The role of cough and hyperventilation in perpetuating airway inflammation in asthma.

Air flowing through a pipe exerts frictional stress on the walls of the pipe. Frictional stress of more than 40 N/m2 (velocity equivalent of air 113 m/s) is known to cause acute endothelial damage in blood vessels. The frictional stress in airways during coughing may be much greater, however, since the velocity of air may be as high as speed of sound in air. We suggest that high levels of frictional stress perpetuate airway inflammation in airways which are already inflamed and vulnerable to frictional stress-induced trauma in patients with asthma. Activities associated with rapid ventilation and higher frictional stress (e.g. exercise, hyperventilation, coughing, sneezing and laughing) cause asthma to worsen whilst activities that reduce frictional stress (Yoga 'Pranayama', breathing a helium-oxygen mixture and nasal continuous positive airway pressure) are beneficial. Therefore control of cough may have anti-inflammatory benefits in patients with asthma.