Respiratory System: Lung compliance

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
 Describe how pressure-volume relationships are obtained.​
 Define compliance and how it relates to elastance. Describe how these
two properties define the pressures required to effect changes in lung
volume.​
 Relate pressure-volume relationships and static compliance to disease
states (emphysema, fibrosis, IRDS).​
 Draw the pressure-volume (compliance) curves for the lungs, chest
wall, and respiratory system on the same set of axes. Show and explain
the significance of the resting positions for each of these three
structures. ​
 Relate changes in the lung compliance to shifts in pressure-volume
curves of the lung and chest wall.
 Elastic properties of lung and chest wall

◼ Lung and chest wall compliance

➢ Pressure-volume curve

➢ Static compliance

➢ Dynamic compliance

◼ Factors that shape the pressure-volume curve

➢ Lung and chest wall elasticity

➢ Surface tension
 Lung compliance

◼ The extend to which the lung expand for each unit

increase in transpulmonary pressure
◼ The change in lung volume per unit change in airway
pressure
◼ Compliance= DV/DP
◼ 0.2 L/cm of H2O (200ml/cm of H2O)
◼ Lower the lung compliance- larger the transpulmonary
pressure gradient that must be created during
inspiration
◼ Decreased in pulmonary fibrosis
 Static lung compliance
◼ Measured when there is NO
AIRFLOW

◼ Pressure is measured across a

range of lung volumes

◼ Static lung compliance is a

function of:
➢ Elastic recoil of the lung

(Elastic properties)

Static isolated lung inflation curve

 Static lung compliance

Static isolated lung inflation curve Lung compliance

 STATIC Compliance graph of respiratory system

◼ A known volume of air inspired,

glottis is closed and muscles
relaxed
◼ Shows CW, CL, and CRS through
the entire range of lung volumes
◼ At FRC, CL and CW are equal
but opposite
◼ As lung volume increases
toward TLC the compliance of
the entire respiratory system
becomes stiff and less compliant
 Specific compliance

◼ This takes into account

different sizes of lungs
◼ Specific compliance =
Static compliance/FRC
◼ Compliance changes with
changes in lung volume
◼ At FRC, static lung
compliance = 0.2 L/cm
H 2O
 Situations which decreases compliance of
the chest wall
◼ Aging –calcification making chest wall less flexible
◼ Pathology of thoracic nerves, muscles, joint or bones
(scoliosis)
◼ Obesity
◼ Chest strapping
 Situations which decreases compliance of
the lung

◼ Fibrosis
◼ Edema
◼ Tumors
◼ Infiltrates
◼ Decreased surfactant (increased surface tension)
◼ Decreased lung compliance means it is harder to expand
and results in a right shift of the static pressure-volume
curve and decreased RV, FRC, and TLC
 Effects of ageing on compliance

◼ Lung tissue loses some of its

elasticity- Lung compliance
INCREASES
◼ The chest wall becomes stiffer-
Chest wall compliance
DECREASES
◼ The overall respiratory
compliance decreases
◼ The overall effect on FRC is an
increase, because the elastic
tissue in the lungs is not pulling
inwards as strongly
 Problem

◼ Tidal volume= 0.6 litres

◼ Intrapleural pressure before inspiration= -5 cm H2O
◼ Intrapleural pressure after inspiration= -8 cm H2O
◼ Lung compliance= ?

= 0.6 liters/3 cm H2O

= 0.200 liters/cm H2O
= 200 mL/cm H2O
Respiratory System: Dynamic compliance
and factors influencing it

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
▪ Draw a normal pulmonary pressure-volume (compliance) curve
(starting from residual volume to total lung capacity and back to
residual volume), labeling the inflation and deflation limbs.​
▪ Describe how airway resistance and elastic recoil of the lung tissue
contribute to the shape of pressure-volume curve. Explain the cause
and significance of the hysteresis in the curves.​
▪ Understand the changes in static and dynamic compliance for patients
with COPD, restrictive diseases, and asthma.​
▪ Define surface tension and describe how it applies to lung mechanics,
including the effects of alveolar size and the role of surfactants.​​
Dynamic lung compliance (Cdyn) OR Pressure-
volume relationship
Pressure volume curve
 Pressure-volume relationship

◼ The pressure-volume relationship is curved

◼ The shape of pressure-volume loop is different during
inflation and deflation
◼ This behavior is known as histeresis
◼ The volume at any given pressure during deflation is
larger than during inflation
◼ The slope of the pressure volume curve is the lung
compliance
◼ Shape of pressure-volume curve during flow is
affected by elastic recoil properties (surface tension
and elastin/collagen) and airway resistance
 Why is measuring compliance important?

