RESPIRATORY PHYSIOLOGY REVIEW Blood reservoir – The lung receives the venous blood to the respiratory muscles causing
to the respiratory muscles causing them to contract or
Functions of the Respiratory System
The functions of the respiratory system are:
Oxygen supplier. The job of the respiratory system is
to keep the body constantly supplied with oxygen.
Elimination. Elimination of carbon dioxide.
Gas exchange. The respiratory system organs
oversee the gas exchanges that occur between the
blood and the external environment.
Passageway. Passageways that allow air to reach the
lungs.
Humidifier. Purify, humidify, and warm incoming air.
Respiratory Anatomy and Physiology
Functionally the respiratory system consists of
the conducting and respiratory zones, namely the
upper and lower respiratory tract. The conducting
zones consist of the nasal cavities, pharynx, larynx
and trachea.
The purpose of the conducting zones is to
filter, humidify, warm and allow the passage of air to
the lower respiratory zones. The respiratory zones are
the site of gas exchange, containing the respiratory
bronchioles, alveolar ducts and alveoli. (Tortora &
Grabowski, 2000).
In addition to the vital function of gas exchange,
the respiratory system fulfils the following
functions
Acid base regulation – Through the process of
ventilation, the lung removes CO2 and regulates the
pH of the body. Regulation of pH is accomplished by
removing volatile acid (ie acid converted into the
gaseous state; in this case, carbonic acid converted to
CO2).
from the right ventricle. Due to the capacity of the
pulmonary circulation to receive blood, the lung acts
as a reservoir from which the left side of the heart
draws blood.
Filtering mechanism – The lung also constantly filters
the air we breathe and removes trapped particles
through the mucocillary clearance mechanism and the
lymphatic system. The lung also acts as a filtering
mechanism for blood by removing particles such gas
bubbles, small fibrin or blood clots, fat cells,
aggregates of platelets or WBC, and other pieces of
cellular debris.
Metabolism – The lung produces some very important
chemicals that serve physiological regulatory
functions such as vascular dilatation, blood clotting,
lung structural stability and neurotransmitters. Some
chemicals passing through the lungs are converted
into their more active form, such as angiotensin I,
produced by the kidneys, which is converted to
angiotensin II, a potent vasoconstrictor
Control of respiration
Breathing is usually involuntary but voluntary
breathing is necessary when the person is doing other
activities such as walking, talking, singing, etc. In
these cases homeostatic changes in ventilatory rate
and volume are adjusted automatically by the nervous
system to maintain normal gas exchange
The lung is innervated by the autonomic
nervous system (ANS). Fibers of the sympathetic
division in the lung branch from the upper thoracic
and cervical ganglia of the spinal cord, while fibers of
the parasympathetic division travel in the vagus
nerve, which is important in the regulation of
ventilation.
The respiratory centers in the brain stem
control involuntary ventilation by transmitting impulses
relax.
The pneumotaxic center in the upper pons
functions to maintain rhythmic respirations. It
stimulates the expiratory center, which then sends
inhibitory signals to the inspiratory center. Inspiration
ends and expiration begins. Strong stimuli from the
pneumotaxic center result in shorter inspiration, and
mild stimuli results in a longer one. The apneustic
center sends stimuli to the inspiratory center and
prolongs inspiration. The pneumotaxic center usually
overrides the apneustic center. Impulses are
transmitted from lung receptors, which are receptors
that respond to physical changes in the pulmonary
system, and chemoreceptors, which are receptors
that respond to changes in oxygen or carbon dioxide
concentrations, through the sympathetic and
parasympathetic divisions of the ANS and the
respiratory centers in the brain stem.
Respiratory Volumes and Capacities
Tidal volume. Normal quiet breathing moves
approximately 500 ml of air into and out of the lungs
with each breath.
Inspiratory reserve volume. The amount of air that can
be taken in forcibly over the tidal volume is the
inspiratory reserve volume, which is normally between
2100 ml to 3200 ml.
Expiratory reserve volume. The amount of air that can
be forcibly exhaled after a tidal expiration, the
expiratory reserve volume, is approximately 1200 ml.
