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Respiratory system – Part 2

5 marks
Illustrate graphically changes occurring in IPP, Intra alveolar pressure & TV during normal
breathing. Explain the significance of negative IPP.
Pressure Changes:
a. Intrapulmonary pressure: (Pressure inside the alveoli)
At the end of inspiration & expiration ---- O mm Hg
(same as that of atmospheric pressure - 760 mm Hg)
During inspiration -- -1 mm Hg
(1 mm Hg less than the atmospheric pressure -759 mm Hg)
During expiration -- +1 mm Hg
(1 mm Hg more than the atmospheric pressure - 761 mm Hg)
b. Intrapleural pressure: (pressure inside the pleural cavity)
At the end of inspiration & expiration -- -2.5 mm Hg (757.5 mmHg)
During inspiration -- - 6 mm Hg (754 mm Hg)
During expiration -- returns back to -2.5 mm Hg
Cause for negative intrapleural pressure
Due to balance of two opposite forces
- recoil tendency of the lungs to collapse
- recoil tendency of the thoracic cage to expand
Significance of negative intrapleural pressure
- keeps the lungs in a stretched condition which prevents the collapse of lungs
- facilitates venous return
Transpulmonary pressure:
The pressure difference across the lung is called transpulmonary pressure
Transpulmonary pressure = Intrapulmonary pressure – intrapleural pressure
Volume changes
Tidal volume
During inspiration – The volume of air in the lungs increases by 500 ml.
During expiration – The volume of air in the lungs decreases by 500 ml.
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2. Describe about surfactant & its functions

 Surfactant is a mixture of phospholipids, proteins & ions
 The major phospholipid is dipalmitoyl – phosphotidylcholine (DPPC)
 The proteins are SPA, SPB, SPC and SPD
 Secreted by type II alveolar epithelial cells
Primary function:-
Reduces the surface tension of intra alveolar fluid by reducing the attraction between water
molecules
Secondary functions
 Stabilizes alveolar size during inspiration and expiration.
During inspiration, surfactant layer becomes thin. This can not reduce the surface tension.
The surface tension opposes further expansion of alveoli during inspiration. During
expiration, surfactant layer becomes thick. This reduces surface tension. This prevents
alveolar collapse during expiration. Thereby the alveolar size is stabilized

 Prevents pulmonary edema

Since surface tension of intra alveolar fluid is one of the causes for pulmonary edema, by
reducing surface tension the surfactant prevents pulmonary edema
 Increase in compliance
Increases compliance by decreasing the elastic recoiling of the lungs which tend to
collapse the lung
 Reduces the work of breathing by causing easy expansion of alveoli
 Facilitates the reopening of collapsed airway & alveoli
 Facilitates phagocytosis of micro-organisms by alveolar macrophages
Factors affecting the secretion of pulmonary surfactant
decrease in secretion increase in secretion
- Hyperbaric O2 therapy for a - Thyroid hormones
Long time
- Hypoxia - Glucocorticoids
- Cigarette smoking
- bilateral vagotomy - Vagal stimulation
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Applied (clinical significance)

RDS (respiratory distress syndrome of newborn)
Decreased surfactant secretion in new born babies (especially premature) causes difficulty in
breathing due to pulmonary edema & lung collapse (atelectasis) The infant may die if not
treated
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3. Draw spirogram. Define & give the normal values of lung volumes & capacities
Pulmonary Volumes
• Tidal Volume (TV)
• Inspiratory Reserve Volume (IRV)
• Expiratory Reserve Volume (ERV)
• Residual volume (RV)
Pulmonary Capacities
• Total Lung Capacity (TLC)
• Vital Capacity (VC)
• Inspiratory Capacity (IC)
• Functional Residual Capacity (FRC)

• Tidal Volume (TV)

