Respiratory System Module

Second semester
2020-2021

Respiratory physiology
 References
• Guyton and Hall Textbook of Medical Physiology.
Author : John E. Hall, 14th Edition, 2021
• Physiology . Author : Linda s. Costanzo , Sixth
Edition, 2018.
• Ganong's Review of Medical Physiology. Authors
Kim E. Barrett, Susan M. Barman, Heddwen L.
Brooks, Jason X.-J. Yuan. 26 Edition, 2019

3/30/2021 3
 Teaching style and office hours

• On line lectures according to module schedule via MS team

• Recorded lectures will be posted on MS team
• PPT slides will be posted on MS team
• Discussion and office hours : 2 hours ( Twice weekly)
• office hours will be announced weekly daily based on
schedule or by appointment via tram
• Office hours can also be requested by appointment through
MS team or by emailing me at zuheirakh@hu.edu.jo
• A practice quiz will be posted on team as informative
assessment in due course before the midterm exam

3/30/2021 4
 Lecture 1
MECHANICS OF PULMONARY VENTILATION
Zuheir A Hasan
Professor of physiology
College of Medicine
HU

3/30/2021 5
 Lecture objectives
• Review the structures and the of the conducting airways, the alveolar–capillary
unit, and the chest wall.
• List the functions of the lungs
• Describe the generation of a pressure gradient between the atmosphere and
the alveoli.
• Define the mechanical interaction of the lung and the chest wall.
• Identify the respiratory muscle and describe their function during tidal
breathing as well as during forced inspiration and expiration
• Define pulmonary pressure (alveolar pressure) , intrapleural pressure ,
transpulmonary pressure and elastic recoil pressure
• Describe the passive expansion and recoil of the alveoli.
• Describe the pressure changes and air flow during the respiratory cycle
• Describe the events involved in a normal tidal breath.
• Define pneumothorax and describe respiratory system pressure changes in
pneumothorax
3/30/2021 6
Anatomical components of the
respiratory system
• The respiratory system is composed of the
• conducting airways
• Lungs
• muscles of respiration, and the chest wall.
• The chest wall consists of the muscles of
respiration— the diaphragm, the intercostal
muscles, and abdominal muscles Rib cage.
• Parts of the central nervous system concerned
with the control of the

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 Functional anatomy of the respiratory system

3/30/2021 8
 Respiratory airways

dead space ( no gas

exchange here)
just passage of air from the
atmosphere to the lung and:-
traveling particles
warming and humidify the air

gas exchange happen

3/30/2021 9
 Air ways

• The airways are divided into two functional zones:

▪ conducting zone :
First 16 generations of branches comprising the and functioning
to conduct air to the deeper parts of the lungs.

▪ Respiratory zone
• The last 7 generations participate in gas exchange

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 The conducting zone

• Functions :
• Warm and humidify inspired air
• Distribute air evenly to all regions of the lungs
• Serve as part of the body’s defense system
(removal of dust, bacteria, and noxious gases
from the lungs).
• No gas exchange occurs in the conducting zone.
• Constitute the anatomic dead space

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 Respiratory Zone
• The respiratory zone is the location of the blood–
gas interface where gas exchange occurs in thin-
walled air sacs called alveoli.
• The respiratory zone (generations 17–23).
• comprising the respiratory bronchioles, alveolar
ducts, and alveolar sacs
• Large cross-sectional area even as the passages
narrow .

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 Alveolar sacs

• Alveoli are thin-walled with internal diameters of 75–300 um

• Adult lungs contain 300 to 500 million alveoli, connected via with pores
of Kohn
• internal surface area of ~75 m2
• In adults, alveoli, if damaged, have limited ability to repair themselves.
• It comprises two types of respiratory epithelial cell, or pneumocyte.
• Type I pneumocytes . : carry the gas exchange function
• Type II, or granular, pneumocytes are
➢ Synthesis pulmonary surfactant.
➢ are capable of rapid division, which allows them to repair
alveolar wall damage.