Residual volume. Even after the most strenuous
expiration, about 1200 ml of air still remains in the
lungs and it cannot be voluntarily expelled; this is
called residual volume, and it is important because it
allows gas exchange to go on continuously even
between breaths and helps to keep the alveoli
inflated.
Vital capacity. The total amount of exchangeable air is
typically around 4800 ml in healthy young men, and
this respiratory capacity is the vital capacity, which is
the sum of the tidal volume, inspiratory reserve
volume, and the expiratory reserve volume.
Dead space volume. Much of the air that enters the
respiratory tract remains in the conducting zone
passageways and never reaches the alveoli; this is
called the dead space volume and during a normal
tidal breath, it amounts to about 150 ml.
Functional volume. The functional volume, which is
the air that actually reaches the respiratory zone and
contributes to gas exchange, is about 350 ml.
Spirometer. Respiratory capacities are measured with
a spirometer, wherein as a person breathes, the
volumes of air exhaled can be read on an indicator,
which shows the changes in air volume inside the
apparatus.
DEAD SPACE VENTILATION
Dead space is the amount of gas that is involved in
ventilation but does not take part in gas exchange.
(Not all the air in each breath is used for the exchange
of oxygen and carbon dioxide. About a third of every
resting breath is exhaled exactly as it came into the
body.)
There are four types of dead space:
Anatomic dead space – This refers to the
amount of gas that fills the conducting passages of
the airway and is not involved in gas exchange. In
most adults, this value is estimated at 2 mL/kg of body
weight. For the normal sized adult, it is usually about
150 mL. Therefore, if the normal tidal volume is 500
mL, only 350 mL of tidal volume is actually involved in
gas exchange as illustrated below.
Alveolar dead space – This is the amount of
gas filling the alveoli that does not contribute to gas
exchange.
Mechanical dead space – This is the
contribution to the patient's dead space through the
addition of respiratory circuit attachments, etc.
Physiologic / total dead space – This value
is the sum of anatomic and alveolar dead space. It
represents the total volume in the airways and alveoli
not participating in gas exchange.
LUNG MECHANICS
1. Compliance
2. Normally inspiration is an active process,
accomplished through the expansion of the
lungs and the thorax. The ease with which the
lungs and thorax can be expanded, or
distended, is referred to as compliance. Total
compliance therefore depends not only on the
elasticity of the lung tissue, but also on that of
the thoracic cage.
LUNG MECHANICS: COMPLIANCE
Compliance is reduced by any factor that:
- Reduces the natural elasticity of the lungs, eg
fibrosis, or interstitial edema.
- Reduces the total number of functional alveoli, eg
atelectasis or airway obstruction.
- Increases the stiffness of the chest wall, eg splinting
because of pain.
- Decreases the stiffness of the chest wall, eg post-
sternotomy, resulting in decreased FRC.
- Checks the ability of the thorax to increase in
volume, eg abdominal distension.
ARTERIAL BLOOD GASES
Measurements of arterial blood gases (ABGs) are
obtained to assess adequacy of oxygenation and
ventilation, to evaluate acid-base status by measuring
the respiratory and non-respiratory components, and
to monitor effectiveness of therapy.
Arterial blood gas measures the following parameters:
pH, PaO2, PaCO2. The ABG derives the base excess or
deficit, HCO3 and SaO2.
Measured Parameters:
1. pH – this reflects the hydrogen ion
concentration in the blood.
2. PaO2 – reflects the partial pressure of oxygen
in the arterial blood
3. PaCO2 – reflects the partial pressure of
carbon dioxide in the arterial blood
Acid base imbalance assessment of ABG4
Buffers. The body will always try to maintain
homeostasis and restore the pH to normal. This
process is called compensation and is controlled by
the use of buffers. Buffers are weak acids or bases
that prevent sudden change in pH.
Examples of buffer systems are:
- Phosphate Buffer System
- Hb/OxyHb System - Hb releases O2 and attracts H
ions
- Protein buffer system - Carboxyl (COO-H+) and
Amine (NH3-) groups.
