HA1O1M MT TERM

LECTURE \ GALLARDO JR. 01

MODULE 10: RESPIRATORY SYSTEM

OUTLINE • Explain the difference between tidal volume, inspiratory

I The Respiratory System reserve volume, expiratory reserve volume, and residual
A Nose volume.
B Pharynx • Differentiate between inspiratory capacity, functional
C Nasopharynx residual capacity, vital capacity, and total lung capacity.
D Oropharynx • Explain Dalton’s law and Henry’s law.
E Laryngopharynx
F Larynx
• Describe the exchange of oxygen and carbon dioxide in
II Structures of Voice Production external and internal respiration.
III Trachea • Describe how the blood transports oxygen and carbon
A Bronchi dioxide.
IV Lungs • Explain how the nervous system controls breathing.
A Lobes, Fissures and Lobules • List the factors that can alter the rate and depth of
V Alveoli
breathing.
A Alveolar cells
VI Blood Supply to the Lungs
VII Pulmonary Ventilation THE RESPIRATORY SYSTEM
A Pressure Changes During Pulmonary Ventilation • The respiratory system consists of the:
VIII Inhalation o Nose
IX Exhalation o Pharynx (throat)
X Other Factors Affecting Pulmonary Ventilation o Larynx (voice box)
A Surface Tension of Alveolar Fluid
B Compliance of the Lungs
o Trachea (windpipe)
C Airway Resistance o Bronchi
XI Breathing Patterns and Modified Respiratory o Lungs
Movements • Its parts can be classified according to either: structure
XII Lung Volumes and Capacities or function.
XIII External and Internal Respiration • Structurally, the respiratory system consists of two
XIV Control of Respiration
parts:
XV Regulation of the Respiratory Center
XVI Other Influences on Respiration
(1) The upper respiratory system includes the nose,
pharynx, and associated structures.
(2) The lower respiratory system includes the larynx,
• The respiratory system contributes to homeostasis by trachea, bronchi, and lungs.
providing for the exchange of gases—oxygen and carbon • Functionally, the respiratory system also consists of two
dioxide—between the atmospheric air, blood, and tissue parts:
cells. It also helps adjust the pH of body fluids. (1) The conducting zone consists of a series of
• Your body’s cells continually use oxygen (O2) for the interconnecting cavities and tubes both outside and
metabolic reactions that release energy from nutrient within the lungs.
molecules and produce ATP. At the same time, these § These include the nose, pharynx, larynx,
reactions release carbon dioxide (CO2). Because an trachea, bronchi, bronchioles, and terminal
excessive amount of CO2 produces acidity that can be bronchioles;
toxic to cells, excess CO2 must be eliminated quickly and § their function is to filter, warm, and moisten air
efficiently. and conduct it into the lungs.
• The cardiovascular and respiratory systems cooperate to (2) The respiratory zone consists of tissues within the
supply O2 and eliminate CO2. The respiratory system lungs where gas exchange occurs.
provides for gas exchange—intake of O2 and elimination § These include the respiratory bronchioles,
of CO2—and the cardiovascular system transports blood alveolar ducts, alveolar sacs, and alveoli;
containing the gases between the lungs and body cells. § they are the main sites of gas exchange
• Failure of either system disrupts homeostasis by causing between air and blood.
rapid death of cells from oxygen starvation and buildup of
waste products. STRUCTURALLY (2) FUNCTIONALLY (2)
• In addition to functioning in gas exchange, the respiratory Upper • Nose Conducting • Nose
system also participates in regulating blood pH, contains Respiratory • Pharynx zone • Pharynx
receptors for the sense of smell, filters inspired air, System • Associated (Function: • Larynx
produces sounds, and rids the body of some water and structures filter, warm, • Trachea
heat in exhaled air. In the respiratory system there is an and moisten • Bronchi
extensive area of contact between the external air and • Bronchioles
environment and capillary blood vessels. This area of conduct it • Terminal
contact allows the body to constantly renew and replenish into the bronchioles
the internal fluid environment that surrounds and lungs)
nourishes every body cell.
Lower • Larynx Respiratory • Respiratory
OBJECTIVES Respiratory • Trachea zone bronchioles
System • Bronchi (Function: • Alveolar
• Describe the anatomy and histology of the nose, pharynx,
• Lungs the main ducts
larynx, trachea, bronchi, and lungs.
sites of gas • Alveolar
• Identify the functions of each respiratory system
exchange sacs
structure. between air
• Describe the events that cause inhalation and exhalation. • Alveoli
and blood)