3/30/2021 13
 here some surfactant
Alveolar capillary Alveoli
synthesis cells well be
occupy
Respiratory
unit membrane

Alveolar Oxygenated
blood
air space
CO2
Type I cell
O2 gas
(epithelial cell exchange
in alveolar wall) by diffusion

Alveolar basement
membrane
Capillary basement
membrane Deoxygenated
this blood is carried by the blood
pulmonary AR Endothelial cell
in capillary wall Capillary
 Alveolus and associated pulmonary capillaries and alveolar
capillary membrane
WBCs
scavenger
(eat them to
stop
infections)

these RBCs
that need to
take O2
from the
lung.

3/30/2021 15
 Respiratory Functions

• The main functions of respiration are to provide oxygen

to the tissues and remove carbon dioxide.
• The four major components of respiration are
(1) pulmonary ventilation, which means the inflow
and outflow of air between the atmosphere and
the lung alveoli;
(2) diffusion of oxygen (O2) and carbon dioxide
(CO2) between the alveoli and the blood
(3) transport of oxygen and carbon dioxide in the
blood and body fluids to and from the body’s
tissue cells
(4) regulation of ventilation and other aspects of
respiration. it is a central function where there is centers in the brain that control the respiration
3/30/2021 16
 Gas Laws and Applications to Respiratory
Physiology
Law Formula Application

Boyle’s P1V1=P2V2 Basis of gas flow during ventilation,

pressure is inversely Derivation of residual volume
proportional with
volume

Charles’ V1/V2=T1/T2 Gas volume varies in proportion to temperature;

temp. is directly
proportional with
volume of the gas.
Dalton’s Ptotal=∑P(gas) x
if we have a container with
mixed gases the total pressure
equal to the sum of each gas
partial pressure
air expands during inspiration
total atmospheric pressure
fractional
component of the
For atmospheric: PB=PN2+PO2 gas in air ‫ﯾﻌﻧﻲ ﻧﺳﺑﺔ‬
‫اﻟﻐﺎز اﻟﻣراد ﺣﺳﺎب‬
Estimate of Inspired O2: PIO2=(PB-PH2O)* FIO2 ‫ﺿﻐطﺔ اﻟﺟزﺋﻲ ﻓﻲ‬
‫اﻟﮭواء‬
partial pressure of atmosphere

Henry’s Cx=KPx Volume of dissolved gas is proportional to partial

pressure

when the air enters the alveoli it become

humidifyed this is why air pressure will
3/30/2021 decrease because the water vapor will 17dillute
it so we have to subtract the water pressure.
 Standard Notations
Symbol Definition Example
Px Partial pressure of x PCO2: partial pressure of CO2
Fx Fractional volume or pressure FN2: nitrogen fraction of pressure
Sx Saturation, decimal fraction or SO2: % saturation of hemoglobin with
% oxygen
Cx Concentration (content) CO2: total oxygen content
Locations
a Arterial blood PaCO2: carbon dioxide partial pressure of
arterial blood
v Mixed venous PvCO2: carbon dioxide partial pressure of
venous blood
c Pulmonary capillary blood PcO2: oxygen partial pressure of arterial
blood
A Alveolar gas PAO2: alveolar oxygen partial pressure
I Inspired gas FIO2: oxygen fraction of inspired gas
E 3/30/2021 Mixed expired gas PECO2: CO2 partial pressure in expired air
18
 External and cellular respiration.

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 External respiration and Internal respiration

External Respiration :
Refers to the entire sequence of events in exchange of O2 and
CO2 between n the external environment and tissue cells. This
achieved through the following events
• Pulmonary ventilation
• Transfer of gas across the respiratory membrane to the
blood
• Transport of gas by the blood to and from the body cells.

