RESPIRATORY

PHYSIOLOGY
PART I
RESPIRATION
 process of taking up oxygen and
removing carbon dioxide from
cells of the body
 GAS EXCHANGE
 Respiration
 External respiration:
ventilation and exchange of
gases in the lungs

 Internal respiration:
ventilation and exchange of
gases in the tissues
External Respiration
 Pulmonary ventilation
 Exchange between lungs and blood
 Transportation in blood
 Exchange between blood and body
tissues
Other Respiratory System
Functions

 HOST DEFENSE
 METABOLISM
Metabolic Roles
STRUCTURE AND FUNCTIONS
OF THE RESPIRATORY SYSTEM
Respiratory System
Structures of the Thoracic
Cavity
 Pleura – membrane
lining of lungs
and chest wall
 Pleural sac
around each
lung
Pleura

 produce a lubricating fluid (15ml) that fills

the gap between them.  This helps the
lungs to move smoothly in the chest when
they are inflating and deflating as we
breathe.  
CLINICAL:
 Lung cancer can
spread to the
pleura.  The
cancer irritates the
pleura producing
pleural effusion.

 Pneumothorax
 Empyema
Respiratory System: Anatomical division
Functional Division:
Respiratory System
 CONDUCTING ZONE

 nasal cavity, pharynx, larynx, trachea, terminal

bronchioles

● RESPIRATORY ZONE
• respiratory bronchioles,
alveolar ducts,
alveolar sacs
Branching of Airways

 Huge increase in cross sectional area

Conducting Zone
 Air passageway
- 150 mL volume = dead space volume
 warms and humidifies inspired air.
 filters and cleans:
 Mucus secreted to trap particles in the
inspired air.
 Mucus moved by cilia to be expectorated
Filtration of Air
 Nasal hairs serve as filters
 Mucosal lining traps particles and bacteria
 Large particles: <6microns
 Sedimentation in larynx
 1-5 microns
 Deposit in alveoli
 Small particles <1 micron
Respiratory Zone
 Region of gas exchange
between air and blood
Structures of the Respiratory
Zone
 Respiratory bronchioles
 Alveolar ducts
 Alveoli
 Alveolar sacs
ALVEOLI
 ~ 300 million air sacs (alveoli)
 Large surface area (60–80 m2)
 Each alveolus is 1 cell layer thick.
Respiratory Membrane

 The area where gas exchange between air

and blood occurs
 It is the fused alveolar and capillary walls (3
layers)
1. Alveolar epithelium
2. Fused basal laminae
3. Capillary epithelium

21
The Respiratory Membrane
CELLS OF THE
AIRWAY
CILIATED CELLS
- line the respiratory tract →
bronchioles
CELLS PRODUCING MUCUS
1. surface secretory cells (goblet cells)
2. submucosal glands
- present wherever there is cartilage
3. Clara cells
- found at the level of bronchioles
- main secretory cell type in the
distal conducting airways
- may play a role in epithelial
regeneration after injury
MUCOCILIARY ELEVATOR

 Ciliated cells + goblet cells

 Impaired by toxins from cigarette smoking
 ALVEOLAR CELLS
 Alveolar type I
> thin squamous
epithelial cells
> form 90% of surface
of alveolus
> Gas exchange
 Alveolar type II
> Round to cube-shaped
secretory cells
 Produce surfactant

 Regenerative capacity
SURFACTANT
 Thin film lining the alveolar surface
 Complex mixture of phospholipids, neutral
lipids, fatty acids and proteins
 Main component: DPPC
 Production starts at 24 wks gestation
3 main functions of
SURFACTANT:
1. lowers surface tension
 has “anti-stick” property

2. promotes stability among alveoli of

different sizes by decreasing the
tendency of small alveoli to
collapse (interdependence)
3. reduces capillary filtration forces
CELLS IN THE ALVEOLI
Dust cells (phagocytes)