- Bicarbonate - Carbonic Buffer System
Acidosis (pH < 7.35) is the abnormal increase in H ions
(acid) or loss of HCO3 (base).
Alkalosis (pH > 7.45) is the abnormal increase in HCO3
(base) or loss of H ions (acid).
Acidosis and alkalosis may be RESPIRATORY or
METABOLIC in nature:
1. Conditions leading to Acidosis/Alkalosis
involve a multitude of physiological processes
such as:
2. Respiratory/renal dysfunction
3. Disturbances of tissue oxygenation, circulation
4. Substance ingestion
 5. Electrolyte loss/gain
NORMAL OXYGENATION PHYSIOLOGY REVIEW
 Adequate oxygenation of the body depends on
a healthy, intact respiratory system.
 The respiratory system obtains oxygen from
the air and transports it into the alveoli, where
oxygen diffuses into capillaries and is carried
by the blood to all cells of the body.
 The respiratory system also passes carbon
dioxide from the body.
 The upper respiratory system is the inlet for air
into the body.
 The nose is the typical inlet.
 The nose is divided into two nares, which are
moist, pink, mucosa-lined passageways.
 Nares warm, humidify, and filter air as it is
breathed into the nose.
The upper respiratory tract has two protective
mechanisms to prevent foreign matter from entering
the lower respiratory tract: sneezing and cilia.
 Foreign matter that enters the nose irritates
the nasal passages and induces sneezing.
 Sneezing is a reflexive action that clears the
upper airway. This reflexive action is active
even in the neonatal period.
 Cilia are microscopic fine hairs within the
posterior portion of the nares that trap small
particles of foreign matter to prevent their entry
into the lower respiratory tract. The cilia propel
foreign matter into the pharynx to be coughed
out or swallowed
Breathing also happens through the mouth, which
allows air to enter the respiratory system through
the pharyngeal cavity. The respiratory system
shares this cavity with the gastrointestinal system,
providing passage for air during breathing and for
food or drink during swallowing.
A protective mechanism within the pharyngeal cavity
prevents food or drink from entering the lower
respiratory tract. The glottis is the opening into the
lower respiratory tract. The epiglottis is pendulous
tissue that covers the tracheal opening during
swallowing or any time foreign matter contacts the
glottis. The closure of the epiglottis is a reflexive
response. The lower respiratory tract is enclosed in
the musculoskeletal structures of the neck and
thoracic cavity.
The trachea, which sits midline in the neck, is the
entrance for air into the lungs. During normal
breathing, the muscular structures of the neck are
relaxed and the larynx easily rises and falls with each
swallow. The chest wall effortlessly and symmetrically
rises and falls with each equally spaced breath.
Inspiration is half the rate of expiration. Eupnea
describes breathing within the expected respiratory
rates. Auscultation, listening to the body’s sounds with
a stethoscope, is an important diagnostic tool. When
airways are clear and functioning, auscultation of the
trachea will reveal a tubular sound of air movement,
as if produced through a tube.
The trachea bifurcates (divides in two) into two
bronchi to access the right and left lungs the right
bronchus is shorter and wider than the left. Each
bronchus further divides into bronchioles that
terminate in the alveoli sacs. These passageways for
air dilate and contract. The trachea and larger bronchi
are supported by C-shaped cartilage rings, as well as
by smooth muscle. The smaller bronchioles are
supported by smooth muscles only. Bronchioles
deliver air to the alveoli. These air passageways dilate
and contract as the autonomic nervous system
regulates the smooth muscles supporting them. The
movement of air within the bronchial tree creates a
mixture of sounds of air flowing through a tube and
the breeziness of the open alveolar lung fields. This is
termed bronchovesicular sound
The lungs are also described in terms of their lobes.