Volume of air breathed in or out during quiet respiration.
Normal value – 500 ml
• Inspiratory Reserve Volume (IRV)
Maximum volume of air breathed in after a normal tidal inspiration.
Normal value – 3000 ml
• Expiratory Reserve Volume (IRV)
Maximum volume of air breathed out after a normal tidal expiration.
Normal value – 1100 ml
• Residual Volume (RV)
Volume of air remaining in the Lungs after a maximal expiration.
Normal value – 1200 ml
Pulmonary Capacities
TLC = IRV + TV + ERV + RV
VC = IRV + TV + ERV
IC = IRV + TV
FRC = ERV + RV
• Total Lung Capacity (TLC)
Volume of air in the lungs after a maximal inspiration
Normal value – 5800 ml
• Vital Capacity (VC)
Maximal volume of air expelled Out from the lungs by forceful expiration after a
maximum inspiration
Normal value – 4600 ml
• Inspiratory Capacity (IC)
Maximum volume of air which is inspired from the resting expiratory level
Normal value – 3500 ml
 Functional Residual Capacity (FRC)
Volume of air remaining in the lungs after normal expiration
Normal value – 2300 ml
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4. What are the salient features of pulmonary circulation?
Pulmonary circulation
Right ventricle  Pulmonary artery Pulmonary capillariesPulmonary veins
Functions of pulmonary circulation
 Respiratory gas exchange (diffusion of O2 into the blood & CO2 out of the blood)
 Reservoir for left ventricle
 Removal of emboli & other particles from blood
 Removal of third from alveoli
 Absorption of drugs
 Synthesis of ACE (Angiotensin Converting Enzyme)
Special features of pulmonary circulation
1. Entire blood volume passes through the two lungs in one minute
2. Differences compared to systemic circulation
Pulmonary circulation Systemic circulation
1. Artery carries deoxygenated blood 1. Artery carries oxygenated blood
2. Vein carries oxygenated blood 2. Vein carries deoxygenated blood
3. Capillary gives up CO2& takes in O2 3. Capillary gives up O2 & takes in CO2
3. High capillary density. Blood flow is referred to as “sheet flow”. Helps in quick exchange of gases
4. It is a low pressure system.
Pulmonary artery – 15 mmHg
Pulmonary capillary – 6-8 mmHg
Cause for low arterial pressure
Pulmonary vessels are thin walled and distensible (high-compliance circulation)
Significance of low arterial pressure
Keeps the alveoli dry. This prevents the formation of pulmonary edema
5. Blood flow during respiration
Inspiration - blood flow is increased
Expiration - blood flow is decreased
6. Hypoxia à Vasoconstriction
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Significance:
Diversion of blood flow from a poorly ventilated area to a well ventilated region
7. Pulmonary blood flow is always equal to cardiac output in all physiological conditions
8. Effect of gravity on pulmonary circulation
Base of the lungs – more blood flow
Apex of the lungs – less blood flow
Significance of low pressure in pulmonary circulation:
Pulmonary circulation is a low pressure low resistance & high capacitance system
Pulmonary arterial pressure – Systolic pressure - 25 mm Hg
Diastolic pressure - 9 mm Hg
Pulmonary capillary pressure – 6-8 mm Hg
Significance of low pressure:
- Capillary pressure is less than colloidal osmotic pressure (25 mm Hg)

- Draws fluid from alveolar interstitial space into pulmonary capillaries

Keeps the alveoli dry

(a safety factor against pulmonary edema)
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5. Draw the normal ODC curve. What is the significance of sigmoid shape of the curve?
Describe the factors influencing the curve
Definition: Curve obtained by plotting the relationship between PO2 (partial pressure of
oxygen) and % of Hb saturation.
Characteristic features of curve:
 sigmoid or S-shaped
 Consists of two zones:
1. Loading zone refers to plateau (upper flat part)
- This is related to the process of O2 uptake in the lungs
- At PO2 of 100 mm Hg, the Hb is 97% saturated (Arterial blood)
2. Unloading (dissociation) zone refers to the steep portion of the curve at PO2
below 60 mm Hg
-concerned with O2 delivery in the tissues
-At PO2 of 40 mm Hg, the Hb is 75% saturated (venous blood)
Advantages of sigmoid shape of ODC
 Allows greater uptake of O2 at lungs inspite variation in alveolar PO2
 Tissues are supplied with O2 according to the needs of tissues
 Hb acts as a buffer for O2 & maintains tissue PO2 at 40 mm Hg.
Factors influencing ODC
Several factors affect the affinity of Hb for O2 & shift the ODC either to right or left
Shifting of curve to right
- Hypoxia
- Increase in PCO2
- Decrease in pH of blood (Accumulation of acidic products like lactic acid, CO2 etc.,)
- Increase in temperature
- 2, 3, DPG (diphosphoglycerate)
-
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Shifting of curve to left

- decreased PCO2 of blood
- increased pH of blood
- decreased temperature
- Fetal Hb
Effect of exercise on ODC
As exercise leads to increase in PCO2 (due to increase in metabolism), increase in pH
(accumulation of acids) & increase in temperature (due to increase in metabolism), the
ODC is shifted to right

