Pathophysiology of human ventilatory control #MMPMID24925922
Dempsey J; Smith C
Eur Respir J 2014[Aug]; 44 (2): 495-512 PMID24925922show ga
We review the substantial progress recently made in understanding the underlying mechanisms controlling breathing and the applicability of these findings to selected human diseases. Emphasis is placed on the sites of central respiratory rhythm and pattern generation as well as newly described functions of the carotid chemoreceptors and the integrative nature of the central chemoreceptors and the interaction between peripheral and central chemoreception. Recent findings supporting critical contributions from cortical central command and muscle afferent feedback to exercise hyperpnea are also reviewed. These basic principles and the evidence supporting chemoreceptor and ventilatory control system plasticity during and following constant and intermittent hypoxemia and stagnant hypoxia are applied: a) to the pathogenesis, consequences and treatment of obstructive sleep apnea; and b) to exercise hyperpnea and its control and limitations with aging, COPD and CHF.