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• Respiration – exchange of gases between the atmosphere, blood and

• Lungs – main organ of respiration
- extends from the diaphragm to the clavicle
- base – broad inferior portion
- apex – narrow superior portion
- costal surface – surface of the lung lying against the ribs
- mediastinal (media) surface
- hilus – region of the lungs through which the bronchi,
pulmonary vessels, lymphatic vessels and nerves enter and exit

Right Lung
- has 3 lobes (upper, middle, lower)
- has the horizontal fissure which separates the superior lobe
from the inferior lobe middle lobe
- oblique fissure separates the superior lobe and the inferior lobe
from the middle lobe
- further divides into 10 broncho-pulmonary segments
- thicker and broader than the left lung

Left Lung
- has 2 lobes (upper, lower)
- has an oblique fissure which separates the superior from the
inferior lobe
- further divides into 8 broncho-pulmonary segments
- has a functional lobe Lingula found at the cardiac notch

2 Properties of the Lungs

1. Compliance
- refers to the distensibility of the lungs
- ability of the lungs to distend/expand

2. Elasticity
- ability of the lungs to return to its original size

3 Steps of Respiration/Basic Functions of the Lungs

1. Pulmonary Ventilation – simple breathing
2. External/Pulmonary Respiration – exchange gas bet. lungs and blood
3. Internal/Tissue Respiration – there is exchange of gas bet. its tissue &

Structural Portion of the Respiratory System

1. Upper Respiratory System – Nose and Pharynx
2. Lower Respiratory System – Larynx, Trachea, Bronchi, Lungs

Functional Portions

1. Conducting Portion – series of interconnecting cavities and tubes that
conduct air into the lungs
2. Respiratory Portion – portion where gas that exchange occurs

• Otorhinolaryngology – branch of medicine that deals with the
diagnosis and treatment of diseases (ENT)

Upper Respiratory Tract

A. Nose
- external nares
- warms, filters, moisten air that is inhaled
- receives olfactory stimuli
- modifies speech sounds (resonating chambers)

B. Pharynx
- funnel shaped, 13 cm long
- passageway for air and food, resonating chamber
- *Eustachian Tube – equalizes air pressure bet. pharynx and
middle ear
- Nasopharynx, Oropharynx, Laryngopharynx

C. Larynx
- aka voice box, C4-C6
- Thyroid cartilage, epiglottis, cricoid cartilage (Single)

- Arytenoids (influence position of vocal cords), cuneiforms
corniculate cartilage (Paired)

Lower Respiratory Tract

D. Trachea
- aka windpipe, tubular passageway, 12 cm in length, 2.5 cm in
- larynx to T5
- layers – muscosa, submuscosa, hyaline cartilage, adventitia
- ciliated columnar epithelium with goblet cell
- 16 -20 incomplete cartilage rings
- * Carina – internal ridge where the trachea divides into the left
and right mainstem bronchi. The most sensitive area for the
cough reflex.
- * cricoid cartilage the only complete ring of cartilage in the
respiratory tract

E. Bronchi

- starts at the level of the superior border of T5
- Right primary bronchus more vertical, shorter and wider than
left (Aspiration is common)

F. Secondary/Lobar Bronchi
- one for each lobe of the lungs
- 3 right, 2 left

G. Tertiary/Segmental Bronchi
- corresponds to the different broncho-pulmonary segments
- 10 right, 8 left

H. Bronchioles
- 6 – 18 division

I. Terminal Bronchioles
- no more secreting cells, macrophages are present

• Note: there are 23 generations of your tracheo-bronchial tree

Respiratory Portion
J. Respiratory Bronchiole
- transitional zone
- area between the conducting portion and the respiratory portion

K. Alveoli
- functional unit of the lungs
- 300 million in number
- small balloons (alveolar space)
- lined with many capillaries (where gas exchange occurs)

