Respiratory

Physiology:

Eric Mayo Dagradi MD

Department of Physiology
Hang Tuah Medical School
 Respiration

• Ventilation: Movement of air into and out

of lungs
• External respiration: Gas exchange between
air in lungs and blood
• Transport of oxygen and carbon dioxide in
the blood
• Internal respiration: Gas exchange between
the blood and tissues
 Respiratory System Functions
• Gas exchange: Oxygen enters blood and carbon
dioxide leaves
• Regulation of blood pH: Altered by changing
blood carbon dioxide levels
• Voice production: Movement of air past vocal
folds makes sound and speech
• Olfaction: Smell occurs when airborne molecules
drawn into nasal cavity
• Protection: Against microorganisms by preventing
entry and removing them
Respiratory System Divisions
• Upper tract
– Nose, pharynx and
associated
structures
• Lower tract
– Larynx, trachea,
bronchi, lungs
Nasal Cavity and Pharynx
 Nose and Pharynx

• Nose • Pharynx
– Common opening for
– External nose
digestive and respiratory
– Nasal cavity systems
• Functions
– Three regions
– Passageway for air
• Nasopharynx
– Cleans the air
• Oropharynx
– Humidifies, warms air
• Laryngopharynx
– Smell
– Along with paranasal
sinuses are resonating
chambers for speech
 Larynx

• Functions
– Maintain an open passageway for air movement
– Epiglottis and vestibular folds prevent swallowed material from
moving into larynx
– Vocal folds are primary source of sound production
Vocal Folds
Trachea

• Windpipe
• Divides to
form
– Primary
bronchi
– Carina:
Cough
reflex
 Tracheobronchial Tree
• Conducting zone
– Trachea to terminal bronchioles which is
ciliated for removal of debris
– Passageway for air movement
– Cartilage holds tube system open and smooth
muscle controls tube diameter
• Respiratory zone
– Respiratory bronchioles to alveoli
– Site for gas exchange
Tracheobronchial Tree
Bronchioles and Alveoli
Alveolus and Respiratory Membrane
• Fig. 4. Effects of methacholine on
depth of airway
• surface liquid. a: control tissue
not exposed to methacholine.
• b: 2-min methacholine exposure.
Putative
• sol and mucous gel are clearly
visible. c: 30-min
• exposure. Tissues were radiant
etched for 20 s to 1
• min. Scale bar 5 20 μm.

• From Am. J. Physiol. 274 (Lung

Cell. Mol. Physiol. 18): L388–L395,
1998.—
 Lungs

• Two lungs: Principal organs of respiration

– Right lung: Three lobes
– Left lung: Two lobes
• Divisions
– Lobes, bronchopulmonary segments, lobules
 Thoracic Walls
Muscles of Respiration
Thoracic Volume
 Pleura

• Pleural fluid produced by pleural membranes

– Acts as lubricant
– Helps hold parietal and visceral pleural membranes
together
 Ventilation

• Movement of air into and out of lungs

• Air moves from area of higher pressure to
area of lower pressure
• Pressure is inversely related to volume
Alveolar Pressure Changes
 Changing Alveolar Volume
• Lung recoil
– Causes alveoli to collapse resulting from
• Elastic recoil and surface tension
– Surfactant: Reduces tendency of lungs to collapse

• Pleural pressure
– Negative pressure can cause alveoli to expand
– Pneumothorax is an opening between pleural
cavity and air that causes a loss of pleural
pressure
Normal Breathing Cycle
 Compliance

