LOWER RESPIRATORY SYSTEM

A. Components and Main Functions

 Anatomically, it consist of the larynx, trachea, bronchi, and lungs
 Functionally it consists of two zones:
 Respiratory zone
o Actual site of gas exchange between air and blood
o Composed of respiratory bronchioles, alveolar ducts, and
alveoli, all microscopic structures
 Conducting zone
o Consists of all the respiratory passageways from the nose to the
respiratory bronchioles.
o Provide fairly rigid conduits for air to reach the gas exchange
sites
o Cleanse, humidify, and warm incoming air
B. Basic Anatomy
Larynx
 Also known as voice box
 Is a short passageway that connects the laryngopharynx with the trachea
 Located in the midline of the neck anterior to the esophagus and the fourth
through sixth cervical vertebrae (C4–C6)
 Three main functions:
 Provide a patent (open) airway
 Act as a switching mechanism to route air and food into the proper
channels
 Voice production
 Framework is composed of nine pieces of cartilage connected by membranes
and ligaments that occurs singly and by pairs. Except for the epiglottis, all
laryngeal cartilages are hyaline cartilages.
 Singly
o Thyroid cartilage
-Formed by the fusion of two cartilage plates at the midline
- Resembles an upright open book, with the book's "spine" lying
in the anterior midline of the neck. The “Book spine” is also
called as the laryngeal prominence which can be seen externally
as the Adam’s apple
-Larger in males than in females because male sex hormones
stimulate its growth during puberty
-Thytohyoid membrane connects the thyroid cartilage to the
hyoid bone
o Epiglottis
-also known as guardian of the airways
-flexible spoon-shaped
- composed of elastic cartilage and is almost entirely covered by
a taste bud containing mucosa
 - extends from the posterior aspect of the tongue to its
anchoring point on the anterior rim of the thyroid cartilage
- landmark for making an emergency airway called tracheotomy
(incision in the windpipe to relieve an obstruction to breathing)
-Parts
 Stem - tapered inferior portion that is attached to the
anterior rim of the thyroid cartilage
 Leaf – broad superior portion of the epiglottis
unattached and free to move up and down like a trap
door
o Cricoid cartilage
-perched atop and anchored to the trachea inferiorly
-Ring-shaped
 Pairs
o Arytenoid
–influence changes in position and tension of the vocal folds
(true vocal cords for speech) which is the most important
o Cuneiform form
-part of the lateral and posterior walls of the larynx
o Corniculate cartilages
 The cavity of the larynx is the space that extends from the entrance into the
larynx down to the inferior border of the cricoid cartilage
  Laryngeal vestibule
 portion of the cavity of the larynx above the vestibular folds (false vocal
cords)
 Infraglottic cavity
 portion of the cavity of the larynx below the vocal folds

The Structures of Voice Production

 Vocal folds (true vocal cords)
 Form the core of mucosa folds
 Principal structure of voice production
 Appear pearly white because it is avascular
 Vibrates and produce sounds as air rushes up from the lungs
 Glottis
 The vocal folds and the medial opening between them through which air
passes
 Vestibular folds (false vocal cords)
 Superior to the vocal folds which is similar pair of mucosal folds
 Play no direct part in sound production but help to close the glottis
when we swallow
 Rimavestibuli
 space between the vestibular folds
 Laryngeal Ventricle
 lateral expansion of the middle portion of the laryngeal cavity inferior
to the vestibular folds and superior to the vocal folds
 Air passing through the larynx vibrates the folds and produces sound
(phonation) by setting up sound waves in the column of air in the pharynx,
 nose, and mouth. The variation in the pitch of the sound is related to the
tension in the vocal folds. The greater the pressure of air, the louder the sound
produced by the vibrating vocal folds.
 Pitch is controlled by the tension on the vocal folds. If they are pulled taut by
the muscles, they vibrate more rapidly, and a higher pitch results. Decreasing
the muscular tension on the vocal folds causes them to vibrate more slowly
and produce lower-pitched sounds.