The lobes lie obliquely in the thoracic cavity. The right
lung has three lobes; the left lung has two lobes. The
inferior lobes are the largest. Most of the inferior lobes
lie in the posterior thoracic cavity. Each lung has a
pleural lining to aid respiration and separate it
from the other lung. The pleural lining has two
layers, and a minute amount of fluid between the
layers allows the structures to glide across one
another during respiration. The final portion of the
lower respiratory system is the air sacs. The
outcroppings of the air sacs are called alveoli. The
alveoli are the portion of the lungs that fulfills the
function of the respiratory system. Alveoli are not
directly connected to a specific bronchiole, but are
interconnected to the terminal airways and to each
other. This facilitates the filling of each alveoli with air.
The sounds of air moving into and out of the
lobes at the alveolar level are soft and breezy,
defined as vesicular.
The alveoli have specialized cells that produce
surfactant. Surfactant controls surface tension and
keeps the alveoli from collapsing and sticking to
themselves. Surfactant is produced only with
adequate oxygenation. Alveolar macrophages keep
the alveoli region free of microbes and are swept
upward from the alveolar region by cilia in the
airway passages. Macrophages are large cells of
the immune system that remove waste and
harmful microorganisms from the alveoli and from
other areas of the body. Mast The typical drive to
breathe occurs due to hypercarbia, an increased
level of carbon dioxide in the blood. Receptor sites
within the medulla and pons are sensitive to carbon
dioxide levels in the blood. Elevated levels of carbon
dioxide induce inhalation of air into the lungs.
Yawns and sighs are induced after periods of shallow
breathing or breath holding. Exhalation is a passive
response to relaxation of the muscles of
respiration. The typical breathing rate is regularly hypercarbia. Hypercarbia interferes with the body’s PHYSICAL ASSESSMENT TECHNIQUES
spaced, with inspiration half as long as expiration (I:E ability to respond appropriately to increased levels of
Physical assessment of the patient involves
= 1:2). Normal respiratory rates range from 30 to 60 carbon dioxide. When this happens, instead of
obtaining a history and the physical examination. With
breaths per minute in newborns to 10 to 20 breaths hypercarbia initiating the breathing response,
the frail elderly patient, the history may be a
per minute in an adult. Depth of normal inspiration is decreased levels of oxygen initiate the drive to
combination of admission information, answers from
about 500 mL of air with each breath. The expansion breathe. This is commonly seen in individuals
the next of kin, and comments from the patient. The
of the chest wall is observable, but is neither shallow with chronic obstructive pulmonary disease
assessment is divided into the data base and the
nor great. (COPD) resulting from prolonged cigarette
focused assessment. Prior to assessing any patient,
smoking because smoking is the primary cause of
Quality of breathing requires a patent airway, one that be sure that the procedure is explained to the patient
prolonged elevated levels of carbon dioxide.
is open and free of obstruction. Receptor sites in the and provision for privacy is assured.
aortic arch and carotid arteries monitor oxygen. These
receptors induce inspiration when oxygen levels fall
below normal. Stretch receptors within the lungs
control the volume of air inhaled with each breath.
During relaxed states, the lungs will fill to
approximately 0.5 L. Strenuous exercise results in
deeper breaths of increasing volume to meet the
oxygen demands of skeletal muscles. The ability of
the respiratory system to deliver oxygen to the blood
depends on an inflated and well-oxygenated alveolus
and an associated capillary with freely flowing blood
at an adequate blood pressure. The movement of
oxygen across the alveolar– capillary membrane
into a well-perfusing capillary is defined as the
ventilation-perfusion (V-Q) ratio. The concentration
levels of oxygen and carbon dioxide dictate the
movement of each gas across the alveolar–capillary
membrane.
Alterations and Manifestations Alterations in
oxygenation can be described in relation to changes
in breathing patterns, patency of airway, or
interference with gas exchange. Damage to the
supporting thoracic structure, either by injury or
disease, can interfere with effective respiration.
Irritation or inflammation of the respiratory mucosa
also affects the ability of the respiratory system to
obtain adequate oxygenation for the cells within the
body. The typical drive to breathe occurs due to
 The physical examination portion of the
assessment requires the techniques of
inspection, palpation, percussion, and
auscultation.