• Measure of the ease with which lungs and

thorax expand
– 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
• Conditions that decrease compliance
– Pulmonary fibrosis
– Pulmonary edema
– Respiratory distress syndrome
 Pulmonary Volumes
• Tidal volume
– Volume of air inspired or expired during a normal inspiration or
expiration
• Inspiratory reserve volume
– Amount of air inspired forcefully after inspiration of normal tidal
volume
• Expiratory reserve volume
– Amount of air forcefully expired after expiration of normal tidal
volume
• Residual volume
– Volume of air remaining in respiratory passages and lungs after
the most forceful expiration
 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
Spirometer and Lung
Volumes/Capacities
 Minute and Alveolar Ventilation
• Minute ventilation: Total amount of air moved
into and out of respiratory system per minute
• Respiratory rate or frequency: Number of
breaths taken per minute
• Anatomic dead space: Part of respiratory
system where gas exchange does not take place
• Alveolar ventilation: How much air per minute
enters the parts of the respiratory system in
which gas exchange takes place
 Physical Principles of Gas
Exchange
• Partial pressure
– The pressure exerted by each type of gas in a mixture
– Dalton’s law
– Water vapor pressure
• Diffusion of gases through liquids
– Concentration of a gas in a liquid is determined by its
partial pressure and its solubility coefficient
– Henry’s law
 Physical Principles of Gas
Exchange
• Diffusion of gases through the respiratory
membrane
– Depends on membrane’s thickness, the diffusion coefficient
of gas, surface areas of membrane, partial pressure of gases
in alveoli and blood
• Relationship between ventilation and
pulmonary capillary flow
– Increased ventilation or increased pulmonary capillary blood
flow increases gas exchange
– Physiologic shunt is deoxygenated blood returning from
lungs
 Oxygen and Carbon Dioxide
Diffusion Gradients
• Oxygen • Carbon dioxide
– Moves from alveoli into – Moves from tissues
blood. Blood is almost into tissue capillaries
completely saturated
– Moves from
with oxygen when it
leaves the capillary pulmonary capillaries
into the alveoli
– P02 in blood decreases
because of mixing with
deoxygenated blood
– Oxygen moves from
tissue capillaries into the
tissues
Changes in Partial Pressures
Hemoglobin and Oxygen Transport
• Oxygen is transported by hemoglobin (98.5%) and
is dissolved in plasma (1.5%)
• Oxygen-hemoglobin dissociation curve shows that
hemoglobin is almost completely saturated when
P02 is 80 mm Hg or above. At lower partial
pressures, the hemoglobin releases oxygen.
• A shift of the curve to the left because of an
increase in pH, a decrease in carbon dioxide, or a
decrease in temperature results in an increase in
the ability of hemoglobin to hold oxygen
 Hemoglobin and Oxygen
Transport
• A shift of the curve to the right because of a
decrease in pH, an increase in carbon dioxide, or an
increase in temperature results in a decrease in the
ability of hemoglobin to hold oxygen
• The substance 2.3-bisphosphoglycerate increases the
ability of hemoglobin to release oxygen
• Fetal hemoglobin has a higher affinity for oxygen
than does maternal
 Oxygen-Hemoglobin
Dissociation Curve at Rest
Bohr effect:
Temperature effects:
Shifting the Curve
 Transport of Carbon Dioxide
• Carbon dioxide is transported as bicarbonate ions
(70%) in combination with blood proteins (23%)
and in solution with plasma (7%)
• Hemoglobin that has released oxygen binds more
readily to carbon dioxide than hemoglobin that
has oxygen bound to it (Haldane effect)
• In tissue capillaries, carbon dioxide combines with
water inside RBCs to form carbonic acid which
dissociates to form bicarbonate ions and
hydrogen ions
 Transport of Carbon Dioxide
• In lung capillaries, bicarbonate ions and hydrogen
ions move into RBCs and chloride ions move out.
Bicarbonate ions combine with hydrogen ions to
form carbonic acid. The carbonic acid is
converted to carbon dioxide and water. The
carbon dioxide diffuses out of the RBCs.
• Increased plasma carbon dioxide lowers blood
pH. The respiratory system regulates blood pH by
regulating plasma carbon dioxide levels
CO2 Transport and Cl- Movement
Ventilation-perfusion coupling:
 Respiratory Areas in Brainstem

• Medullary respiratory center

– Dorsal groups stimulate the diaphragm
– Ventral groups stimulate the intercostal and
abdominal muscles
• Pontine (pneumotaxic) respiratory group
– Involved with switching between inspiration and
expiration
Respiratory Structures in Brainstem
 Rhythmic Ventilation
• Starting inspiration
– Medullary respiratory center neurons are continuously active
– Center receives stimulation from receptors and simulation from parts of
brain concerned with voluntary respiratory movements and emotion
– Combined input from all sources causes action potentials to stimulate
respiratory muscles
• Increasing inspiration
– More and more neurons are activated
• Stopping inspiration
– Neurons stimulating also responsible for stopping inspiration and
receive input from pontine group and stretch receptors in lungs.
Inhibitory neurons activated and relaxation of respiratory muscles
results in expiration.
 Modification of Ventilation

• Cerebral and limbic • Chemical control

system – Carbon dioxide is major
regulator
– Respiration can be
• Increase or decrease in
voluntarily controlled pH can stimulate chemo-
and modified by sensitive area, causing a
emotions greater rate and depth of
respiration
– Oxygen levels in blood
affect respiration when a
50% or greater decrease
from normal levels exists
Modifying Respiration
Regulation of Blood pH and Gases
 Herring-Breuer Reflex

• Limits the degree of inspiration and prevents

overinflation of the lungs
– Infants
• Reflex plays a role in regulating basic rhythm of
breathing and preventing overinflation of lungs
– Adults
• Reflex important only when tidal volume large as in
exercise
 Ventilation in Exercise
• Ventilation increases abruptly
– At onset of exercise
– Movement of limbs has strong influence
– Learned component
• Ventilation increases gradually
– After immediate increase, gradual increase
occurs (4-6 minutes)
– Anaerobic threshold is highest level of exercise
without causing significant change in blood pH
• If exceeded, lactic acid produced by skeletal muscles
 Effects of Aging

• Vital capacity and maximum minute

ventilation decrease
• Residual volume and dead space increase
• Ability to remove mucus from respiratory
passageways decreases
• Gas exchange across respiratory membrane
is reduced