Internal respiration
Refers to the intracellular metabolic processes carried out
within the mitochondria which use O2 and produce CO2
while deriving energy from nutrient molecules

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 The respiratory quotient (RQ)
during metabolism

• RQ = ml of O2 used/ml CO2 produced co2 produced / O2 used

• For carbohydrate utilization RQ is =1
• For fat utilization, the RQ is 0.7
• For f protein utilization , is 0.8.
• On a typical diet consisting of a mixture of these
three nutrients, resting O2 consumption averages
about 250 mL/min, and CO2 production averages
about 200 mL/min
• So RQ 200/250 0.8

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 Respiratory mechanics and pulmonary ventilation

Key words • Respiratory muscle

• Atmospheric pressure • Respiratory cycle
• Alveolar pressure • Boyle's law
• Intrapleural pressure • Tidal normal breathing
• Transpulmonary • Inspiration
pressurethe
is the net distending pressure applied to
• Expiration
lung by contraction of the inspiratory
muscles or by positive-pressure
ventilation
• Elastic recoil pressure • Pneumpthorax
• Lung volume
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 Pleural sac and lung relationship

totally closed system even if the lung is in contact

with the atmosphere but the thoracic wall is not

filled with serous pleural fluid

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 Schematic diagram of the lung and chest-wall system.

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 Absolute and relative pressures in
the respiratory system
sense the lungs are in contact
with the atmospheric pressure
its more easy to use when we are not breathing the
the relative pressure lung pressure will equal to the
instead of absolute atmospheric pressure. where as
and numbers are the pressure in the pleural
small and simple space is subatmospheric.

so if the atmospheric
absolute pressure is 760 it
will be the same in the
lungs,but it will be 756 in the
pleural cavity. and if the
atmospheric relative
pressure is zero the lung's
relative pressure is zero &
the pleural cavity relative
pressure will be -4 or -5.

3/30/2021 25
 Schematic diagram of the lung and chest-wall
system.

when we are not breathing these two

forces are exactly equal but at
opposite directions, according to this,
the elastic recoil of the chest wall
create a negative pressure in the
pleural cavity (intrapleural pressure)
also the lymphatic system act as a
suction pressure and contribute to the
negativity of intrapleural pressure.
while as the alveolar (intrapulmonary
or intra-alveolar) pressure equal zero
cmH2O

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 Respiratory system pressures important in ventilation

mainly O2 &N2

3/30/2021 27
 Transmural Pressure pressure outside - pressure inside
transmural pressure across the lung wall = intraalveolar.press - intrapleural. press(760-756=4)
transmural pressure across the thoracic wall = atmospheric .press - intrapleural .press(760-756=4)

transmural .press (trans

alveolar) of the lung wall
sometimes may be
equal to the tendency of
lung recoil.(= recoil
pressure but in opposite
direction)

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Relationship between transpulmonary pressure (PL) and the pleural
(Ppl), alveolar (PA), and elastic recoil (Pel) pressures of the lung.

but the transpulmonary

expand the lung and the
recoil collapse the lung

Alveolar pressure is the sum of pleural pressure and elastic recoil

pressure. Transpulmonary is the difference between alveolar pressure and
intrapleural pressure
transpulmonary = pleural .press + elastic recoil .press - pleural .press= elastic recoil .press
3/30/2021 29
 Representation of the interaction of the lung and
chest wall
At end expiration, same as rest
• The muscles of respiration are relaxed.
• The inward elastic recoil of the lung is balanced by
the outward elastic recoil of the chest wall.
• Intrapleural pressure is –5 cm H2O
• alveolar pressure is 0.
• The transmural pressure gradient across the
alveolus is therefore 0 – (–5) cm H2O, or 5 cm
H2O.
• Since alveolar pressure is equal to atmospheric
pressure, no airflow occurs.
3/30/2021 30
 so in order to flow air from and to the atmosphere & the lung, we have to change the
pressure gradeant within the respiratory syetem particularly, we have to change the
alveolar (intrapulmonary) pressure and the intrapleural .press. so without changing the
pressure we can not inhale or exhale.