Inspection - is informed observation, or looking at your
patient with a purpose. Adequate lighting is an
important tool for inspection. Inspection takes place
during all components of the assessment from the
health history through the physical examination.
Palpation - all parts of the body can be palpated
including tissues, bones, muscles, glands, organs,
hair, and skin. When palpating, make sure that your
hands are warm. Try to get the patient to relax, since
tension can tighten muscles and alter the palpation
technique. One method for helping the patient to relax
is to have him/her take some slow deep breaths in
and out of the mouth. This serves the purpose of
relaxing the muscles and helping the patient to focus
on something else. Palpation can be done with
different parts of the hands for assessing different
qualities.
Auscultation - involves listening with the ear or a
stethoscope. Try to keep the environment free of
extraneous sounds. For example, turn the T.V. off
when auscultating. Essential to auscultation is a good
stethoscope. The stethoscope should have short,
thick, tubing and contain a bell and a diaphragm.
Percussion - involves tapping one finger on top of the
finger of the other hand to determine sounds from
underlying structures. Helpful to determine if there is
air or consolidation. For the lungs, percussion is
performed at the location of the intercostals spaces.
PAST HEALTH HISTORY
Respiratory System - ask if patient has had
pneumonia, asthma, bronchitis, emphysema,
tuberculosis, and how often he/she gets colds.
Cardiovascular disease - a history of Congestive
Heart Failure or
Pulmonary Edema may in fact be the problem that is
presented to you which would have symptoms of
shortness of breath.
Chest surgery - find out if patient has had any surgery
on the lungs.
Allergies - chronic allergies may predispose client t
other respiratory disorders.
PRESENT ILLNESS
Progression of symptoms
Dyspnea or shortness of breath with chronic
obstructive pulmonary disease (COPD)
 usually progresses over a long period of time.
An acute situation produces dyspnea at rest. Acute
onset of dyspnea or shortness
 of breath is important for assessing
pneumonia, pneumothorax, hemothorax, or
pulmonary embolism.
Cough occurring daily over 2 or more years is
indicative of chronic bronchitis.
 Coughing is usually caused by irritants such
as smoking.
Sputum production
 purulent sputum is associated with lung
abscess
 viscous sputum associated with chronic
obstructive pulmonary disease (COPD)
 Blood tinged sputum can occur with
tuberculosis, carcinoma, or pulmonary
embolism.
Chest pain - may be associated with cardiovascular
disorders or musculoskeletal
 chest pain. The lungs do not have pain-
sensitive nerves. The pleura and
 tracheobronchial tree are sensitive to pain.
Pleuritic pain usually hurts more during
 deep breaths.
REVIEW OF SYSTEMS
actual pulmonary problems
cardiovascular difficulties - differentiate if the
shortness of breath is from
 a cardiac or respiratory origin. Acute onset of
congestive heart failure is treated
 differently than pneumonia or bronchitis.
neurological problems - since the stimulus for
breathing is in the brain, the breathing
pattern you see could represent a neurological
problem
Inspection
Respiratory Rate and Pattern - to observe your
patient, make sure that he/she is at rest and unaware
that you are observing the respirations.
Rate - normal respiratory rate is 12 to 20 / minute
 eupnea - normal rate and rhythm
 tachypnea - fast respiratory rate
 bradypnea - slow respiratory rate
Patterns
 apnea - absence of breathing, may be periodic
  hyperpnea - deeper respirations with normal
rate
 Cheyne-Stokes - respirations gradually
become faster and deeper than normal, than
slower with periods of apnea.
 Biot's - faster and deeper respirations than
normal, with abrupt pauses in between. Each
breath has the same depth. May occur in
spinal meningitis or other central nervous
system conditions.
 Kussmaul's - faster and deeper respirations
without pauses. Can occur from renal failure or
metabolic acidosis (especially in diabetes with
hyperglycemia).
 Apneustic - prolonged gasping inspiration
followed by short inefficient expiration.
 Can occur from lesions in the brain's
respiratory center.
Chest Wall Movements
 Asymmetrical - can occur with tension
pneumothorax, a large pleural effusion,
consolidation, and atelectasis.