Epithelium of Larynx
 Stratified squamous epithelium lines the superior portion of the larynx, an area
subject to food contact
 Below the vocal folds the epithelium is a pseudostratified ciliated columnar type
that filters dust. The power stroke of its cilia is directed upward toward the
pharynx to continually move mucus away frorn the lungs
Laryngitis
 An inflammation of the larynx that is most often caused by a respiratory
infection or irritants such as cigarette smoke
 Causes hoarseness or loss of voice by interfering with the contraction of the
folds or by causing them to swell to the point where they cannot vibrate freely
 Long-term smokers acquire a permanent hoarseness from the damage done by
chronic inflammation
Cancer of the Larynx
 Found almost exclusively in individuals who smoke
 Characterized by hoarseness, pain on swallowing, or pain radiating to an ear
 Treatment consists of radiation therapy and/or surgery

Trachea (windpipe)
  Tubular passageway for air that is about 12 cm (5 in.) long and 2.5 cm (1 in.) in
diameter
 Located anterior to the esophagus and extends from the larynx to the superior border
of the fifth thoracic vertebra (T5), where it divides into right and left primary bronchi
 Layers of trachea wall (deep to superficial
 Mucosa
o Consists of an epithelial layer of ciliated pseudostratified columnar
epithelium and an underlying layer of lamina propria that contains
elastic and reticular fibers
o Provides the same protection against dust as the membrane lining the
nasal cavity and larynx
 Submucosa
o Consists of areolar connective tissue that contains seromucous glands
and their ducts
 Hyaline cartilage
o Contains 16-20 incomplete horizontal rings that resemble the letter C
stacked one above another, and are connected by dense connective
tissue
o provide a semirigid support to maintain patency so that the tracheal
wall does not collapse inward (especially during inhalation) and
obstruct the air passageway
 Adventita
o Composed of areolar connective tissue that joins the trachea to
surrounding tissues

Bronchi
 The trachea divides into a right main (primary) bronchus which goes into the right
lung, and a left main (primary) bronchus, which goes into the left lung that is
located at the superior border of the fifth thoracic vertebra
 Right main bronchus
 More vertical, shorter, and wider than the left where most aspirated object
enter and lodge in the right main bronchus
 Carina
 Internal ridge where the trachea divides into right and left main bronchi
 Formed by a posterior and somewhat inferior projection of the last tracheal
cartilage
 Its mucous membrane is one of the most sensitive areas of the entire larynx
and trachea for triggering a cough reflex
 Main Bronchus Subdivision
 Lobar (secondary) bronchi
o Three on the right and two on the left, each supplying one lung lobe
 Segmental (tertiary) bronchi
o supply the specific bronchopulmonary segments within the lobes
 Bronchioles
 Terminal Bronchioles
o Contain club (Clara) cells, columnar, non-ciliated cells interspersed
among the epithelial cells
o Club cells may protect against harmful effects of inhaled toxins and
carcinogens, produce surfactant, and function as stem cells (reserve
cells), which give rise to various cells of the epithelium
o Represent the end of the conducting zone of the respiratory system
This extensive branching from the trachea through the terminal
bronchioles resembles an inverted tree and is commonly referred to as the
bronchial tree
 Microscopic Bronchioles
 Respiratory bronchioles and alveolar ducts
 The respiratory passages from the trachea to the alveolar ducts contain about 23
generations of branching
 First-generation branching
o Branching from the trachea into main bronchi
 Second-generation branching
o From main bronchi into lobar bronchi
 Tissue composition of the walls of the main bronchi mimics that of the trachea.
However, as the conducting tubes become smaller, the following structural changes
occur:
 Support structures change
o Irregular patches, or plates, of cartilage replace the cartilage rings, and
by the time the bronchioles are reached, the tube walls no longer
contain supportive cartilage. However, the tube walls throughout the
bronchial tree contain elastic fibers.
 Epithelium type changes
o Mucosal epithelium thins as it changes from pseudostratified columnar
to simple columnar and then to simple cuboidal in the terminal
bronchioles
  Amount of smooth muscle increases
o Relative amount of smooth muscle in the tube walls increases as the
passageways become smaller.