L. Alveolar Sacs

M. Alveolar ducts

2 types of Alveolar Cells/Pneumocytes

1. Type I
- flat cells, main composition of the alveoli
- squamous pulmonary epithelial

2. Type II (septal cells)
- ovoid shaped cells, fewer in number
- function: produce surfactant

* Surfactant – decreases the surface tension, prevent the collapse
of the lungs
- produces an interface which separates the fluid from the
alveolar lining thus preventing cohesive force of the fluid
- dipalmitoyl lecithin

* Alveolar Macrophages (dust cells) – wandering phagocytes
• Proximal Passageway is lined with Pseudostratified Squamous
Ciliated Epithelium
• Muco-Ciliary Action/Transport

Pulmonary Ventilation
- aka Breathing
- process by which gases are exchanged between the atmosphere
and lung alveoli
- Air moves in the lungs if the pressure inside the lungs is greater
than the pressure in the atmosphere
- Accomplished by the muscle work.

A. Inspiration/Inhalation
- the process of taking in air into the lungs


Muscles of Inspiration:

1. Diaphragm - main muscle of inspiration
- innervated by the phrenic nerve (C3-C5)
- increases the thoracic space by moving downward (piston

2. External Intercostals
- innervated by T1 – T2 roots
- accessory muscles of inspiration
- increases the diameter of the rib cage in all directions (pulls the
ribs upward and laterally)

• Other muscle of Inspiration: SCM, Traps, Scalenes

B. Expiration/Exhalation
- is a passive process in N breathing
- elastic recoil of the lungs and tissues causes expiration
- intrathoracic/pleural pressure becomes less negative, intra-
alveolar pressure becomes positive in reference to atmospheric
- Active expiration only occurs during physical exertion and
pathological conditions

Active expiratory muscles:

1. Abdominals (T10-T12)
- main muscle of active expiration
- when these muscle contract the abdominal contents are pushed
upwards toward the diaphragm promoting expiration

2. Internal Intercostals (T1-T12)
- decreases the diameter of the thorax thereby increasing the
pressure of the thoracic cage.

Breathing Patterns:

1. Euphea - normal breathing
2. Apnea - absence of breathing
3. Dyspnea – painful or labored breathing
4. Tachypnea – rapid breathing
5. Costal breathing – shallow chest breathing
6. diaphragmatic – deep abdominal breathing

Note: Airways increase in diameter during inspiration and decreases in
diameter during expiration. Therefore more airway resistance is
encountered during expiration.

Mechanics of Respiration:

1. Pump Handle Motion
- increase in the A-P diameter
- there is forward and upward movement of the sternum
- accomplished by muscle action

2. Bucket Handle Motion
- increase in the lateral/transverse diameter
- * Caliper motion – term used in the lower ribs (8th to 10th ribs
glare outward increasing the subcostal angle

3. Piston Action
- action of the diaphragm (central tendon of diaphragm descends
as the muscle contracts
- increase the vertical diameter/dimension of the thoracic space

Lung Volumes and Capacities

1. Tidal Volume - 500 ml
- relaxed inspiration followed by relaxed expiration

2. Inspiratory Reserve Volume – 3000 ml
- amount of air which can be breathed in after normal resting
inspiration. Usually kept in reserve

3. Expiratory Reserve Volume – 1100 ml
- amount of air which can be exhaled after normal resting

4. Residual Volume - 1200 ml
- amount of air left in the lungs after maximal expiration

5. Vital Capacity
- TV + ERV + IRV
- maximal inspiration followed by maximal expiration
- total amount of air in the lungs which is under volitional control

6. Total Lung Capacity
- VC + RV
- total amount of air in the lungs after maximal inspiration

7. Inspiratory Capacity
- maximum amount of air breathed in after resting expiration

8. Functional Residual Capacity
- ERV + RV
- amount of air left in the lungs after normal resting expiration

Flow Rates - amount of air that can be expired in a given time
- reflects the elasticity of the lungs and tissues
- ability to expel air in a hurry
- reflects the resistance the air meets as it is blown outside

FEV1 - forced expiratory volume in 1 sec.