 Retractions - can be seen with bronchial
plugging that may be seen in asthma or
COPD.
 Use of accessory muscles - Increases work of
breathing common during an acute phase of
COPD.
 Expiratory bulging of chest - this is an opposite
or paradoxical observation. Can be seen with
flail chest.
General Signs and Symptoms
 Pursed-lip breathing - seen with the COPD
patient that needs to breath this way to get
trapped air in the alveoli expelled.
 Nasal flaring - seen in respiratory distress.
Tracheal deviation - the trachea is normally midline.
When tracheal deviation occurs, it will shift to the side
of least resistance.
 pneumothorax - to affected side
 tension pneumothorax - unaffected side
 pleural effusion - unaffected side
 atelectasis - affected side
Restlessness, anxiety, apprehension, headache,
confusion, disorientation, impaired judgment,
hypotension, tachycardia, yawning,
Central cyanosis (on mouth and lips) are related to
hypoxia (decreased oxygen in the blood).
This hypoxia can result from COPD, pneumonia,
central nervous system depression,
 neuromuscular disorders, musculoskeletal
disorders, Adult Respiratory Distress
Syndrome (ARDS), or pulmonary edema.
 Drowsiness, tremors, confusion, generalized
seizures, or headache are related to
hypercapnia (increased levels of carbon
dioxide). This results from hypoventilation that
can be seen in COPD or central nervous
system depression.
Palpation
Posterior Chest
 Chest Expansion - Place both hands on the
back with the thumbs pointed to the spine.
Have the patient take a deep breath. Watch for
equal movement of your hands. This is called
checking for bilateral chest excursion. In the
COPD patient, they tend to have a barrel
shaped chest. You will notice that chest
excursion is decreased. Try this on a co-
worker to determine normal chest excursion.
 Vocal or tactile fremitus - use the top portion of
each palm and place on the back. For vocal
fremitus have the patient say "99". Vibrations
will be transmitted from the tracheobronchial
tree to your palms and fingers. Check for
symmetry of vibrations. Fremitus will be more
pronounced in the upper airways where there
is a greater amount of air flow. The level
where you no longer feel vibration is the
diaphragm.
 diminished or absent - pleural effusion,
thickened pleura, or pneumothorax
 slightly increased - consolidation
Anterior Chest
 Tracheal position - normally trachea is midline.
Gently place fingers in the space between the
sternum and the clavicle to determine position.
 Sternum and cartilages - palpate for
tenderness or deformity.
Percussion
Overview - the lungs normally have a resonant or
hollow sound. To percuss place the middle finger on
the surface of the chest and tap firmly with the middle
finger of the other hand (mediate percussion). When
percussing the lungs be sure to place your finger in
the intercostal spaces and not on the ribs. Percuss in
a side to side manner on the anterior and posterior
chest walls.
Percussion Notes
 Resonance - represents air-filled spaces. This
is normal over the peripheral lung fields.
  Hyperresonance (tympany) - drumlike sound  Respiratory Tumors – Masses, cysts, or  Emphysema
representing excess air in the space. Seen in tumors invading the lungs.
Vascular Lung Disease
pneumothorax or emphysema.
Some obstructive lung diseases are:
 Dullness or flatness - represents fluid or solid Notable vascular lung diseases include:
tissue in area and will vary with patient's  Emphysema
position if fluid is gravity dependent. Seen in  Pulmonary edema
 Bronchitis
emothorax, hydrothorax, empyema, or  Pulmonary embolism
 Asthma
pleuraleffusion.  Pulmonary hypertension
 Chronic obstructive pulmonary disease
Auscultation (COPD) Infectious Lung Disease
 Bronchiectasis
Overview - auscultation is one of the most useful Infectious Lung Diseases are, as the name
 Byssinosis
assessment techniques for evaluating changes in the suggests, typically caused by one of many infectious
 Bronchiolitis
respiratory system. Breath sounds are produced by agents able to infect the mammalian respiratory
 Asbestos
turbulent airflow through the airways. Crackles, system (for example the bacterium Streptococcus
rhonchi and wheezing are heard through auscultation. Notable restrictive lung diseases include: pneumonia).