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Functions: THE EXTERNAL NOSE

• Provides for gas exchange–intake of O2 for delivery to • It is the portion of the nose visible on the face and consists
body cells and elimination of CO2 produced by body cells. of a supporting framework of bone and hyaline cartilage
• Helps regulate blood pH. covered with muscle and skin and lined by a mucous
• Contains receptors for the sense of smell, filters, inspired membrane.
air, produces vocal sounds (phonation), and excretes
small amounts of water and heat. BONY FRAMEWORK
• Frontal bone
• Nasal bones
• Maxillae
• The bones mentioned form the bony framework of the
external nose.

CARTILAGINOUS FRAMEWORK
The cartilaginous framework of the external nose consists
of the:
• Septal nasal cartilage – which forms the anterior portion
of the nasal septum;
• Lateral nasal cartilages – inferior to the nasal bones;
• Alar cartilages – which form a portion of the walls of the
nostrils.

• Because it consists of pliable hyaline cartilage, the

cartilaginous framework of the external nose is
somewhat flexible.
• External nares or nostrils – two openings on the
undersurface of the external nose

• The interior structures of the external nose have three

functions:
(1) warming, moistening, and filtering incoming air;
(2) detecting olfactory stimuli; and
(3) modifying speech vibrations as they pass through
the large, hollow resonating chambers.
• Resonance refers to prolonging, amplifying, or modifying
a sound by vibration.

NOSE
• The nose can be divided into external and internal
portions.

INTERNAL NOSE
• The internal nose is a large cavity beyond the nasal
vestibule in the anterior aspect of the skull that lies
inferior to the nasal bone and superior to the mouth.
• It is lined with muscle and mucous membrane.
• Anteriorly:
o the internal nose merges with the external nose
• Posteriorly:
o it communicates with the pharynx through two
openings called the internal nares or choanae.
• Ducts from the paranasal sinuses (which drain mucus)
and the nasolacrimal ducts (which drain tears) also
open into the internal nose.
• Paranasal sinuses à are cavities in certain cranial and
facial bones lined with mucous membranes that are
continuous with the lining of the nasal cavity.

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• Skull bones containing the paranasal sinuses are the:

o Frontal
o Sphenoid
o Ethmoid
o Maxillae
• Besides producing mucus, the paranasal sinuses serve
as resonating chambers for sound as we speak or sing.
• The lateral walls of the internal nose are formed by the:
o Ethmoid
o Maxillae
o Lacrimal
o Palatine
o Inferior nasal conchae bones;
• The conchae, almost reaching the nasal septum,
• The ethmoid bone à also forms the roof.
subdivide each side of the nasal cavity into a series of
• Hard palate:
groovelike passageways—the superior, middle, and
o The palatine bones and palatine processes of the
inferior meatuses.
maxillae, which together constitute the hard palate,
• Mucous membrane lines the cavity and its shelves.
form the floor of the internal nose.
• The arrangement of conchae and meatuses increases
• The space within the internal nose is called the nasal surface area in the internal nose and prevents
cavity. dehydration by trapping water droplets during exhalation.
o Nasal vestibule à The anterior portion of the
nasal cavity just inside the nostrils, is surrounded by • The olfactory receptors lie in a region of the membrane
cartilage; lining the superior nasal conchae and adjacent septum
o The superior part of the nasal cavity is surrounded called the olfactory epithelium.
by bone. • Inferior to the olfactory epithelium, the mucous
• Nasal septum à A vertical partition, the nasal septum, membrane contains capillaries and pseudostratified
divides the nasal cavity into right and left sides. ciliated columnar epithelium with many goblet cells.
o The anterior portion of the nasal septum consists • As inhaled air whirls around the conchae and meatuses,
primarily of hyaline cartilage; it is warmed by blood in the capillaries.
o the remainder is formed by the vomer, perpendicular • Mucus secreted by the goblet cells moistens the air and
plate of the ethmoid, maxillae, and palatine bones traps dust particles.
• Drainage from the nasolacrimal ducts also helps moisten
• When air enters the nostrils, it passes first through the the air, and is sometimes assisted by secretions from the
vestibule, which is lined by skin containing coarse hairs paranasal sinuses.
that filter out large dust particles. • The cilia move the mucus and trapped dust particles
• Three shelves formed by projections of the superior, toward the pharynx, at which point they can be swallowed
middle, and inferior nasal conchae extend out of each or spit out, thus removing the particles from the
lateral wall of the nasal cavity. respiratory tract.