at rest after expiration the

remaining gas in the lung is called
the functional residual capacity

3/30/2021 31
 Intrapleural pressure in a normal person and in a person
.
with a pneumothorax hole in the chest wall

• The arrows show expanding or

the lung's pressure
collapsing elastic forces. is still zero but the
intrapleural .press
• Normally, at rest, intrapleural become zero also,
pressure is −5 cm H2O because of this is why the lung
equal and opposite forces trying to collapsed
collapse the lungs and expand the preventing
chest wall. breathing ‫ﻋﺷﺎن ھﯾك‬
‫ﺑﻧﺣط اﻟﻣرﺿﻰ ﻋﻠﻰ اﺟﮭزة‬
• With a pneumothorax, the ‫ﺗﻧﻔس‬
intrapleural pressure becomes
equal to atmospheric pressure,
causing the lungs to collapse and
the chest wall to expand.

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 Pneumothorax may caused by trauma or it can happen
spontenuously specialy with people with
.emphysema or tall people
both cause collapsed lung

3/30/2021 33
 CLINICAL CORRELATION
Pneumothorax.
• A 26-year-old man comes to the emergency department because of sudden dyspnea (a
feeling that breathing is difficult, also called “shortness of breath”) and pain in the upper
part of the left side of his chest. He has no history of any medical problems. He is 183-cm
(6′2″) tall and weighs about 63.5 kg (140 lb). Blood pressure is 125/80 mm Hg, heart rate is
90/min, and respiratory rate is 22/min( usually12–15/min in a healthy adult). There are no
breath sounds on the left side of his chest, which is hyperresonant (louder and more
hollow-sounding) to percussion (the physician tapping on the chest with his or her
fingers). The patient has a pneumothorax. Air has entered the pleural space on the left
side of his chest and he is unable to expand his left lung. Therefore, there are no breath
sounds on the left side of his chest and it is hyperresonant to percussion

3/30/2021 34
 CLINICAL CORRELATION
Pneumothorax

In this case, the pneumothorax is a primary spontaneous pneumothorax because it occurred suddenly,
and is not attributable to an underlying pulmonary disease (secondary spontaneous pneumothorax) or
trauma (traumatic pneumothorax).
The inability to ventilate his left lung, combined with pain and anxiety, explains his high respiratory rate
Primary spontaneous pneumothorax is most common in tall, thin males between 10 and 30
years of age, although the reason for this is not known. It is believed to occur when
overexpanded alveoli rupture, perhaps as a result of a cough or sneeze. If the pneumothorax
is mild and the patient is not in too much distress, it may resolve without treatment other
than observation. More severe pneumothorax is treated by inserting a catheter or chest tube
through the skin and intercostal muscles into the pleural space to allow removal of the air by
external suction.
A tension pneumothorax is a potentially life-threatening disorder that most commonly
occurs as a result of trauma or lung injury. Air enters the pleural space on inspiration but
cannot leave on expiration, progressively increasing intrapleural pressure above atmospheric.
This can compress the structures on the affected side of the chest (e.g., blood vessels, heart,
etc.) and eventually the structures on the other side of the chest as well.

3/30/2021 35
‫‪Boyle's law,‬‬
‫‪pressure * volume = always constant‬‬
‫ﯾﻌﻧﻲ ﻟﻣﺎ ﺗﺣطﻲ اﻟﺿﻐط ﺿرب اﻟﺣﺟم و ﺑﻌدﯾن ﺗﻐﯾري ﻋﺎﻣل ﻣﻧﮭم و‬
‫‪• P1V1 = P2V2 constant‬‬ ‫ﺗرﺟﻌﻲ ﺗﺿرﺑﯾﮭم ﺑﺑﻌض داﺋﻣﺎ اﻟﺟواب ﺳوف ﯾﻛون ﺛﺎﺑت ﻗﺑل اﻟﺗﻐﯾﯾر و‬
‫ﺑﻌد و ذﻟك ﻻن اﻟﻌﻼﻗﺔ ﺑﯾﻧﮭم ﻋﻛﺳﯾﺔ‬

