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This review highlights recent advances in understanding how distributed neural circuits, particularly in the ventrolateral medulla and dorsolateral pons, integrate both homeostatic and non\u2010homeostatic influences on respiratory control. We examine how higher\u2010order brain regions interact with brainstem rhythm generators such as the preB\u00f6tzinger complex, emphasizing a dynamic, state\u2010dependent framework for respiratory regulation. Once considered a reflexive brainstem function, breathing is now recognized as the emergent output of interconnected networks that flexibly adapt rhythm and pattern based on internal state, behavior, and environmental context. Grasping this complexity is critical for understanding both the normal versatility and pathological vulnerability of respiratory control.<\/jats:p>","DOI":"10.1002\/bies.70072","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T13:45:47Z","timestamp":1758548747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Multimodal Breathing Control: Pontomedullary Mechanisms and Current Perspectives"],"prefix":"10.1002","volume":"47","author":[{"given":"Nathan A.","family":"Baertsch","sequence":"first","affiliation":[{"name":"Center For Integrative Brain Research Seattle Children's Research Institute  Seattle USA"},{"name":"Department of Pediatrics University of Washington  Seattle USA"},{"name":"Center For Excellence in Neurobiology of Addiction, Pain, and Emotion University of Washington  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elora","family":"Reily","sequence":"additional","affiliation":[{"name":"Center For Integrative Brain Research Seattle Children's Research Institute  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Sedano","sequence":"additional","affiliation":[{"name":"Center For Integrative Brain Research Seattle Children's Research Institute  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Center For Integrative Brain Research Seattle Children's Research Institute  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph W.","family":"Arthurs","sequence":"additional","affiliation":[{"name":"Center For Integrative Brain Research Seattle Children's Research Institute  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-91534-2.00015-1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-40812-x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.2008.042424"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2024.104227"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.24869\/psyd.2018.11"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.ats898"},{"issue":"3","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1152\/jappl.1984.57.3.635","article-title":"Hales: Neglected Respiratory Physiologist","volume":"57","author":"West J. 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