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6. What is Bohr effect & Haldane effect?
Bohr effect:
The effect of increased PCO2 on oxygen dissociation curve is called Bohr effect
In tissues, increase in PCO2 causes unloading of oxygen from Hb and loading of CO2
This shifts the curve to right
Significance of Bohr effect
This helps to supply oxygen to the tissues and remove CO2 from tissues
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Haldane effect:
The effect of increased PO2 on CO2 dissociation curve is called Haldane effect
In lungs, increase in PO2 causes unloading of CO2 from Hb and loading of oxygen
This shifts the curve to right
Significance of Haldane effect
This helps to deliver CO2 in the lungs so that it can be expelled out of lungs

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7. Explain chloride shift and its significance
CO2 is converted into bicarbonate inside the RBC and then diffuses into plasma
-the steps involved are
CO2 in the tissues

Enters into the blood

Enters into the RBC

Combines with H2O to form carbonic acid in the presence of enzyme “carbonic Anhydrase”

Carbonic acid dissociates into bicarbonate ions (HCO3-) and Hydrogen ions (H+)

Diffusion of bicarbonate into the plasma and H+ are buffered by hemoglobin

Chloride Shift:

- Diffusion of HCO3- out of RBC into plasma  less negative inside  to

neutralize this effect negatively charged chloride ions diffuse from plasma into
the RBC
- this movement of chloride ions into the RBCs is called chloride shift
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RBC

Plasma

-
Significance of chloride shift:
- maintains the membrane potential of RBC
- causes movement of other ions into RBC which is followed by osmosis of water
into RBC. This increases the volume of RBC in venous blood. This increases the
hematocrit value of venous blood
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8. Define & give the normal value of vital capacity. Describe the factors influencing vital
capacity
Definition
Maximal volume of air expelled out from the lungs by forceful expiration after a maximum
inspiration (IRV + TV + ERV)
Normal values : Males – 4.8 lts & Females – 3.2 lts
Factors influencing :
1. Respiratory muscle power
2. Airway patency (resistance)
3. Compliance of the lungs
4. Elasticity and viscosity of lung
Physiological variations
• Increased in: Athletes, Europeans, Divers, Swimmers, Standing Posture, High altitude
• Decreased in: Old age, sedentary life & Obesity, Lying Posture
Pathological variations
Decreased in
Pulmonary congestion Myasthenia gravis
Emphysema Chronic asthma
Bronchitis Poliomyelitis
Pleural effusion Pulmonary fibrosis
Respiratory obstruction Pneumothorax
Asthma
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3 marks
1. Define compliance. What is its significance? What are the factors that influence compliance?
Definition: The change in lung volume per unit change in transpulmonary pressure.
Normal value: 0.22 l/cm H2O
Factors that influence compliance:
- Surface tension
- Lung volume
- Phase of respiratory cycle
- Effect of gravity
Significance:
Compliance is increased in emphysema & old age, decreased in pulmonary congestion,
pulmonary fibrosis & pulmonary edema
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2. What is dead space? What are the two types? Give the normal values. Describe a method to
measure
Definition
The air in the respiratory tract that does not take part in the gas exchange process.
Types
Anatomical dead space
Physiological dead space
Anatomical dead space
The volume of air present in the conducting zone of respiratory passage, i.e. from nose to
terminal bronchiole
Physiological dead space
Total dead space which includes anatomical dead space + alveolar dead space.
Alveolar dead space
Air in the alveoli that does not take part in the gas exchange
Alveolar dead space caused by
1. Obstruction to pulmonary capillary blood flow (no perfusion)
e.g. pulmonary embolism
2. over ventilation of alveoli
e.g. emphysema and Bronchiectasis
Normal values
Healthy adult:
Anatomical dead space = Physiological dead space
Young males – 150 ml
Young females – 100 ml
Older subjects – 200 ml
Measurement of dead space
Anatomical dead space: Fowler’s method
Physiological dead space: Bohr’s equation
Fowler’s method
Quiet expiration

Deep breathing of pure O2

Breathing out slowly and evenly into a nitrometer

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No N2 in the earlier part (Area with Dots)

&
N2 concentration gradually rises in the latter part (Area of diagonal lines) and reaches 60%