‫‪• PV = Pressure multiplied by volume equals some‬‬

‫‪constant k‬‬
‫•‬

‫‪3/30/2021‬‬ ‫‪36‬‬
Mechanics of Respiration weincrease
increase the chest cavity to
the air volume and
decrease pressure inside the
lung so the air can flow from the
atmosphere to the lung, so we
can increase the volume by 2
way ether by increasing the
vertical diameter by
diaphragmatic contraction or by
increasing the anterior posterior
diameter by elevating the rib
. cage
note that both
alveolar and
intrapleural
to pressures will
increase decrease
the A-P alveolar will
diameter become -1 and
intrapleural will
become -7

contraction of
it, decrease the
A-P diameter
Patmospheric

Palveolar

Rest
then at expiration the muscles will relax and pressures return back as in rest state but
because of lung's elastic recoil pressure the lung's pressure will be raised to +1 so the air
which is filled with CO2 can flow out.

Patmospheric Patmospheric

Palveolar
Palveolar

↓ Pleural Pressure

Rest Inhalation
Muscles that cause lung expansion and
contraction during inspiration and expiration
The lungs can be expanded and contracted in two ways:
• (1) by downward and upward movement of the diaphragm to lengthen or
shorten the chest cavity
• (2) by elevation and depression of the ribs to increase and decrease the
anteroposterior diameter of chest wall
• Normal quiet breathing is accomplished almost entirely by the first method, that
is, by movement of the diaphragm.
• During inspiration, contraction of the diaphragm pulls the lower surfaces of the
lungs downward.
• Then, during expiration, the diaphragm simply relaxes, and the elastic recoil of
the lungs, chest wall, and abdominal structures compresses the lungs and expels
the air

3/30/2021 40
 Muscles of respiration

they only contract

during powerful
expiration, pushing
up the diaphragm
and lowering the
ribs down,
increasing the
pressure within the
alveoli so the air
flow out from the
lung.

3/30/2021 41
Function of respiratory muscles

elevation of ribs by
contraction of the external
intercostal muscles is
called sometimes by :
bucket action .

3/30/2021 42
 Action of expiratory muscle during forceful powerful
breathing
expiration by :
contraction of the internal
intercostal muscles resulting in
decrease of anterior - posterior
diameter of the lung, increasing
the alveolar and interpleural
pressures.
also by contraction of
abdominal muscles specially
the rectus abdominus and
pushing the diaphragm up
resulting in further decreasing
in the vertical diameter of the
lung, increasing the pressure
pushing air out powerfully.
** usually we don't use this
unlis we are excersizing or in a
disese COPD (chronic
obstructive pulmonary
diseases).because they face
problems in expiration not
inspiration they try to make
high effort to contract the
muscles to make expiration, but
truely that is not what happen,
normal (passive) because of this high increase in
expiration depending the intrapleural pressure the air
on the relaxation of way will collapse so this will not
the muscles and help. this is why these people
return back the will suffer from air trappeng ‫ﯾﻌﻧﻲ‬
diaphragm into ‫ ﺑﻘدروا ﯾﺎﺧدوا ھوا ﺑس ﻣﺎ ﺑﻘدروا ﯾرﺟﻌوه‬so
normal, and by the with time their lung will expand
elastic recoil of the so they start face problems in
taking fresh air.
lung.

