The cough is initiated when intrapulmonary pressure

is raised against a closed glottis, causing the smaller

bronchi to narrow in size.
The abrupt opening of the glottis with the onset of
cough leads to high pressure and rapid flow through
narrow airways, which can facilitate removal of
obstructing secretions.
Different types of cough stimuli
cough is a reflex response to stimuli that irritate
receptors in the larynx, trachea, or large bronchi.
These stimuli include mucus, pus, and blood
For external agents such as dusts, foreign bodies, or
even extremely hot or cold air.
Other causes include inflammation of the respiratory
mucosa and pressure or tension in the air passages
from a tumor or enlarged peribronchial lymph nodes.
 Those cough stimuli may affect receptors in the upper
airway (especially the pharynx and larynx) or in the
lower respiratory tract, following access to the
tracheobronchial tree by inhalation or by aspiration
One of the common cause of tracheobronchial
irritation is regurgitation of acidic gastric contents into
the tracheobronchial tree during sleep
 Coughing may be initiated either voluntarily or
reflexively.
As a defensive reflex it has both afferent and efferent
pathways.
Afferent limb of the cough reflex
The afferent limb includes receptors within the
sensory distribution of the trigeminal (CN V),
glossopharyngeal (CN IX), superior laryngeal, and
vagus nerves (CN X).
Efferent limb of the cough reflex
The efferent limb includes the recurrent laryngeal nerve
and the spinal nerves.
The cough starts with a deep inspiration followed by glottic
closure, relaxation of the diaphragm, and muscle
contraction against a closed glottis.
The resulting markedly positive intrathoracic pressure
causes narrowing of the trachea. Once the glottis opens,
the large pressure differential between the airways and the
atmosphere coupled with tracheal narrowing produces
rapid flow rates through the trachea.
The shearing forces that develop aid in the elimination of
mucus and foreign materials.