the diaphragm during breathing and cough. Electromyograms (EMGs) of the crural diaphragm, abdominal oblique complex, thyroarytenoid, posterior cricoarytenoid, thyropharyngeus, cricopharyngeus and thyrohyoid muscles were measured along with esophageal and stomach pressures were recorded in spontaneously breathing (non‐paralyzed) anesthetized (sodium pentobarbital) cats. Cough was elicited by mechanical stimulation of the lumen of the intrathoracic trachea. Following acute C2 hemisection there was an ~50% reduction in cough number from 1:1 sec to 1:2 sec; additionally there was a bilateral reduction in crural diaphragm recruitment with a significant increase in upper airway EMG activity. Temporal progression of changes in cough characteristics was captured for up to 2 hours following acute hemisection. Lesion levels were verified post‐mortem and histology was used to assess lesion extent in each animal. Of note the blood pressure and pCO2 remained relatively consistent, and the animals were not placed on a ventilator. We conclude that there is a balance of excitation and inhibition from the spinal cord to the brainstem regulating the excitability of airway protective behaviors and cranial/spinal motor drive during coughing.