Abraham Guz memorial: Still unresolved hypotheses: Lung reflexes and perceptions of breathing

This article constitutes a review of the studies performed by the group of the late A. Guz and other authors on the subjects of lung reflexes and perceptions of respiration. The experimental data suggest that the lung inflation and deflation reflexes are present in man, mediated by large myelinated afferent nerve fibres in the vagus nerves, but that the inflation reflex is weaker than in animals, possibly due to central neuronal inhibition. The authors of animal results on the deflation reflex differ as to the afferent fibres involved in the vagi, but it is argued, on the basis of the data, that the preferred hypothesis is that increased activity of the large myelinated mediates the inflation reflex, and decreased activity in these same fibres mediates the deflation reflex. Smaller myelinated fibres are thought to mediate cough and increased breathing in response to airway irritation, while small non-myelinated C fibres mediate hyperpnoea in response to parenchymal congestion and various disease states. The unpleasant sensation at the break point of breath-holding is not chemically mediated but may depend on a complex response involving vagal afferent, phrenic efferent and phrenic afferent pathways. Other experiments in humans on perception of various unpleasant respiratory sensations are discussed with unclear conclusions.