Respiratory System

 Functions
 Gas exchange
 Host defense
 Metabolic function
 Excretory function
RESPIRATION
 is the gaseous interchange
between an organism and the
environment.
 ultimate goal is to oxygenate
the tissues.
RESPIRATION
Functional Anatomy of the Respiratory System
Thorax and Thoracic Cavity

4 Liters

1 kilogram
60% - lung tissue
- (alveolar spaces)
- (interstitium)
40% - blood
Pleura and Pleural Cavity

Pneumothorax
Pleural effusion
Empyema
Intrapleural or Intrathoracic Pressure
 Airways (Upper and Lower)
 begins at the nose and ends in the most distal
alveolus.
 Upper Airway
 consists of the nose, sinuses, pharynx, vocal cords and
larynx.
 Lower Airways (tracheobronchial tree)
 begins with the trachea and ends in the most distal
alveoli.
 consists of tubes that bifurcate up to 23 generations.
Bronchopulmonary segment

Berne and Levy, Medical Physiology 6th edition

Conducting Airways and Respiratory Units of the Lungs
 Lower Airway
 Conductive Zone (Anatomic Dead Space)
 from the trachea up to the terminal bronchiole
 1 – 16 generations ( > 150 ml)
 does not participate in gaseous exchange
 Respiratory Zone/Unit (gas exchanging unit)
 involves the respiratory bronchioles, alveolar duct,
atrium and alveoli or alveolar sac (300 M).
 17 – 23 generations ( >2500 ml and 70 m2)
 participates in gaseous exchange
 Anatomic Dead Space versus
Physiologic Dead Space
 Anatomic Dead Space
 area that involves the conducting zone
 approximately 150 ml (dead space air)
 30% of tidal volume
 Physiologic Dead Space
 anatomic dead space + non functional and
 non perfused alveoli
Airway Resistance
 highest in the medium sized airway
(normal condition)
 highest in the small sized airway
(disease conditions)
 Alveolar cells/Pneumocytes
 Type 1
 the primary cells responsible for gas exchange
 occupies 96 and 98% of the surface area of the alveolus
 Type 11
 synthesizes pulmonary surfactant and responsible for
regeneration of the normal alveolar structure (injury).
 occupies ~ 2% to 4% of the surface area.
 Type 111
 also known as brush cells
 function as chemoreceptors
 Intraalveolar or Intrapulmonic Pressure
 pressure inside the alveoli
 atmospheric at rest
 varies with respiration
 Innervation
 Parasympathetic
 bronchoconstriction
 increases glandular secretion
 vasodilatation
 Sympathetic
 bronchodilatation
 decrease glandular secretion
 vasoconstriction
 Nonadrenergic and noncholinergic
stimulatory
 constriction
 Nonadrenergic and noncholinergic
inhibitory
Berne and Levy, Medical Physiology 6th edition
 relaxation
 Surfactant
 is a complex mixture of phospholipids, neutral fats,
fatty acids and proteins that lines the surface of the
alveoli.

Lipids 85 – 90%
Phospholipids 65 – 70%
Neutral lipids 5%
Glycolipids 5 - 10%
Proteins 10 – 15%
 Surface tension
 directly related to the
collapsing pressure but
inversely related to the
alveolar radius
 Large alveoli
 have low collapsing
pressure and are easy to
keep open
 Small alveoli
 have high collapsing
pressure and are difficult to
open
Functions
 lowers the surface tension (anti-stick and
surface tension-lowering properties DPPC)
 relationship between tension, radius and
pressure is explained by laplace law.
↓ surface tension

facilitate lung inflation prevent lung collapse ↓ work of breathing

 Compliance (Stretchability and
Distensibility) of the Lungs and chest wall
 is the change in lung volume per unit change in
airway pressure.
 comparable with capacitance in cardiovascular
system
 inversely related to elastance and stiffness
 greater at the base of the lung than at the apex.
ΔV
C = ------------
ΔP
 Hysteresis

Compliance of the
lungs (Hysteresis loop)

hysteresis

Transmural pressure
= alveolar - intrapleural
pressure

(-) intrapleural pressure

- expansion (volume
increases)

(+) intrapleural pressure

- deflation (volume
Taken from: ernielijoi.wordpress.com
23
decreases) - lung collapse
 Mechanics of Respiration
 Inspiration
 inflation of the lungs
 inflow of air
 Expiration
 deflation of the lungs
 outflow of air
 CHANGE IN THORACIC CAVITY SIZE OR VOLUME