 Alveolar macrophages
 Phagocytize inhaled particles and
bacteria
 Impaired by smoking
PULMONARY BLOOD FLOW
 is the cardiac output
of the right heart

 ejected from the right

ventricle and is
delivered to the lungs
via the pulmonary
artery
PULMONARY BLOOD FLOW
 The pulmonary
arteries branch into
increasingly smaller
arteries and travel with
the bronchi toward the
respiratory zones. The
smallest arteries divide
into arterioles and then
into the pulmonary
capillaries, which form
dense networks
around the alveoli.
PULMONARY BLOOD FLOW
 UNEVENLY distributed because of
gravitational effect
 On standing, blood flow is lowest at the
apex (top) of the lungs and highest at the
base (bottom) of the lungs.
 When the person is supine (lying down),
these gravitational effects disappear
REGULATION of PULMONARY
BLOOD FLOW
 accomplished by altering the resistance of
the pulmonary arterioles
 Changes in pulmonary arteriolar
resistance are controlled by local factors,
mainly O2
 a ↓ in PaO2 causes a hypoxic vasoconstriction
that shifts blood away from poorly ventilated
regions of lung to well-ventilated areas
BLOOD SUPPLY TO THE LUNGS:
 1. PULMONARY CIRCULATION
- brings deoxygenated blood from
the RV to the gas exchanging units
- largest vascular bed in the body
 2. BRONCHIAL CIRCULATION
- the blood supply to the conducting
airways (which do not participate in gas
exchange) and is a very small fraction of the
total pulmonary blood flow.
The lung’s low vascular resistance
is due to

1. Low vascular tone

2. Large capillary compliance

 Pulmonary Circulation Differs
From
Systemic Circulation
• thinned walled arteries and its branches
• contain less elastin and smooth muscle
than systemic vessels, highly
compliant
• capillaries form a dense capillary bed

• high flow, high compliance, low

resistance, and a low pressure system
Characteristics of the Pulmonary Circulation
Pulmonary lymphatics

 Two lymphatic supplies: superficial and deep

lymphatic vessels. Exit from hilus
 No lymphatics drain alveoli
 remove plasma filtrate, particulate matter absorbed
from alveoli, and escaped protein from the vascular
system
 helps to maintain negative interstitial pressure which
pulls alveolar epithelium against capillary
endothelium.
INNERVATION Of the
RESPIRATORY SYSTEM
 1. nervous control
sympathetic control
- activation of β2 receptors
- causes dilatation
parasympathetic control
- activate muscarinic receptors
- causes constriction
INNERVATION Of the
RESPIRATORY SYSTEM
 2. Local control
> exerted by substances released in the
lungs by mast cells
 histamine
binds to H1 receptors constriction
binds to H2 receptors dilation
 SRS-A: constriction-allergic response to pollen
 Prostaglandins E series dilation
 Prostaglandins F series constriction
PROTECTIVE MECHANISMS
OF THE RESPIRATORY
SYSTEM
Mucociliary Clearance System
 aka mucociliary elevator
 Mucus continually
secreted by goblet cells
 Mucus blanket contains
impacted particles and
debris
 Immunoglobulin A (IgA)
protects against bacteria
and viruses
SNEEZE REFLEX

 Functions to dislodge foreign substances from

the nasal cavity
 Stimulus: irritation in the nasal passageways
 Afferent impulses pass in CN V to the medulla
 During the reflex, uvula and soft palate are
depressed so that rapidly flowing air from the
lungs is directed through the nasal
passageways
COUGH REFLEX
 From trachea to alveoli
sensitive to irritants
 Afferents utilize CN X
 Process:
 2.5 L of air rapidly inspired
 Epiglottis closes and vocal cords close tightly
 muscles of expiration contract forcefully which
causes pressure in lungs to rise to 100 mm Hg
 Epiglottis and vocal cords suddenly open widely
which results in explosive outpouring of air to
clear larger airways at speed of 75 – 100 miles
per hr
Reflex Bronchoconstriction

 Response to inhaled irritants

 Asthma causes bronchoconstriction in

response to cold air, perfumes, etc.
The Heimlich Maneuver
Can Save Lives
How Do We breathe?
 Inspiration is normally active
 Expiration is normally passive.
2 ways by which lungs can be
expanded and contracted:
 1. by downward and upward movement of
the diaphragm to lengthen and shorten the
chest cavity