3/30/2021 43
Intra-alveolar and intrapleural pressure changes throughout
the respiratory cycle
Movement of Air in and Out of Lungs During Tidal Breathing

Changes in pressure Volume pressure curves

• Pleural Pressures
• Resting -5 cm
H20
• Inspiration -8 cm
H20
• Alveolar Pressure
• Resting 0 cm
H20 at rest
• Inspiration
-1 cm H20
• Expiration 1 cm
H20 Duration of inspiration = 2 sec
Length of expiration 3 sec
3/30/2021 44
 Changes of pressure and volume during Eupneic Respiratory Cycle

Pleural pressure
• Pleural pressure is the pressure of the fluid in the thin
space between the lung pleura and the chest wall pleura.
• It is slightly negative pressure compared to atmospheric
pressure .
• The negative pressure is because of the balanced forces
generated by the chest wall (tends to increase lung
volume) and the lungs (tends to shrink, i.e. elastic recoil).
• The normal pleural pressure at the beginning of
inspiration is about −5 centimeters of water,
• During normal inspiration, expansion of the chest cage
pulls outward on the lungs with greater force and creates
more negative pressure, to an average of about −7.5
centimeters of water.

Alveolar pressure
• Is the pressure of the air inside the lungalveoli. It is
equal to 0 cm H2O when no air is flowing into or out of
the lungs.
• During the respiratory cycle alveolar pressureranges -7.5
between -1 cm H2O to +1 cm H2O. The quiet cycle is
made of inspiration (2 seconds) and expiration (2-3
seconds).

3/30/2021 45
 Changes in transpulmonary pressure of pressure and volume during
tidal (Eupneic ) Respiratory Cycle

Transpulmonary Pressure
• Is the alveolar-distending pressure is
often referred to as the
transpulmonary pressure
• It is pressure difference between that
in the alveoli and that on the outer
surfaces of the lungs (pleural
pressure)
• It is a measure of the elastic forces 0--5=5
in the lungs that tend to collapse the 0--5=5
-1--8=+7
lungs at each instant of respiration,
called the recoil pressure.

3/30/2021 46
 Intra-alveolar and intrapleural pressure changes
throughout the respiratory cycle.

• During inspiration, intra-alveolar pressure is less than atmospheric

pressure.
• During expiration, intra-alveolar pressure is greater than
atmospheric pressure.
• At the end of both inspiration and expiration, intra-alveolar
pressure is equal to atmospheric pressure because the alveoli are
in direct communication with the atmosphere, and air continues to
flow down its pressure gradient until the two pressures equilibrate.
• Throughout the respiratory cycle, intrapleural pressure is less than
intra-alveolar pressure.
• Thus, a transmural pressure gradient always exists, and the lung
is always stretched to some degree, even during expiration.

3/30/2021 47
 Pulmonary ventilation: Summary of events during inspiration
(Tidal Breathing)

1. Inspiration is an active process, normally produced by contraction of the

inspiratory muscles (negative-pressure breathing). negative ‫ﺗﻧﻔس طﺑﯾﻌﻲ ﺑدون اﺟﮭزة و ال اﺷﻲ ﺑﻛون‬
2. Brain initiates inspiratory effort
2. Nerves carry the inspiratory command to the inspiratory muscles
3. Diaphragm (and/or external intercostal muscles) contracts
4. Thoracic volume increases as the chest wall expand
5. Intrapleural pressure becomes more negative
6. Alveolar transmural pressure gradient increases
7. Alveoli expand (according to their individual compliance curves) in
response to the increased transmural pressure gradient.
8. Alveolar pressure falls below atmospheric pressure as the alveolar
volume increases, thus establishing a pressure gradient for airflow

3/30/2021 48
 Pulmonary ventilation: Summary of events during
inspiration (Tidal Breathing )
• Expiration (passive)
• Brain ceases inspiratory command
• Inspiratory muscles relax
• Thoracic volume decreases, causing intrapleural pressure to
become less negative and decreasing the alveolar transmural
pressure gradient
• Decreased alveolar transmural pressure gradient allows the
increased alveolar elastic recoil to return the alveoli to their pre
inspiratory volumes
• Decreased alveolar volume increases alveolar pressure above
atmospheric pressure, thus establishing a pressure gradient for
airflow
• Air flows out of the alveoli until alveolar pressure equilibrates
with atmospheric pressure

3/30/2021 49
 Representation of alveolar, intrapleural pressures at end
expiration (left) and during a strong inspiratory effort

Maximal inspiratory
intrapleural
pressures can be as
low as –80 cm H2O.

recognize that this is in a very strong

inspiration where contraction of external
intercostal muscles is so strong where
the volume increases alot and the
pressure decreases also. this is so
useful at exercise where the air flow
become greater and faster.