Auscultation should be done in the same sequencing
 Acute respiratory distress syndrome (ARDS) The clinical features and treatment options
as shown for palpation. Auscultation of the right
 Asbestosis vary greatly between infectious lung disease sub-
middle lobe is accomplished by listening on the right
 Fibrosis types as each type may be caused by a different
side in the midaxillary line. The diaphragm of the
infectious agent, with different pathogenesis and
stethoscope is used. When listening to lungs you will  Hypersensitivity pneumonitis
virulence.
listen to a full inspiration and expiration at each  Infant respiratory distress syndrome (IRDS)
location.  Lung Cancer Features also vary between:
 Mechanical diseases affecting pulmonary
Categorizing Lung Diseases  Upper respiratory tract infection, including
musculature, including myasthenia gravis
strep throat and the common cold; and
Another method is to divide respiratory orders by  Neurologic diseases affecting the ability of the
body to alter respiration rate, including spinal  Lower respiratory tract infection, including
categories of:
cord injury pneumonia and pulmonary tuberculosis
 Obstructive Lung Diseases – Increased airway  Pleural effusion Respiratory neoplasms are most often malignant,
resistance.
 Pleurisy although there are non-malignant neoplasms which
 Restrictive Lung Diseases – Loss of airway
 Sarcoidosis can affect lung tissue.
compliance.
 Severe acute respiratory syndrome (SARS)
 Parenchymal Lung Diseases – Destruction of Respiratory neoplasms include the following:
the air sacs or alveoli. Parenchymal Lung Disease
 Mesothelioma
 Vascular Lung Diseases – Affect the
pulmonary capillary blood vessels that impair
Notable parenchymal diseases include:  Small cell lung cancer
the exchange of oxygen and carbon dioxide.  Non-small cell lung cancer
 COPD
 Infectious Lung Diseases – Caused by  Non-neoplastic respiratory tumors:
 Sarcoidosis
bacteria invading the lungs. Tuberculosis cysts, other non-neoplastic
 Pulmonary fibrosis
masses
Acute Respiratory
Distress Syndrome
(ARDS)
A sudden failure of the respiratory system that occurs
when fluid builds up in alveoli,
resulting in destruction. In a short time, breathing
becomes difficult, resulting in
hypoxemia. Most often occurs in critically ill persons.
Severe shortness of breath — the
main symptom of ARDS — usually develops within a
few hours to a few days after the
original disease or trauma. ARDS is fatal in 25 to 40
percent of the people who develop
it. Restrictive
Diffusion
Asthma is a chronic lung disease that inflames and
narrows the airways. Asthma causes
recurring periods of wheezing, chest tightness,
shortness of breath, and coughing Obstructive
Ventilation
Bronchitis inflammation of the bronchial tubes, the
major airways into the lungs. It may be caused
by a variety of bacteria and viruses. Acute bronchitis gradually destroyed. Smoking is the leading cause of
can last from a few days to 10 emphysema. As it worsens,
days. But the cough that comes with acute bronchitis emphysema turns the alveoli — into large, irregular
may last for several weeks after pockets with gaping holes in their
the infection has gone Obstructive inner walls. This reduces the number of air sacs and
keeps some of the oxygen entering
Ventilation
your lungs from reaching your bloodstream. In
❤
addition, the elastic fibers that hold open
1
the alveoli are slowly destroyed, so that they collapse
when exhaling preventing gas
from leaving the lungs Obstructive
Parenchymal
Chronic obstructive pulmonary disease (COPD) refers Diffusion
to a group of lung diseases that
block airflow and make it increasingly difficult for to
breathe. Emphysema and chronic
bronchitis are the two main conditions that make up
COPD, but COPD can also refer to
damage caused by chronic asthmatic bronchitis.
Obstructive
Parenchymal
Diffusion
Emphysema is a condition that limits the flow of air
when breathing out. Emphysema
occurs when the air sacs at the ends of your smallest
air passages (bronchioles) are