VERTICAL DIAMETER

TRNASVERSE OR HORIZONTAL DIAMETER

CHANGE IN INTRATHORACIC AND INTRAALVEOLAR PRESSURE

INSPIRATION EXPIRATION
B M E B M E
+4

+3

INTRAALVEOLAR/
+2 INTRAPULMONARY PRESSURE

+1

-1

-2
INTRATHORACIC/INTRAPLEURAL
PRESSURE
-3

-4
 CHANGE IN LUNG VOLUME

INSPIRATION EXPIRATION
B M E B M E
1600

1400

1200

1000

800

600

400

200

0
LUNG VOLUMES
 TIDAL VOLUME
 INSPIRATORY RESERVE VOLUME
 EXPIRATORY RESERVE VOLUME
 RESIDUAL VOLUME
LUNG CAPACITIES
 INSPIRATORY CAPACITY
 FUNCTIONAL RESIDUAL CAPACITY
 VITAL CAPACITY
 FORCED VITAL CAPACITY
 TOTAL LUNG CAPACITY
 Forced expiratory volume (FEV1)
 Normally 80% of the forced vital capacity
 Expressed as FEV1 / FVC = 0.8
 Ventilation rate
 Minute Ventilation

Minute Ventilation = Tidal Volume X Respiratory Rate

 Alveolar ventilation

Alveolar Ventilation = (Tidal Volume – Dead Space X Respiratory Rate

 Regional Differences
 Ventilation
 Perfusion
 V/Q ratio
 Compliance
 PO2
 PCO2

Taken from: www.memorangapp.com

PERFUSION
VENTILATION /PERFUSION
ANATOMIC SHUNT
PHYSIOLOGIC SHUNT
RESPIRATORY MEMBRANE
 Layers:
 Epithelial cells of the alveoli
 Epithelial basement membrane
 Interstitial space (space between the alveolar
epithelium capillary membrane)
 Capillary basement membrane
 Endothelial cells of the capillary
 INTERSTITIAL LAYER
 structure formed by the fusion of the epithelial
basement membrane, interstitial space and
capillary basement membrane
 Thickness
 0.6 um
 Surface area
 50 – 100 m2
 AIR COMPOSITION
Barometric Pressure (sea level) - 760 mmHg
(1 atm)
Nitrogen = 760 mmHg X 0.79 = 600.0 mmHg
O2 = 760 mmHg X 0.21 = 159.6 mmHg
CO2 = 760 mmHg X 0.0004 = 0.3 mmHg
Other inert gases (argon, helium etc) -
---------------------
760.0 mmHg
 values are reduced by water vapor
 PH2O (37oC) = 47 mmHg
 In dry inspired air, the partial pressure of O2 can
calculated as follows:
Partial pressure = 760 mmHg x 0.21
(PO2) = 160 mmHg
 In humified tracheal air at 37oC, the calculation is
modified to correct for partial pressure of H2O = 47
mmHg
Partial pressure = 760 mmHg - 47 mmHg
= 713 mm Hg x 0.21
= 150 mmHg
Net diffusion

O2 - ALVEOLI BLOOD

CO2 - BLOOD ALVEOLI

Factors that affect the rate of gas diffusion
through the respiratory membrane
( O2 and CO2)
 pressure gradient or difference across the
respiratory membrane (P)
 surface area of the membrane (A)
 diffusion coefficient (Df)
 solubility (S)
 molecular weight (MW)
O2 = 1.0
CO2 = 20.3
 thickness of the membrane (d)
 temperature
 DIFFUSION CAPACITY
 volume of gas that diffuses through the
membrane each minute for a pressure difference
of 1 mmHg.
O2 = 21 ml / min / mmHg
CO2 = 400 – 450 ml / min / mmHg
 PO2
160
Partial Pressure (mmHg)

120

80

40
PCO2
0
air lung blood tissues

arterial venous
Column1

Ganong, Review of Medical Physiology, international edition

Ways of transporting O2 and CO2
OXYGEN CARBON DIOXIDE

 Dissolved  Dissolved
 Combination with  Formation of carbamino-
hemoglobin hemoglobin compounds
 Hydration, H+ buffered,
70% of HCO3-

 94.5% ungergo series of

 99% combines with O2
reversible chemical
–carrying protein
reactions -- compounds
TRANSPORT OF OXYGEN AND CARBON
DIOXIDE
IN THE BLOOD

 Two ways of transporting oxygen

to the tissues
 chemical combination with hemoglobin in
the RBC (97%)
 dissolved state in the H2O of the plasma
(3%)
 Chemical Combination
with Hemoglobin
 Hemoglobin
 globular protein made up of 4 subunits (2  and 2 ),

O2 O2

heme moiety (iron ferrous state) + globin ( polypeptide portion )

O2 O2

NV = 15 g/dL or 150 g/L

Female = 14 – 16 g/dL
Males = 15 – 16 g/dL
1 gram of hgb  1.34 of O2 (1.39
if pure Hgb
1.34 ml X 15 = 20.1 ml of O2 (100%)
20.1 X 97% (saturation) = 19.5 ml (arterial) 19.4 ml
20.1 X 75% (saturation = 15.0 ml (venous) 14.4 ml

O2 extraction (tissues) = 4.5 ml (5 ml)

Characteristics of O2 and Hgb binding
a) rapid
b) loose and reversible
c) sigmoid curve (S shaped curve)