3/30/2021 50
 Pressures across the alveoli and conducting airways during
forced expiration in a normal person and a person with
emphysema and dynamic compression of airways
normal people in forced
this could happen also in asthma and copressed lund diseases expiration the intra-
alveolar pressure
increases to +35 and the
intrapleural .press more
remember that the transmural lung press = the elastic recoil pressure of the lung than +20 but in people
with emphysema (has
low elastic recoil
pressure, if the
intrapleural pressure
reaches +20 and the
recoil lung pressure
equals +5 so the
intraalveolar will be +25,
so we need to increase
the pressure gradient in
order to increase the air
flow ( we can do this in
transmural press =+35 - 20=15 normal people) but in
this what keeps the people with emphysema
lung opened and not to because there is an
collapse because the obstruction (dynamic
transmural pressure is compression) so at some
greater than recoil point the intraalveolar
pressure of the lung. pressure become less
than the intrapleural
pressure so the
transmural lung pressure
become negative (-5)
which lead the airway to
collapse .
Alveolar pressure is the sum of the pleural pressure and
elastic recoil pressure of the lung
3/30/2021 51
 Schematic diagram illustrating dynamic compression of airways and the equal pressure
point hypothesis during a forced expiration.
Left: Passive (eupneic) expiration. Intrapleural pressure is –8 cm H2O, alveolar elastic recoil
pressure is +10 cm H2O, and alveolar pressure is +2 cm H2O.
Right: Forced expiration at the same lung volume. Intrapleural pressure is +25 cm H2O,
alveolar elastic recoil pressure is +10 cm H2O, and alveolar pressure is +35 cm H2O. (
the transmural lung
pressure is negative
which lead to
collapsing of the
airway and the
Increasing effort dynamic
compression will
during forced occur, the solution
in normal people we
expiration can increase the
pressure in order to
generate a positive get air out, but
peolpe with
intrapleural emphysema
because they have
pressure, which can dynamic
compression in a
be as high as 120 point before the
transmural become
cm H2O during a negative this is
make breathing
maximal forced hard and no way to
increase the
expiratory effort pressure bacause
the airway is
collapsed.

3/30/2021 52
 Schematic diagram illustrating dynamic compression of airways and the equal pressure
point hypothesis during

Alveolar elastic recoil is

also important in opposing ‫ﺳﺣب‬
dynamic compression of
the airways because of its
role in the traction of the
alveolar septa on small
airways,
but if the intrapleural pressure is
so high and the transmural lung
pressure is negative so the
airway is going to collapse
.anyway

3/30/2021 53
 Additional notes

• Expiratory muscle contraction is required when

respiration is increased during exercise or in the
presence of severe respiratory disease
• Obesity, pregnancy, wall can impede the
effectiveness of the diaphragm in enlarging the
thoracic cavity.
• Damage to the phrenic nerves can lead to paralysis
of the diaphragm.
• When a phrenic nerve is damaged, that portion of
the diaphragm moves up rather than down during
inspiration
3/30/2021 54
 Additional Notes

• Muscular dystrophy, poliomyelitis Neuromuscular

disorders (ALS , Myasthenia gravis can lead to
respiratory failure
• Such patients require mechanical respirators (positive-
pressure breathing)
• Spine Curvature Disorders disorders decrease lung and
chest wall compliance
• Lordosis. Also called swayback, the spine of a person with
lordosis curves significantly inward at the lower back.
• Kyphosis. Kyphosis is characterized by an abnormally rounded
upper back
• Scoliosis. A person with scoliosis has a sideways curve to their
spine. The curve is often S-shaped or C-shaped.

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