 2. by elevation and depression of the ribs

to increase and decrease the A-P diameter of
the chest cavity
 Muscles of Respiration
 Inspiratory muscles
 Diaphragm.
 External intercostals.
 Accessory muscles.
 Include sternomastoids,
scalene muscles

 Expiratory muscles
 Abdominal muscles.
 Internal intercostals.
DIAPHRAGM
 during quiet inspiration, its
contraction accounts for 2/3 (75%) of
increase in size of thoracic volume

 innervated by phrenic nerve

(C3,C4,C5)
DIAPHRAGM

 During quiet breathing → moves 1 cm

 During deep breathing → move as much as
10cm
Normal quiet breathing

During inspiration: contraction of the

diaphragm, pulls the lower surfaces of the
lungs downward

During expiration: by relaxation of the

diaphragm and elastic recoil of the lungs,
chest wall, and abdominal structures
compresses the lungs
MECHANICAL PROPERTIES
OF THE LUNG and CHEST
WALL

STATIC LUNG VOLUMES

 Pulmonary Volumes
 Tidal volume
 Volume of air inspired or expired during a normal
inspiration or expiration (500ml)
 Inspiratory reserve volume
 Amount of air inspired forcefully after inspiration of
normal tidal volume (3000ml)
 Expiratory reserve volume
 Amount of air forcefully expired after expiration of normal
tidal volume (1200ml)
 Residual volume
 Volume of air remaining in respiratory passages and
lungs after the most forceful expiration (1200ml)
 Pulmonary Capacities
 Inspiratory capacity
 Tidal volume plus inspiratory reserve volume
 Functional residual capacity
 Expiratory reserve volume plus the residual volume
 Vital capacity
 Sum of inspiratory reserve volume, tidal volume, and
expiratory reserve volume
 Total lung capacity
 Sum of inspiratory and expiratory reserve volumes
plus the tidal volume and residual volume
 Physiologic variations in vital
capacity:
 Vital capacity is affected by:
a. sex - adult females is 20-25% less than
males
b. age - decreases with age
RV increases with age
c. height
d. body built – thin people > obese
 Well trained athletes have a VC 30-40% >
untrained
Aging and the Pulmonary System
Obstructive Pulmonary
Diseases
 Associated with increased airway
resistance
 Residual volume increases (harder to
expire)
 Functional residual capacity increases
 Total lung capacity increases
Restrictive Pulmonary
Diseases
 More difficult for lungs to expand
 Total lung capacity decreases
 Vital capacity decreases
FACTORS AFFECTING
PULMONARY VENTILATION:
1. COMPLIANCE
2. AIRWAY RESISTANCE
LUNG COMPLIANCE
 Refers to how easily can the lung be
distended or expanded
 a measure of how volume changes as a
result of a pressure change
 Inversely correlated with ELASTANCE
Lung Compliance
 The greater the compliance, the
easier it is for a change in pressure
to cause expansion

 A lower-than-normal compliance
means the lungs and thorax are
harder to expand
LUNG COMPLIANCE
 depends on lung volume
 slightly greater when measured during
deflation than when measured during inflation
 Compliance = V
P

 normally 200ml/cm of water pressure

 Determined by two main factors
1. Elastic forces of the lung tissue and
surrounding thoracic cage
2. Surface tension of the alveoli
CHANGES IN LUNG COMPLIANCE
(pathologic states)
 EMPHYSEMA ( increased lung compliance)
- loss of elastic fibers

 FIBROSIS (decreased lung compliance)

- stiffening of lung tissues
Surface Tension
 Law of Laplace states
that pressure in alveolus
is directly proportional to
ST; & inversely to radius Insert fig. 16.11
of alveoli