TWO TYPES OF HEMOGLOBIN

A. Tense (T) Form
 globin units are tightly bound
 less O2 affinity
B. Relaxed (R) form
 exposed more binding sites
 greater O2 affinity
 100
O2
7.49 7.3
80
S
7.4 pH
A
T 60
U
R 40
A
T 20
I
O 0
N 0 20 40 60 80 100 120 140 160
PO2
Factors affecting affinity of
Hemoglobin for Oxygen
 pH
 H+ concentration
 Carbon dioxide
 Temperature
 2,3 DPG
 Shift to the right
  in O2 affinity of hemoglobin (T form)
 release of O2 in the tissues
 occurs when PO2 is decreased
 causes:
  pH - acidosis
  H+
  CO2
  temperature
  2,3, BPG
 Shift to the left
  in O2 affinity of hemoglobin (R form)
 uptake of O2 in the lungs
 occurs when PO2 is increased
 causes:
  pH - alkalosis
  H+
  CO2
  temperature
  2,3, BPG
TRANSPORT OF CARBON
DIOXIDE IN THE BLOOD
A. Dissolved State
 0.3 ml/dL or 7%
B. Formation of Bicarbonate (HCO3-)
 major way of transporting CO2
 about 60%
CO2 + H2O

H2CO3 (CA, RBC)

H+ HCO3-
(RBC) plasma Cl-
C. Combination with hemoglobin
and plasma proteins
 1.5 ml/dL or 30%
 carboxyhemoglobin and carbamino
compounds
Other gases that bind with
hemoglobin
 carbon monoxide
 nitric oxide
MYOGLOBIN
 oxygen carrying substance in the
muscle.
 carries only 1 molecule of O2 per
molecule of myoglobin
 produces hyperbolic curve
HALDANE EFFECT
  O2 binding with hemoglobin reduces
the affinity of CO2 with hemoglobin.
 release of CO2 from hemoglobin (lungs)
 O2 + Hgb  oxyhemoglobin 
stronger acid  displacement of H+ and
CO2  expired
BOHR EFFECT
  CO2 binding with hemoglobin reduces
the affinity of O2 with hemoglobin.
 release of O2 from hemoglobin (tissues)
 greater affinity of deoxyhemoglobin to
H+ and 2,3 DPG.
69
NEURAL CONTROL
 VOLUNTARY CONTROL
 located in the cerebral cortex
 corticospinal tract  spinal neurons  muscles

 AUTOMATIC CONTROL
 located in the pons and medulla
 efferent output → spinal cord → respiratory muscles
 RESPIRATORY CENTERS
 Medullary center
 dorsal respiratory group
 ventral respiratory group
 Pontine centers
 pneumotaxic center
 apneustic center
 PONTINE AREA

 Pneumotaxic center

 Apneustic center
Pre-Botzinger Complex
 contains small group of synaptically coupled
pacemaker cells.
 initiates rhythmic discharge that produce
spontaneous respiration
 located on either side of medulla between
the nucleus ambiguus and the lateral
reticular nucleus
 RESPIRATORY RECEPTORS

 Chemoreceptors
 respond to changes in
CO2, O2 and H+
 Central
Chemoreceptors
 also known as medullary
chemoreceptors
 activated by an increase
in pCO2 and H+
concentration
 Peripheral
Chemoreceptors
 involved the aortic
and carotid bodies
 activated by an
increase in pCO2,
H+ concentration
and a decrease in
pO2.
 Other Types of Receptors
 Lung Stretch Receptors
 located in the smooth muscle of the airways
 stimulated by over-distension of the lungs
 involved in Herring Breuer Reflex
 Irritant Receptors (rapidly adapting pulmonary
stretch receptors
 located in the airway epithelial cells
 stimulated by noxious stimuli
 increases airway resistance
 results to reflex apnea, coughing and sneezing
 J receptors
 located in the alveoli close to the capillaries.
 stimulated by mechanical and chemical stimuli
 responsible for sensation of dyspnea and
rapid shallow breathing pattern
 Joint and Muscle Receptors
 activated by muscular contraction
 involved in early stimulation during exercise
 Nose and facial receptors
 (+) by cold water
 sneeze and diving reflex
 leads to bradycardia, apnea and cessation of
breathing
 Joint and Muscle Receptors
 activated by muscular contraction
 involved in early stimulation during exercise
 Chemical Stimuli
Stimulation Inhibition
↑ pCO2 ↓ pCO2

↑ H+ concentration ↓ H+ concentration
(↓ pH) (↑ pH)
↓ pO2 ↑ pO2
 PULMONARY FUNCTION TEST OBSTRUCTIVE RESTRICTIVE
PULMONARY DISEASES PULMONARY
DISEASES

TIDAL VOLUME decreased decreased

INSPIRATORY RESERVE VOLUME decreased decreased

RESIDUAL VOLUME increased Normal

FUNCTIONAL RESIDUAL increased normal

CAPACITY

TOTAL LUNG CAPACITY decreased decreased

VITAL CAPACITY decreased decreased

FEV1 Markedly decreased decreased