Lungs
 paired cone-shaped organs in the thoracic cavity
 separated from each other by the heart and other structures of the mediastinum,
which divides the thoracic cavity into two anatomically distinct chambers
 Pleural Membrane (pleura)
 Double-layered serous membrane that encloses and separates each lung
 Extends about 5 cm (2 in.) below the base from the sixth costal cartilage
anteriorly to the twelfth rib posteriorly
o Parietal Pleura
- Superficial layer that lines the wall of the thoracic cavity
o Visceral Pleura
- Deep layer that covers the lungs themselves
o Pleural Cavity
- A small space between the visceral and parietal pleurae , which
contains a small amount of lubricating fluid secreted by the
membranes
- Reduces friction between the membranes, allowing them to
slide easily over one another during breathing
- causes the two membranes to adhere to one another just as a
film of water causes two glass microscope slides to stick
together, a phenomenon called surface tension
 Pleurisy or Pleuritis
o Inflammation of pleural membrane
o Early stages cause pain due to friction between the parietal and visceral
layers of the pleura
 Pleural Effusion
o excess fluid accumulates in the pleural space if the inflammation
persists

Surface Anatomy of the Lungs

 The lungs extend from the diaphragm to just slightly superior to the clavicles and
lie against the ribs anteriorly and posteriorly
 Base
 Broad inferior portions of the lung
  Concave and fits over the convex area of the diaphragm
 Extends from the sixth costal cartilage anteriorly to the spinous process of
the tenth thoracic vertebra posteriorly
 Apex
 Narrow superior portion of the lung
 Lies superior to the medial third of the clavicles, and this is the only area
that can be palpated
 Costal Surface
 Surface of the lung lying against the ribs and matches the rounded
curvature of the ribs
 The anterior, lateral, and posterior sur faces of the lungs lie against the
ribs
 Hilium
 Region located at the mediastinal surface of each lung through which
bronchi, pulmonary blood vessels, lymphatic vessels, and nerves enter and
exit
 These structures are held together by the pleura and connective tissue and
constitute the root of the lung.
 Cardiac Notch
 Concavity located medially in the left lung in which the apex of the heart
lies
 Due to the space occupied by the heart, the left lung is about 10% smaller than
the right lung
 Although the right lung is thicker and broader, it is also somewhat shorter than
the left lung because the diaphragm is higher on the right side, accommodating
the liver that lies inferior to it
 Thoracentesis
 With this procedure, removal of excessive fluid in the pleural cavity can be
accomplished without injuring lung tissue by inserting a needle anteriorly
through the seventh intercostal space
 The needle is passed along the superior border of the lower rib to avoid
damage to the intercostal nerves and blood vessels. Inferior to the seventh
intercostal space there is danger of penetrating the diaphragm
Lobes, Fissures, and Lobules
 One or two fissures divide each lung into sections called lobes
 Both lungs have an oblique fissure, which extends inferiorly and anteriorly;
the right lung also has a horizontal fissure. The oblique fissure in the left lung
separates the superior lobe from the inferior lobe.
 In the right lung, the superior part of the oblique fissure separates the superior
lobe from the inferior lobe; the inferior part of the oblique fissure separates
the inferior lobe from the middle lobe, which is bordered superiorly by the
horizontal fissure.
 Each lobe receives its own lobar bronchus; the right main bronchus gives rise
to three lobar bronchi called the superior, middle, and inferior lobar
 bronchi, and the left main bronchus gives rise to superior and inferior lobar
bronchi.
 The lobar bronchi within each lung lung give rise to 10 segmental bronchi which are
constant in both origin and distribution
 Bronchopulmonary segment
o Portion of lung tissue that each segmental bronchus supplies
o Bronchial and pulmonary disorders (such as tumors or abscesses) that
are localized in a bronchopulmonary segment may be surgically
removed without seriously disrupting the surrounding lung tissue.
 Each bronchopulmonary segment of the lungs has many small compartments called
lobules
 Each lobule is wrapped in elastic connective tissue and contains a lymphatic
vessel, an arteriole, a venule, and a branch from a terminal bronchiole
 Terminal bronchioles and lobule subdivide into microscopic branches called
respiratory bronchioles. They also have alveoli budding from their walls
 Alveoli participate in gas exchange, and thus respiratory bronchioles begin the
respiratory zone of the respiratory system
 As the respiratory bronchioles penetrate more deeply into the lungs, the epithelial