- amount of air expired forcefully in 1 sec.
- 75-85 % of Forced vital capacity
- Dependent on the size of the airways

Note: The ration of the FEV1 to FVC should equal to 1. A decrease of wich
indicates restrictive lung disease. An increase of which indicates obstructive
lung disease.

Dead Space:
- amount of air in the lungs which does not participate in gas

A. Anatomical Dead Space
- these are air in the conducting portion of the respiratory tract

B. Alveolar Dead Space
- amount of air in the alveoli which do not participate in gas
- also referred as pathological dead space

C. Physiological Dead Space
- anatomical dead space + alveolar dead space
- In normal people anatomical dead space equals
physiological dead space.

Ventilation – Perfusion Ratio (V-Q Ratio)
- ratio between the air going in the alveolar space and the amount
of blood perfused (unoxygenated blood that goes for

Note: If you have an occlusion in the capillary perfusion is decreased,
ventilation is normal. If you have an occlusion in the ventilation path, the
part is well perfuse and ventilation is decreased. These 2 conditions will
have an imbalance on the V-Q ratio and no gas exchange will occur.

External (Pulmonary) Respiration
- Exchange of Q2 and CO2 between air in the alveoli of the lungs
and blood in the pulmonary capillaries.

Factors affecting the Rate of External Respiration

1. Partial Pressure difference of the gases
 alveolar pO2 is higher than pO2 in pulmonary capillaries,
O2 diffuses from alveoli to blood
2. surface area for gas exchange – the greater the surface area the
higher is the rate of gas exchange.
3. Diffusion distance – the less the distance the higher the rate
4. Solubility and molecular weight of gases – greater solubility
greater rate of exchange, lower molecular weight greater

Internal (Tissue) Respiration
- exchange of O2 and CO2 between tissue blood capillaries and
tissue cells.
- Results in the conversion of oxygenated blood into
deoxygenated blood

Respiratory Center

- the area from which nerve impulses are sent to respiratory
- Bilaterally located in the medulla oblongata and pons.
- Consists of widely dispersed group of neurons that is
functionally divided into three areas:
i. Medullary rhythmicity area in the medulla oblongata
ii. Pheumotaxic area in the pons
iii. Apneustic area in the pons.

HYPOXIA – Any condition which there is no adequate supply of oxygen to
the tissues. The term anoxia has been used interchangeably by common
usage, to mean the same. Several types of hypoxia are recognized:

1) Hypoxic hypoxia – characterized by lower than normal pO2 in arterial

2) Anemic Hypoxia – characterized by lowered O2 capacity of the blood.

3) Circulatory hypoxia – characterized by a decrease rate of blood flow.

4) Histotoxic hypoxia – there is actually no O2 lack but rather an inability of
the cells to utilized the O2 brought to them.

ANOXEMIA means reduced O2 in the body fluids especially in the arterial

CYANOSIS – Bluish color of the skin because of the presence of the
excessive amount of deoxygenated blood in the skin capillaries. Frank
cyanosis will appear whenever the arterial blood contains more than 5 grams
percent of deoxygenated blood.

ASPHYXIA – refers to conditions where anoxia is combined with increased
carbon dioxide tension in the arterial blood and hence in the tissue also.

Respiratory acidosis – Decrease the rate of pulmonary ventilation will
increase the concentration of dissolved carbon
dioxide, carbonic acid and hydrogen ions thus
resulting in acidosis.
Respiratory alkalosis – Excessive pulmonary ventilation causes excessive
loss of CO2, decreases the hydrogen ion
concentration and results in alkalosis.
Metabolic acidosis – The high hydrogen ion concentration in metabolic
acidosis causes increased pulmonary ventilation
favoring the loss of CO2 thus reducing the hydrogen
ion concentration.
Metabolic alkalosis – The pulmonary ventilation is decreased thus
the hydrogen ion concentration and lowering the ph