Professor of Medicine, Harvard medical school, Chief-Emeritus, pulmonary and critical care unit, Massachusetts general Hospital, Boston, U.S.A
Abstract
Central respiratory drive is of paramount importance in control of ventilation. The central drive is exquisitely sensitive to changes in CO2/H+ concentration. New data show that the fast- acting neurotransmitter acetylcholine is essential in the CO2/H+ ventilatory response as well as in generating the central drive. Ret gene and MASH-1 are essential in development of the parasympathetic system and thus in the central respiratory drive. Clinical states of hypoventilation most likely have a genetic defect affecting the cholinergic system.This article will review briefly the site and mechanisms of action of CO2 centrally, the neurotransmitters involved in the process, the gene(s) involved in the process and clinical states where there are abnormalities in the system and inevitably hypoventilation results. (Tanaffos 2002;1(1):9-13 )
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