◼ Indicator of disease
◼ Important for determining pressures during mechanical
ventilation
➢ More compliant lung will need lower positive
pressures
➢ Less compliant lung will need higher positive
pressures
Factors contributing to the shape of pressure-
volume curve

1. Elastic
properties of 2. Surface
the lung tension force
tissue
 1. Elastic properties of the lung tissue

◼ The elastic forces of the lung tissue are determined

mainly by elastin and collagen fibers interwoven among
the lung parenchyma
◼ In deflated lungs, these fibers are in an elastically
contracted and kinked state
◼ When the lungs expand, the fibers become stretched and
unkinked, thereby elongating and exerting even more
elastic force
 2. Surface tension force

◼ When the lungs are filled with air,

there is an interface between the
alveolar fluid and the air in the
alveoli
◼ This causes surface tension
◼ Makes alveoli less compliant
◼ Creates hysteresis effect
◼ Majority of the majority of work
required to inflate the lungs is due
to overcoming the surface tension
◼ Filling excised lung with saline
removes the hysteresis
Effect of changing airway resistance on dynamic
compliance

Normal Asthmatic
 Law of Laplace

◼ It expresses the relationship between the pressure in the

alveolus and the wall tension
Law of Laplace- application in alveoli
If the surface tension is same in all alveoli, then the
pressure in the smaller ones would be greater than
the larger ones

▪ Result in flow of air

into the larger
alveoli from small
alveoli

▪ The collapsing
tendency for the
smaller ones
increases
Respiratory System: Dynamic compliance
and factors influencing it. Conti.

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
▪ Define atelectasis and the role of Law of Laplace, surfactants and other
factors in preventing it. ​
▪ Describe the principal components of pulmonary surfactant and explain
the roles of each. ​
 Factors prevent collapse of smaller alveoli

◼ Surfactant
◼ Interdependence of alveoli
Surfactant
Surfactant promotes alveolar stability
at low lung volumes
 Interdependence of alveoli
◼ Alveoli are connected by shared
interconnecting walls
◼ Stress on one alveolus is therefore
transmitted to neighbouring alveoli
◼ “Radial traction" or "alveolar
interdependence"
◼ The interconnected network of walls
allows mechanical stress to be shared
across a larger area of lung
Representation of alveolar interdependence helping to
parenchyma prevent an alveolus from collapsing spontaneously.
This two-dimensional representation does not show
◼ This mechanism contributes to the alveoli in front of and behind the plane.

elastic recoil of the lung in distension

and resists the collapse of individual
alveoli in atelectasis
Cellular population of the alveoli
 Surfactant composition

◼ Surfactant is comprised of a complex mixture of

➢ ≈90% Phospholipids (at least 8, with dipalmitoyl
phosphatidylcholine being most abundant)
◼ <10% Apoproteins (A-D)
➢ B absolutely critical for function
➢ C important but less critical
➢ A and D important for immunologic function, but not
critical
◼ Poorly defined others
Surfactant- dipalmitoyl phosphatidylcholine

◼ Released from Type II

pneumocytes when airways
are being inflated
◼ The surfactant is stored in
lamellar inclusion bodies
◼ The stretch releases
surfactant
◼ Shallow breathing reduces
surfactant release and
promotes lung collapse
(atelectasis)
 Dipalmitoyl phosphatidylcholine- Synthesis

Dipalmitoyl phosphatidyl-
choline (DPPC) is a key
component of surfactant
 Deficiency of surfactant lead to the following

◼ Increased alveolar surface tension

◼ Atelectasis
◼ Decreased lung compliance
◼ Increased work of breathing
◼ Decreased alveolar ventilation
◼ Arterial hypoxemia (paO2 < 60 mmHg = real problems)
◼ Respiratory acidosis due to CO2 build up
◼ IRDS & ARDS
 Atelectasis

◼ Collapse of part of the

lung
◼ Can be caused by lack of
surfactant
◼ Other causes include
compression of part of the
lung, obstruction, build up
of fluid
◼ Often happens after
abdominal or thoracic
surgery
 IRDS (Infant respiratory distress syndrome)

◼ Surfactant is produced in the fetus at

about 24 to 28 weeks of pregnancy
◼ By about 35 weeks gestation most
babies have developed adequate
amounts of surfactant
◼ IRDS may occur in infant born before
enough surfactant is manufactured
◼ Lung compliance is low due to surface
tension, and the infant may be treated
with articifical surfactant and or
positive end expiratory pressure
ventilation (PEEP) to help to maintain
airway patency
 Summary
◼ Compliance tells you how easy it will be to inflate the lung
◼ Static compliance is measured with no air flow – measures elastic
properties
◼ Dynamic compliance is during air flow – measures both elastic
and resistive properties
◼ Specific compliance = Compliance/FRC
◼ Compliance is high at FRC and lower at RV and TLC
◼ Inverse of compliance = elastance
◼ Emphysema- loss of elastic tissue leads to high compliance
◼ Loss of elastic recoil occurs with normal aging
◼ Fibrosis makes lungs “Stiff” and reduces compliance (Increases
Elastance)