lining changes from simple cuboidal to simple squamous. Respiratory bronchioles in
turn subdivide into several (2–11) alveolar ducts which consist of simple squamous
epithelium
Alveolar Sacs and Alveoli
 Alveolar Sac
 The terminal dilation of an alveolar duct analogous to a cluster of grapes
 Each alveolar sac is composed of outpouchings called alveoli analogous to
individual grapes
 Three major types of alveolar epithelial cells
o Type I alveolar cells (squamous pulmonary epithelial)
- Squamous epithelial cells that form the major part of the
alveolar walls.
- The thin type I alveolar cells are the main sites of gas exchange
o Type II alveolar cells (septal cells)
- Cuboidal epithelial cells that are scattered among the type I
cells
- They secrete alveolar fluid which keeps the surface between
the cells and the air moist. It also contains a detergent-like
substance called surfactant, a complex mixture of
phospholipids and lipoproteins which lowers the surface
tension of alveolar fluid. It reduces the tendency of alveoli to
collapse and thus maintains their patency
- Secrete a number of antimicrobial proteins that are important
elements of innate immunity
o Alveolar macrophages (dust cells)
- crawl freely along the internal alveolar surfaces consuming
bacteria, dust, and other debris
 Two significant features:
o They are surrounded by fine elastic fibers of the same type that
surround the entire bronchial tree
o Open alveolar pores connecting adjacent alveoli allow air pressure
throughout the lung to be equalized and provide alternate air routes
to any alveoli whose bronchi have collapsed due to disease
 Alveolar surfaces are usually sterile because the alveoli are "dead ends,"
aged and dead macrophages must be prevented from accumulating in them
 The exchange of O2 and CO2 between the air spaces in the lungs and the
blood takes place by diffusion across the alveolar and capilary walls, which
together form the respiratory membrane
 Extending from the alveolar air space to blood plasma, the respiratory
membrane consists of four layers:
o Alveolar Wall
- A layer of type I and type II alveolar cells and associated
alveolar macrophages
o Epithelial Basement Membrane
- Underlying the alveolar wall
o Capillary Basement Membrane
- Often fused to the epithelial basement membrane
o Capillary Endothelium
C. Blood Supply to the Lungs
 Lungs receive blood through two sets of arteries
 Pulmonary Arteries
o Deoxygenated blood passes through the pulmonary trunk, which
divides into a left pulmonary artery that enters the left lung and a
right pulmonary artery that enters the right lung
o Only arteries in the body that carry deoxygenated blood
o Return of the oxygenated blood to the heart occurs by way of the four
pulmonary veins, which drain into the left atrium
- Pulmonary blood vessels constrict in response to localized
hypoxia (low O2 level)
- Hypoxia
 In all body tissues, it causes dilation of blood vessels to
increase blood flow. However, in the lungs
vasoconstriction in response to hypoxia diverts
pulmonary blood from poorly ventilated areas of the
lungs to well-ventilated regions for more efficient gas
exchange. This process is commonly known as
ventilation–perfusion coupling because the perfusion
(blood flow) to each area of the lungs matches the extent
of ventilation (airflow) to alveoli in that area.
 Bronchial Arteries
 o Provide oxygenated systemic blood to lung tissue
o Arise from the aorta, enter the lungs at the hilum, and then run along
the branching bronchi
o Blood mainly perfuses the muscular walls of the bronchi and
bronchioles
 Connections do exist between branches of the bronchial arteries and branches of the
pulmonary arteries, however; most blood returns to the heart via pulmonary veins
 Some blood drains into bronchial veins, branches of the azygos system, and returns
to the heart via the superior vena cava

D. Patency of Respiratory System

 Below were the given structures and secretions that help to maintain patency of the
system so that air passageways are kept free of obstruction
 Bony and cartilaginous frameworks of the nose
 Skeletal muscles of the pharynx
 Cartilages of the larynx
 C-shaped rings of cartilages in the trachea and bronchi
 Smooth muscle in the bronchioles
 Surfactant in the alveoli
 Other factors that can compromise patency
 Crushing injuries to bone and cartilage
 A deviated nasal septum
 Nasal polyps
 Inflammation of mucous membranes
 Spasms of smooth muscle
 Deficiency of surfactant
References:
Tortora, G. & Bryan Derrickson (2017). Chapter 23: The Respiratory system. Principles of
Anatomy & Physiology (15th Ed., pp. 856-869.). Danvers, Massachusetts, USA: John Wiley &
Sons, Inc.
Marieb, E. & Hoehn, K. (2019). Chapter 22: The Respiratory System. Human Anatomy and
Physiology. (11th Ed., pp. 824-834). USA: Pearson Education Inc.