4L Volume of Lungs

Upper Airways Function is to humidify and warm inspired air

Nose ● Filters, entraps, and clears particles > 10 um in size

● Lined with respiratory epithelial cells
● Tall columnar cells with cilia

Cilia ● moves secretions

● Has secretory cells in between
● Produces immunoglobulins (first line host defense)

Paranasal Sinuses ● Lined with ciliated epithelial cells

● Fluid covering their surfaces is continually propelled to the

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 nose

Functions of Paranasal 1. Lessen weight of the skull (makes upright posture easier)
Sinuses 2. Offer resonance to the voice
3. Protect brain from frontal trauma

Passageways (Ostia) easily obstructed by nasal edema

Nasal edema retention of secretions and infections (sinusitis)

Nasal turbinates greatly increase surface area

Pharynx 1. Nasopharynx
3 subdivisions 2. Oropharynx
3. Laryngopharynx

Nasopharynx ● small masses of lymphoid tissues

● Adenoids and pharyngeal tonsils
○ Prevention and control of infections

Oropharynx ● from soft palate to epiglottis

Laryngopharynx ● Regulate passage of food into the esophagus

● Regulate air in the lungs

Epiglottis and Arytenoid cover or act as a hood over the vocal cords during swallowing
Cartilage

Lower Airways 1. Trachea

2. Bronchi
3. Bronchioles
4. Respiratory unit

Carina where trachea splits

Right Lung ● 3 Lobes

1. Middle
2. Upper
3. Lower

● 10 segments

Empyema accumulation of pus in the pleural space

Pleural effusion accumulation of fluid

Pneumothorax air in pleural space

Right Upper Lobe 1. Apical

2. Posterior
3. Anterior

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 Right Middle Lobe 1. Lateral
2. Medial

Right Lower Lobe 1. Superior Segment

2. Medial Basal
3. Anterior Basal
4. Lateral Basal
5. Posterior Basal

Left Upper Lobe 1. Apicoposterior

2. Anterior
3. Superior Lingual
4. Inferior Lingual

Left Lower Lobe 1. Superior Segment

2. Anteromedial Segment
3. Lateral Basal
4. Posterior Basal

Left Lung ● 8 segments

Alevoli approximately 250 um in diameter

2 types of cell 1:1 ratio ● Type 1 Pneumocytes

● Type 2 Pneumocytes

Type 1 Pneumocytes ● primary site for gas exchange

● Occupies 96-98% of the surface area of the alveolus
● Periphery, lines

Type 2 Pneumocytes ● cuboidal

● Found in corners of alveolus
● synthesize pulmonary surfactant

Pulmonary surfactant ● reduces surface tension (nonsticking properties) in the

alveolus
● Promotes less resistance during inhalation and exhalation

Alveolar Capillary dense mesh-like network of capillaries and alveoli where gas
Network exchange occurs

Pulmonary Circulation ● O2 and CO2 exchange

● 500mL total blood volume
○ 10% of total circulating blood volume
○ 75mL blood in the alveolar-capillary network
○ Up to 200 mL during exercise
○ Recruitment of new capillaries

Bronchial Circulation ● supply O2 to lung tissue

● Arises from Aorta
● Part of systemic circulation

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 ● Receives approximately 1% of total cardiac output
○ Vessels undergo hyperthropy in certain diseases
(cystic fibrosis, TB, Bronchiectasis)**

Innervation of Lungs ● Breathing is automatic, under control of the Central

Nervous System (CNS)
● Lungs innervated by Autonomic Nervous System of the
Peripheral Nervous System, under CNS control
● No Voluntary motor innervation in the lung
● No pain fibers in the lung
○ Pain fibers are found only in the pleura

Circulatory Systems in ● unique

Lung ● Low pressure
○ Arteries in the pulmonary circulation compared to
systemic vessels
● 7x more compliant
● Dilated and have larger diameters
● Right Ventricle < less muscular than Left Ventricle

