Key messages

• Reflexes from the upper respiratory tract (irritant receptors, mechanoreceptors) may cause bronchoconstriction, laryngospasm, and coughing.

• Respiratory muscle fatigue is a loss of capacity of respiratory muscles to develop force and/or velocity under load. Failure in central motor output, neuronal transmission, and generating muscular force are possible mechanisms.

• Breathlessness is the recognition of an inappropriate relationship between respiratory work and total body work; it is a subjective symptom with many different factors involved. Adaptation allows a significant disability to be tolerated, which may result in underestimation of the actual risk.

• Hypercapnia only occurs when both the diaphragm and the intercostal muscles are involved. Under normal conditions, the paralysis of the diaphragm alone does not result in hypercapnia.

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