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Neuronal control of the airways

Maria G Belvisi, PhD
Peter J Barnes, DM, DSc, FRCP, FRS
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


The primary function of the lungs is gas exchange. The upper and lower airways serve as a conduit for airflow to and from the gas exchange regions of the lungs. Nerves innervating the airway mucosa initiate homeostatic and defensive reflexes that preserve lung capacity for gas exchange. In airway diseases, such as allergic rhinitis, asthma, and chronic obstructive pulmonary disease (COPD), homeostatic and defensive reflexes are dysfunctional and/or dysregulated. Much of the pathology and many of the symptoms associated with upper and lower airway disease are directly or indirectly related to these changes in neuronal function (figure 1).

Neural control of the upper and lower airways will be reviewed here; other aspects of the pathogenesis of asthma, allergic rhinitis, and COPD are presented separately. (See "Pathogenesis of asthma" and "Pathogenesis of allergic rhinitis (rhinosinusitis)" and "Chronic obstructive pulmonary disease: Risk factors and risk reduction".)


Afferent innervation — The olfactory nerve (cranial nerve I) provides afferent innervation associated with the sensation of smell. (See "Anatomy and etiology of taste and smell disorders".)

The remaining afferent innervation of the nasal mucosa arises from the ophthalmic (through the ethmoidal nerve) and maxillary branches of the trigeminal nerve. The cell bodies of non-olfactory, primary sensory nerves from the nose are located in the trigeminal ganglion. These afferent nerve fibers branch extensively, innervating the epithelium, vessels, and glands of the nasal mucosa. The extensive branching and innervation of multiple effectors in the mucosa, along with synthesis and peripheral transport of neuropeptides with many potential actions in the nose, provides the anatomical substrate necessary for producing axonal reflexes [1,2]. (See 'Axon reflexes' below.)

Reflexes (eg, sneezing, itching, rhinorrhea, and nasal congestion) can be initiated within the nose by a variety of stimuli including mechanical probing, hypertonic saline, cold and/or dry air, histamine, allergen, nicotine, bradykinin, and capsaicin [2]. Evidence for nasal afferent nerve subtypes that are differentially responsive to inflammatory mediators and irritants has been reported [3]. While both histamine and bradykinin, when applied selectively to the nasal mucosa, initiate reflex-mediated, atropine-sensitive mucus secretion, only histamine readily initiates sneezing in normal patients [4-7]. The data are at least suggestive of the notion that nasal autonomic reflexes and sneezing are differentially regulated by nasal afferent nerve subtypes.

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Literature review current through: Nov 2017. | This topic last updated: Aug 04, 2017.
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