Breathing and the nervous system.

Breathing requires complex interactions of the central and peripheral nervous systems with the respiratory system. It involves cortical (volitional) as well as subcortical (automatic) output. Cortical output is mainly through the corticospinal tract, whereas the brainstem sends signals via the reticulospinal tract. Groups of nuclei in the brainstem (pneumotaxic center, dorsal and ventral respiratory group), situated in the pons and medulla, function as rhythm generators. Some of these nuclei have intrinsic pacemaker activity; however, their output is affected extensively by various chemical (through aortic and carotid bodies), mechanical (stretch reflexes), and neural feedbacks from the peripheral nervous system involving cranial nerves V, VII, IX, X, and XI. Brainstem nuclei also have central chemoreceptors that detect changes in serum carbon dioxide and pH. Various neurologic disorders such as stroke or neurodegenerative diseases (Parkinson's disease, multiple system atrophy) can adversely affect respiration and may even be the first sign of disease onset. Clinicians should have a better understanding of this complex but important physiological process to better appreciate pathologies affecting it. Future research is needed to enhance our understanding of this intricate process.