Fluid Mechanics

Lecture 6
 Outline
❑ Pulmonary Pathophysiology
➢ Bronchitis
➢ Emphysema
➢ Asthma
➢ Pulmonary fibrosis
➢ Chronic obstructive pulmonary disease (COPD)
➢ Heart disease
❑Respiration in Extreme Environments
➢ Barometric pressure
➢ Partial pressure of oxygen
➢ Hyperventilation and the alveolar gas equation
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Pulmonary Pathophysiology:
❑ Bronchitis:
➢ Bronchitis is an inflammation of the airways resulting in excessive mucus production
in the bronchial tree.
➢ Bronchitis occurs when the inner walls of the bronchi become inflamed.
➢ It often follows a cold or other respiratory infection and happens in virtually all
people, just as the common cold.
➢ When the bronchitis does not go away quickly but persists, then it is termed chronic
bronchitis.
❑ Emphysema:
➢ Emphysema is a chronic disease in which air spaces beyond bronchioles are increased. The
stiffness of the alveoli is decreased, (static compliance is increased), and airways collapse more
easily.
➢ Because of the decreased stiffness of the lung, exhalation requires active work and the work of
breathing is significantly increased.
➢ The surface area of the alveoli become smaller, and the air sacs become less elastic. As carbon
dioxide accumulates in the lungs, there becomes less and less room available for oxygen to be
inhaled, thereby decreasing the partial pressure of oxygen in the lungs.
➢ Emphysema is most often caused by cigarette smoking, although some genetic diseases can
cause similar damage to the alveoli. Once this damage has occurred, it is not reversible.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Pulmonary Pathophysiology:
❑ Asthma:
➢ In asthma, the airways become overreactive with increased mucus production,
swelling, and muscle contraction.
➢ Because of the decreased size of the bronchi and bronchioles, flow of air is
restricted and both inspiration and expiration become more difficult.
❑ Pulmonary fibrosis:
➢ Pulmonary fibrosis is caused by a thickening or scarring of pulmonary membrane.
The result is that the alveoli are gradually replaced by fibrotic tissue becoming
thicker, with a decreased compliance (increased stiffness) and a decrease in
diffusing capacity.
➢ Symptoms of pulmonary fibrosis include a shortness of breath, chronic dry, hacking
cough, fatigue and weakness, chest discomfort, loss of appetite, and rapid weight
loss. Traditionally, it was thought that pulmonary fibrosis might be an autoimmune
disorder or the result of a viral infection. There is growing evidence that there is a
genetic link to pulmonary fibrosis.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Pulmonary Pathophysiology:
❑ Chronic obstructive pulmonary disease (COPD):
➢ It is a slowly progressive disease of the lung and airways.
➢ COPD can include asthma, chronic bronchitis, chronic emphysema, or some
combination of these conditions.
➢ The disease is characterized by a gradual loss of lung function.
➢ The most significant risk factor for COPD is cigarette smoking.
➢ Other documented causes of COPD include occupational dusts and chemicals.
➢ Genetic factors can also play a significant role in some forms of this disease.
❑ Heart disease:
➢ Some forms of cardiac disease can certainly lead to respiratory pathologies.
➢ For example, a stenotic mitral valve can cause back pressure in pulmonary
capillaries leading to fluid in the lungs.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Pulmonary Pathophysiology:
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Pulmonary Pathophysiology:

Figure: Spirometer comparisons between a normal lung, fibrosis, asthma,

and emphysema.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
➢ Consider how you might feel if you drive your automobile to the top of Pikes Peak in
north America (14,109 ft above sea level, ASL). If you have had the opportunity to visit
this location, you probably experienced the shortness of breath associated with
breathing in environments with low oxygen pressure.
➢ The percentage of oxygen does not vary much with the increase in altitude, but the
partial pressure of oxygen diminishes.

❑ Barometric pressure:
➢ Just as with normal respiration, at high altitude the driving force which helps to push
oxygen into your blood is the partial pressure of oxygen.
➢ This partial pressure depends on both the barometric pressure and the relative
percentage of air that consists of oxygen.
➢ Barometric pressure depends on the altitude above the earth’s surface and varies
approximately exponentially as shown in figure below.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Barometric pressure:

Figure: Barometric pressures

as a function of altitude above
sea level.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Barometric pressure:
➢ The equation for barometric pressure as a function of altitude depends on the
density of the air at varying altitudes and therefore on air temperature.
➢ The equation for the standard atmosphere between sea level and 11 km above the
earth’s surface can be given by:

➢ where Patm is the barometric pressure in millimeters of mercury, and z is the

altitude above mean sea level in kilometers.
➢ With the decrease in altitude and corresponding decrease in barometric pressure
comes a decrease in the partial pressure of oxygen.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Partial pressure of oxygen:
➢ The partial pressure of oxygen, PO2 is the driving pressure for getting oxygen into
the blood.
➢ Air is 21 percent oxygen, so the partial pressure of oxygen in standard air is FIO2 =
0.21 times the barometric pressure PB. This is also known as the fraction of inspired
oxygen, FIO2 .
➢ The PO2 in air on a standard day in Terre Haute, Indiana, is PO2= FIO2 × PB which
equals 0.21 × 747 = 157 mmHg.
➢ If PO2 is low, the driving pressure to push oxygen into the bloodstream will be low,
making it more difficult to breathe.
➢ Further, the air inside your lungs is not dry air. Water vapor also displaces oxygen. In
fact, the air in your lungs is saturated with water, and the vapor pressure of water at
37°C, the temperature inside your lungs, is 47 mmHg.
➢ Now the PO2 of sea-level dry air is: 760 (0.2093) = 159 mmHg, but the PO2 of
saturated, inspired air is: (760 – 47)(0.2093) = 149 mmHg.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Hyperventilation and the alveolar gas equation:
➢ Inspired oxygen is not the complete story. What about the CO2 in your lungs?
Doesn’t it also displace air, making the PO2 even lower?
➢ The amount of oxygen in the alveoli depends on the production of carbon dioxide
and the rate of transfer of oxygen from the lungs to the blood in the pulmonary
capillaries.
➢ To understand what is happening with the person’s arterial oxygen concentration,
begin with the alveolar gas equation which takes into account the patient’s arterial
CO2 partial pressure (PaCO2), fraction of inspired oxygen (FIO2), and the barometric
pressure (PB). Take care with the symbols since “a” in PaCO2 represents “arterial”
while “A” in PACO2 stands for “alveolar.”

➢ where P is partial pressure, A is alveolar, FIO2 is fraction of inspired oxygen, PB is

barometric pressure, PH2O is the vapor pressure of water at 37oC, and R is the
respiratory quotient.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Hyperventilation and the alveolar gas equation:
➢ The respiratory quotient or respiratory exchange ratio is:

➢ This alveolar gas equation is valid if there is no CO2 in inspired gas. If we assume a
typical value for R of 0.8, the following abbreviated alveolar gas equation is often
used for clinical purposes.

➢ This equation uses a water vapor pressure of 47 mmHg, which is the vapor pressure
of water at body temperature, 37°C.
➢ Ambient FIO2 is the same at all altitudes, 0.21.
➢ The partial pressure of carbon dioxide in your lungs can approach 40 mmHg. Since
the partial pressure of inspired oxygen at an altitude of 18,000 ft ASL was calculated
as 70 mmHg without considering CO2, the PO2 of air in the alveoli could be as low as
70 - 1.2(40) = 22 mmHg.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Hyperventilation and the alveolar gas equation:
➢ At the top of Mt. Everest it could be as low as 43 - 1.2(40) = -5 mmHg.
➢ If that is true, how can so many people climb above 14,000 ft so easily and a few
people even reach the summit of Mt. Everest without oxygen? The short answer is
hyperventilation. By breathing faster, climbers are able to lower the partial pressure
of carbon dioxide in their alveoli. If you increase ventilation rate by four, you can
lower the PCO2to about 10 mmHg. By hyperventilation, the PO2 of alveolar oxygen at
the top of Mt. Everest can be calculated as follows.
➢ PO2 of inspired air at 29,000 ft is (250 - 47)(0.2093) = 43 mmHg.
➢ PCO2 of the air in the alveoli is 10 mmHg. The partial pressure of the oxygen in the
alveoli is 43 - 1.2(10) = 30 mmHg.
 Pulmonary Anatomy, Pulmonary Physiology, and
Respiration
❑ Respiration in Extreme Environments:
❑ Example: A high-altitude native living in the Andes in Potosi, Bolivia, at 13,000 ft (~4000
m) above sea level has a hematocrit 53 percent. If the partial pressure of alveolar
oxygen in this man’s lungs is 50 mmHg, calculate the partial pressure of arterial carbon
dioxide using the abbreviated form of the alveolar gas equation. The water vapor
pressure of 47 mmHg.
❑ Solution: The abbreviated form of the alveolar gas equation is:

➢ Solving for the partial pressure of CO2 yields:

➢ To solve for the barometric pressure at altitude, we use the equation:

➢ Therefore,

➢ The partial pressure of carbon dioxide in the arterial blood is 31 mmHg.

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