Area of dots
Dead space = --------------- X Volume of expired air (TV )
Area of dots and diagonals
Measurement of Physiological dead space
Bohr’s equation:
TV (PACO2 – PECO2)
Dead space (VD) = -------------------------
PACO2
TV – Tidal volume
PACO2 – Partial pressure of CO2 in alveolar air
PECO2 – Partial pressure of CO2 in expired air
Increased physiological dead space
Pulmonary embolism
Bronchiectasis
Emphysema
Effect : Hypoxia
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3. FRC (Functional Residual Capacity) - normal value & functional importance.
Definition
Volume of air remaining in the lungs after normal expiration
Normal value – 2300 ml (ERV + RV)
Measurement
• Spirometry cannot measure
• Thus Functional Residual Capacity (FRC) cannot be determined using spirometry alone.
• FRC can be determined by
1) Helium dilution technique
2) Nitrogen washout technique
Physiological significance
1. Helps in continuous exchange of gases between the lungs and blood between two breaths.
(Prevents the marked rise or fall of blood O2 and CO2 level between respirations)
2. Required for breath holding
3. Dilution of toxic inhaled gases
4. Reduces the work of breathing by preventing the collapse
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Conditions Affecting FRC

Increased in - Emphysema, COPD & Old age
Decreased in - Pulmonary fibrosis (scarring of lung tissue) & Atelectasis (collapse of lung)
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4. What is timed vital capacity? What is its significance?
TIMED VITAL CAPACITY (FORCED VITAL CAPACITY)
Definition:
It is the volume of air that can be expired with maximum effort after a maximal inspiration in a given
unit time
Components
FEV1 (forced expiratory volume in 1st sec)

FEV2 (forced expiratory volume in 2nd sec)

FEV3 (forced expiratory volume in 3rd sec)

TVC in normal individuals

FEV1% = FEV1
----------*100 = 80%
FVC
FEV2% = 90%
FEV3% = 100%
Significance
Helps in differentiating the obstructive lung diseases from the restrictive lung diseases
Obstructive lung diseases Restrictive lung diseases

FEV1 < 80 % FEV1 = normal

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5. Draw the respiratory membrane & label its components

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6. Give a short account on peripheral chemoreceptors.
Peripheral chemoreceptors are the sensory nerve endings which are present in the peripheral
blood vessels and stimulated by changes in O2 & CO2 content of blood
Location :
- Carotid sinus (carotid bodies)
- Aortic arch (aortic bodies)
Structure:
- 2 types of cells (type I & type II cells)
- Unmyelinated nerve endings are found at intervals between type I & type II cells
- Type I cells consists of dopamine which is released in hypoxia and stimulates the
nerve endings via D2 receptors
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Nerve supply:
- Carotid body -- By sinus nerve, a branch of glossopharyngeal (IX nerve)
- Aortic body --- by aortic nerve, a branch of vagus (X nerve)

Blood supply:
- 2000 ml/ 100 gm/ mt (highest blood flow in the body)
- O2 needs of the receptor cells are met by dissolved oxygen content
Mechanism of stimulation: Hypoxia  inhibition of K+ channels  decrease in K+ efflux
increase in Ca++ influx  depolarization of type I cells  release of neurotransmitter 
stimulation of afferent nerve endings
Effect of stimulation:
- Stimulation of peripheral chemoreceptors  increase in both rate & depth of
respiration
- Carotid bodies are seven times more effective in stimulating respiration than the
aortic bodies
- Not stimulated in anemia or carbon monoxide poisoining as dissolved O2 content
is normal
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7. What is acclimatization? What are the cardiorespiratory changes that occur at high altitude?
Definition:
Changes in body mechanisms to bring an adaptation of the person to the high altitude
Changes in Respiratory System
Hyperventilation
Hypoxemia (decreased O2 tension of blood) – stimulation of peripheral
chemoreceptors – hyperventilation – increased PO2 & decreased PCO2 (Starts within
the 1st few hours of exposure)
Increase in lung volumes & capacities
Hypertrophy of respiratory muscle power  ↑ chest size and somewhat ↓body size
high ventilatory capacity to body mass  Increase in lung volumes & capacities
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↑ Diffusion capacity
– ↑ pulmonary capillary blood volume
– ↑ lung volume
– ↑ pulmonary arterial pressure
Respiratory alkalosis
Hypoxia  Hyperventilation  Washout of CO2  Respiratory alkalosis (↑pH)
Shift of ODC curve to right
• ↑ in 2,3 DPG
• Hypoxia
Changes in Cardiovascular System
Hypoxia

Activation of sympathoadrenal system

↑in HR, CO & BP ↑ Muscle blood flow ↑ Coronary blood ↓in cutaneous &
(vasodilatation) flow Splanchnic
blood flow (vasodilatation)
(vasoconstriction) (Indirect effect)