 Thus, pressure in
smaller alveoli would
be greater than in
larger alveoli, if ST
were same in both
Downloaded from: StudentConsult (on 23 August 2009 05:14 PM)
© 2005 Elsevier
Surfactant
 Lowers Surface tension by getting between
H20 molecules, reducing their ability to attract
each other via hydrogen bonding
 has “anti-stick” property
 Increases lung compliance
 Decreases work of breathing
Factors That Diminish Lung Compliance
 Scar tissue or fibrosis that reduces the
natural resilience of the lungs ex. pulmonary
fibrosis, TB
 Blockage of the smaller respiratory passages
with mucus or fluid ex. Pulmonary edema
 Reduced production of surfactant ex. HMD
 Decreased flexibility of the thoracic cage or
its decreased ability to expand ex.
Deformities, muscle paralysis
Factors That INCREASE Lung Compliance

 Emphysema – destruction of elastic fibers

in alveolar walls

 Old age
AIRWAY RESISTANCE

 determined by rate of gas flow (velocity

of gas molecules multiplied by cross
sectional area) and diameter of airways

 Gas flow is inversely proportional to

resistance with the greatest resistance
being in the medium-sized bronchi
AIRWAY RESISTANCE
 From trachea to alveolar
ducts, total cross sectional
area of airways progressively
increases
 Velocity of airflow decreases
rapidly
 In trachea and main bronchi,
airflow is turbulent
 In small airways, airflow is
laminar
 Highest resistance to airflow
is in medium sized bronchi
AIRWAY RESISTANCE
 Airway radius is the most important
determinant of resistance
(POISEUILLE’S LAW)
R =8ηl
π r4
 Smaller airway means higher resistance for
any flow rate
 COPD narrows small airways
high airway resistance
 Factors that change airway
resistance:

1. Contraction or relaxation of
bronchial smooth muscle
2. Lung volume
3. Viscosity or density of the
inspired gas
 1. Contraction or relaxation
of bronchial smooth muscle
↑ airway resistance
 Vagal stimulation → bronchoconstriction
 Noncholinergic excitatory mediators
( substance P, neurokinins) → bronchoconstriction
 VIP relax smooth muscle
 Histamine

↓ airway resistance
Sympathetic stimulation → bronchodilation
2. LUNG VOLUMES
 High lung volumes
 More traction and decreased airway
resistance

 Low lung volumes

 Less traction and ↑ airway resistance
 3. Viscosity or density of the
inspired gas
 During a deep sea dive, there is
↑ resistance due to ↑ gas density
because of increased pressure

 Breathing a low-density gas like helium

reduces resistance to air flow
Neurohumoral Regulation of
Airway Resistance
INCREASE AIRWAY RESISTANCE
 Stimulation of efferent vagal fibers

 Inhalation of smoke, dust, cold air

 Histamine, Ach, thromboxane A2, Prostaglandin F2,

leukotrienes

DECREASE AIRWAY RESISTANCE

 Sympathetic stimulation

 epinephrine
DYNAMIC LUNG
VOLUMES
 PULMONARY
FUNCTION TESTS
Pulmonary Function Tests:
Forced Vital Capacity (FVC)

Maximum volume inhale followed

by exhale as fast as possible

 Low FVC indicates restrictive pulmonary

disease
Pulmonary Function Tests:
Forced Expiratory Volume (FEV)

Percentage of FVC that can be exhaled

within certain time frame

 FEV1 = percent of FVC that can be exhaled

within 1 second
 FEV1 & FVC

• Forced expiratory
volume in 1 second
– young trained athletes:
4.0 L FEV1

• Forced vital capacity FVC

– young trained athletes:
5.0 L

• FEV1/FVC = 80%
 Normal FEV1 = 80%
 ( If FVC = 4000 ml, should expire 3200 ml in
1 sec)
 FEV1 < 80% indicates obstructive pulmonary
disease
Work of Breathing
 Compliance work (elastic work)
- required to expand the lungs against its elastic
forces
 Tissue resistance work
- Work required to overcome viscosity of the lung
and chest wall structures
 Airway resistance work
- Required to overcome airway resistance during
the movement of air into the lungs
WORK ENERGY REQUIRED
FOR RESPIRATION
 Only 3-5% of the total work energy
expended by the body is required
 During heavy exercise, can increase
50 fold