Stimulation of ● Airway smooth muscle constriction

Parasympathetic ● Blood vessel dilation
Nervous System ● Increased glandular secretion

Stimulation of ● Relaxation of airway smooth muscle

Sympathetic Nervous ● Constriction of blood vessels
System ● Inhibition of glandular secretion

Parasympathetic ● From Medulla in the Brainstem

Innervation of Lung ● Vagus Nerve
● Preganglionic and postganglionic fibers with excitatory
(cholinergic) and inhibitory (non adrenergic) motor
neurons

Breathing ● Autonomic
● Rhythmic
● Centrally regulated process with voluntary control

Regulation of respiration 1. Generation and maintenance of a respiratory rhythm

requires: 2. Modulation of rhythm by sensory feedback loops and
reflexes
3. Recruitment of respiratory muscles that can contract
appropriately for gas exchange

Herring Breuer Reflex ● Initiated by lung expansion, which excites stretch

receptors in the airways.
● Stimulation of these receptors, which send signals to the
medulla by the vagus nerve, shortens inspiratory times as
tidal volume (the volume of air inspired) increases,
accelerating the frequency of breathing.
● When lung inflation is prevented, the reflex allows

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 inspiratory time to be lengthened, helping to preserve tidal
volume.

Major Muscles of 1. Diaphragm

Respiration 2. External Intercostals
3. Scalene

Diaphragm Major muscle of respiration

150 - 200 cm H20 airway pressure (max respiratory effort)

Innervation of Diaphragm Phrenic Nerve (C3 - C5)

Tidal breathing (Quiet 1 cm

breathing)

Deep breathing (Vital As much as 10 cm

capacity)

Other important muscles External Intercostal Muscles

of respiration

External Intercostal Pull the ribs upward and forward during inspiration
Muscles Innervation: T1, T2

Accessory muscles of 1. Scalene

inspiration 2. Alae Nasi
3. Pharyngeal wall muscles

Scalene Elevate sternocleidomastoid

Alae Nasi Nasal flaring

Pharyngeal wall muscles Genioglossus and arytenoid

Maintain upper airway patent during inspiration

Exhalation Passive during normal breathing

Active during exercise

Important Muscles of 1. Rectus abdominis

Exhalation 2. Internal and external oblique
3. Transversus abdominis
4. Internal intercostal muscles

Internal intercostal Pull the ribs downward and inward

muscles

Lung Embryology ● Bronchial tree developed by week 16 of AOG

● Intrauterine events before the 16th week of gestation will
affect the number of airways
● Alveoli develop after birth
● The number of alveoli increases until 8 years

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 ● Size of alveoli increases until growth of the chest wall is
completed at adulthood

Optimal Lung 20 - 25 years of age

Decrease in Lung <1% per year

Function Earlier and faster in individuals who smoke and are exposed to
toxic environmental factors

Static Lung When lung volume properties are NOT CHANGING

Dynamic Lung Lung volume properties are CHANGING

Pleural Fluid Occupies the lungs to the chest wall

The lungs and chest wall move together
Changes in their volume are equal during inspiration and
exhalation

Pleural Pressure Pressure inside pleura

Alveolar Pressure Pressure inside lung

Atmospheric Pressure Pressure outside lung

Transpulmonary Pressure PL = PA - Ppl

Pressure difference between the air spaces (alveolar pressure
PA) and pressure surrounding the lung (pleural pressure PPL)

Pressure across chest Pw = P pl - Pb

wall Difference between pleural (inside) pressure (Ppl) and the
pressure surrounding the chest wall (Pb)

Pressure across the PA - P ATM = 0

respiratory system

Negative PA ● 1-3 cm H20 during normal breathing

● pleural space pressure lower than atmospheric pressure

Difference between ● No movement

alveolar and atmospheric ● Equal at the end of inspiration and end of exhalation
pressure is equal to zero ● Lungs at that point is static

Onset of inspiration ● Diaphragm and chest wall contract = downward

movement of diaphragm, outward and upward movement
of rib cage
● Negative alveolar pressure = a

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