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Cigarette Smoking, Cough Reflex, and Respiratory Tract Infection
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It is very meaningful that Arcavi and Benowitz1 remind us of the impact of smoking on susceptibility to infections, especially respiratory tract infections. Although they reviewed the mechanism of increased susceptibility to infections in smokers, ranging from structural changes in the respiratory tract to alternation of cellular and humoral immune system functions, we greatly regret that they did not mention swallowing and cough reflexes, possibly the most important defense mechanism of airway infection.
Cigarette smoking raises the threshold volume required to trigger reflexive pharyngeal swallow, resulting in increased risk for silent aspiration of pathogen containing oropharyngeal and gastric content.2 Once a pathogen is aspirated, cough reflex is important in removing the pathogen from the respiratory tract by triggering a forceful cough. The threshold for cough reflex sensitivity in smokers was reported to be higher than in nonsmokers.3 These blunted sensitivities of swallowing and cough reflexes in smokers undoubtedly contribute to . . . [Full Text of this Article]
AUTHOR INFORMATION
Satoru Ebihara, MD;
Takae Ebihara, MD;
Tatsuma Okazaki, MD;
Hidetada Sasaki, MD
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Lidia Arcavi and Neal L. Benowitz
Arch Intern Med. 2004;164(20):2206-2216.
ABSTRACT
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