Topics for five sessions of respiratory physiology

• Review on anatomy and histology of respiratory system

• Respiratory and Non-respiratory function of the respiratory system
• Pulmonary Ventilation
• Pulmonary circulation
• Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide
Trough the Respiratory Membrane
• Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids
• Regulation of Respiration

Reference:
th
Guyton and Hall Textbook of Medical Physiology, 14 edition, 2021,
Chapters; 38 , 39, 40, 41 , 42 (Pages: 531-535).

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 Session-1
Subjects:

• Basics of Respiration: Respiratory and Non-respiratory Functions of

Respiratory System

• Respiratory Tract Divisions

• Mucociliary system

• Tracheobronchial Tree in lower tract

• Structure of an Alveolus

• Two kinds of blood circulation in respiratory system

• Neurohumoral Regulation of Airway Resistance

• Lung Nervous System

• Dead Space

Basics of Respiration:

• Respiratory Function of Respiratory System:

– Provide oxygen (O ) for the peripheral tissues

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– Remove carbon dioxide (CO ) from the peripheral tissues

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– Oxygen is utilized by cells for energy production (ATP) and

CO produced during metabolism of the cells.
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 • It is the process by which the body takes in oxygen and utilizes and
removes CO2 from the tissues into the expired air

• It comprises of

 Ventilation by the lungs (inflow & outflow of air inspiration and

expiration)

 Gas exchange across alveolar membrane (Diffusion of oxygen &

carbon dioxide between alveolus & pulmonary Capillary, Fick’s law)

 Transport of oxygen & carbon dioxide in the blood & body fluids to
& from the cells.

 Uptake of O2 and release of CO2 by tissues Diffusion at the cellular

level

Non-Respiratory Functions:

o Regulation of acid-base status

o Phonation (Voice production)

o Olfaction (Smell)

o Pulmonary Defense mechanisms

 Mucociliary system

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  Secretion of the antimicrobial agents by airway epithelial cells, such as;
IgA, Proteases, ROS, ….

 The pulmonary alveolar macrophages (PAMs)

 Contain a fibrinolytic system that lyses clots in the pulmonary vessels

o Metabolic and Endocrine Function

Respiratory Tract Divisions

• Upper tract

 Nose,

 pharynx

 Larynx

 Sinuses

 Lower tract
 trachea

 bronchi

 bronchiol

 Alveoli

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Nose
• Functions

– Air Conditioning:

– Cools and warms the inspired air to body temperature (37±0.5º C)

– Humidify (Moistening) the inspired dry air

– Filter and Clear the inspired air from foreign matters

(Particle with diameter more than 6 micrometer can’t pass from nose to lungs)

– Smell

– Along with paranasal sinuses are resonating chambers for speech

Mucociliary system:
• All the respiratory passages, from the nose to the terminal bronchioles, are
kept moist by a layer of mucus that coats the entire surface.

• The mucus is secreted partly by individual mucous goblet cells in the

epithelial lining of the passages and partly by small submucosal glands.

• The mucus traps small particles out of the inspired air and keeps most of
these
particles from ever reaching the alveoli.

• The epithelium of the respiratory passages from the nose to the beginning of
the respiratory bronchioles is lined with ciliated epithelium (with about 200
cilia on each epithelial cell).

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 • These cilia beat at a frequency of 10-20 times per second

• This continual beating causes the coat of mucus to flow slowly, at a velocity
of a few millimeters per minute, toward the pharynx. Then the mucus and its
entrapped particles are either swallowed or coughed to the exterior.

Changes in structure of the airways from trachea to

respiratory bronchioles

• From trachea toward bronchi:

 These conducting tubes become smaller (in diameter), shorter (in length) and
structural changes occur as below:

 Cartilage support structures change (from rings to plates)

 Amount of smooth muscle increases

 Epithelium type is columnar

• Bronchioles, Terminal bronchioles, respiratory bronchioles

- Cuboidal epithelium

- A layer of circular smooth muscle

– Lack cartilage support

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Conducting Zone
• Conducting zone is the first 16th generations of lower airways.

• This zone begins from the trachea and continues to the end of the terminal
bronchioles.

• This area of the lung (≈150 mL in volume) does not participate

in gas exchange and forms the anatomical dead space.

• This zone includes:

 Trachea (generation 0)

 Bronchi (generation 1-10)

 bronchioles (generation11-15)

 terminal bronchioles (generation 16)

Respiratory Zone
• Respiratory zone is the region of lower tract which gas exchange take places
between lung and pulmonary capillaries.

• Respiratory zone is the remaining seven generations of lower airways.

• Begins from respiratory bronchioles and

includes the following airways:

 Respiratory bronchioles (generation 17-19)

 alveolar ducts (generation 20-22)

 alveolar sacs (generation 23)

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Respiratory Unit
 The respiratory unit (also called “respiratory lobule”) is composed of a
respiratory bronchiole, alveolar ducts and alveoli.

 The alveolar walls are extremely thin, and between the alveoli is an almost
solid network of interconnecting capillaries

Structure of an Alveolus
 There are about 300 million alveoli in the two lungs, and each alveolus has
an average diameter of about 0.2 millimeter.

 Each alveolus is composed of type I and type II epithelial cells. Under

normal conditions, type I and type II cells exist in a 1:1 ratio.

 The type I cell occupies 96% to 98% of the surface area of the alveolus, and
it is the primary site for gas exchange.

 The thin cytoplasm of type I cells is ideal for optimal gas diffusion.

 In addition, the basement membrane of type I cells and the capillary

endothelium are fused, which minimizes the distance for gas diffusion and
thereby facilitates gas exchange.

 Type II cells usually found in the “corners” of the alveolus, where they
occupy 2% to 4% of the surface area.

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  Also, type II cells synthesize pulmonary surfactant, which reduces surface
tension in the alveolus and thereby promotes less resistance during
inhalation and exhalation.

Two kinds of blood circulation in respiratory system

 Bronchial circulation:
 originate from aorta in the systemic circulation (High pressure)

 Supplies blood for conducting zone and the connective tissue of the lung.

 This bronchial arterial blood is oxygenated blood, in contrast to the partially

deoxygenated
blood in the pulmonary arteries.

 It empties into the pulmonary veins and enters the left atrium, rather than
passing back to the right atrium (venous admixture of blood or anatomic
shunt).
Pulmonary circulation:
 is a low pressure circulation

 supplies blood for respiratory zone

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Neurohumoral Regulation of Airway Resistance
• Airway resistance can be affected or regulated through two ways:

 1- Autonomic Nervous system

 Sympathetic fibers: Direct control of the airways by sympathetic nerve
fibers is relatively weak because distribution of sympathetic fibers is poor in
the lung. However, the bronchial tree is very much exposed to
norepinephrine and epinephrine released into the blood by sympathetic
stimulation of the adrenal gland medullae. Both these hormones, especially
epinephrine because of its greater stimulation of beta-adrenergic receptors,
cause dilation of the bronchial tree.
 Parasympathetic fibers: derived from the vagus and has a high distribution.

 2-Local (Humoral) agents.

Lung Nervous System

• Adrenergic (Sympathetic + Adrenal gland) :

 Airway muscle: β2-adrenoceptors: relaxation of airways (Bronchodilation)

 Vessels: Vasoconstriction by α-receptor activation

 Glands (Mucus secretion): Increased (via activation of β- receptor)

Decreased (via activation of α- receptor)

• Cholinergic (Parasympathetic or Vagus):

 Airway muscle: M3 receptor, constriction of airways (Bronchoconstriction)

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  Vessels: No effect (a little dilation by extreme stimulation)

 Glands (Mucus secretion): Increased

 Non Adrenergic- Non Cholinergic ( NANC ):

- NANCi : dynorphin and VIP: Dilation of airways

- NANCe : SP and Tachykinine: Constriction of airways

Points:
• Sometimes Vagus nerves are stimulated by reflexes from epithelial cells of
lungs.

• Smoke inhalation, dust, cold air, or other irritants can result this reflex and
lead to airway constriction and coughing.

• During Allergic Reactions, local secretory factors by mast cells in lung

tissue [such as histamine and slow reactive substance of anaphylaxi (SRS-
A) ] may cause bronchiolar constriction

Dead Space
Dead space is the volume of air that is inhaled that does not take part in the gas
exchange, because it either remains in the conducting airways or reaches alveoli
that are not perfused or poorly perfused.

• Anatomical dead space : volume of the conducting zone (150 ml)

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• Alveolar dead space: alveoli without blood flow (There is no O2 and CO2
exchange in alveoli, PO2= 149 mmHg and PCO2=0)

• Physiological dead space: sum of alveolar and anatomical dead spaces

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