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• The cilia move the mucus down toward the most inferior
part of the pharynx.
• The nasopharynx also exchanges small amounts of air
with the auditory tubes to equalize air pressure between
the pharynx and the middle ear.

nasopharynx

oropharynx
laryngopharynx

OROPHARYNX
• The intermediate portion of the pharynx
PHARYNX
• It lies posterior to the oral cavity and extends from the
• The pharynx, or throat, is a funnel-shaped tube about 13 soft palate inferiorly to the level of the hyoid bone.
cm (5 in.) long
• It has only one opening into it, the fauces, the opening
• It starts at the internal nares and extends to the level of from the mouth.
the cricoid cartilage à the most inferior cartilage of the
• This portion of the pharynx has both respiratory and
larynx (voice box).
digestive functions.
• The pharynx lies just:
• It serves as a common passageway for air, food, and
o posterior to the nasal and oral cavities
drink.
o superior to the larynx
• Because the oropharynx is subject to abrasion by food
o anterior to the cervical vertebrae
particles, it is lined with nonkeratinized stratified
• Its wall is composed of skeletal muscles and is lined with
squamous epithelium.
a mucous membrane.
• Two pairs of tonsils are found in the oropharynx:
• Contraction of the skeletal muscles assists in deglutition
o palatine
(swallowing).
o lingual tonsils
• The pharynx functions as a:
o passageway for air and food
o provides a resonating chamber for speech sounds,
o houses the tonsils, which participate in
immunological reactions against foreign invaders
• The pharynx can be divided into three anatomical
regions:
(1) Nasopharynx
(2) Oropharynx
(3) Laryngopharynx
• The muscles of the entire pharynx are arranged in two
layers: (acronym à OCIL)
(1) an outer circular layer
LARYNGOPHARYNX
(2) an inner longitudinal layer • The inferior portion of the pharynx is the
laryngopharynx, or hypopharynx
NASOPHARYNX • It begins at the level of the hyoid bone.
• At its inferior end it opens into the:
• The superior portion of the pharynx, called the
o esophagus (food tube) à posteriorly
nasopharynx
o larynx (voice box) à anteriorly
• It lies posterior to the nasal cavity and extends to the soft
• Like the oropharynx, the laryngopharynx is both a
palate.
respiratory and a digestive pathway
• The soft palate, which forms the posterior portion of the
• It is also lined by nonkeratinized stratified squamous
roof of the mouth, is an arch-shaped muscular partition
epithelium.
between the nasopharynx and oropharynx that is lined by
mucous membrane.
• There are five openings in its wall: LARYNX
(1) two internal nares
(2) two openings that lead into the auditory
(pharyngotympanic) tubes (commonly known as the
eustachian tubes), and
(3) the opening into the oropharynx
• The posterior wall also contains the pharyngeal tonsil
(adenoid).
• Through the internal nares, the nasopharynx receives
air from the nasal cavity along with packages of dust-
laden mucus.
• The nasopharynx is lined with pseudostratified ciliated
columnar epithelium

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• The larynx, or voice box, is a short passageway that • The broad superior “leaf” portion of the epiglottis is
connects the laryngopharynx with the trachea. unattached and is free to move up and down like a trap
• It lies in the midline of the neck anterior to the esophagus door.
and the fourth through sixth cervical vertebrae (C4–C6). • During swallowing, the pharynx and larynx rise.
• The wall of the larynx is composed of nine pieces of • Elevation of the pharynx à widens it to receive food or
cartilage. drink;
• Three occur singly: • Elevation of the larynx à causes the epiglottis to move
(1) Thyroid cartilage down and form a lid over the glottis, closing it off.
(2) Epiglottis • The glottis consists of a pair of folds of mucous
(3) Cricoid cartilage membrane:
• Three occur in pairs o the vocal folds (true vocal cords) in the larynx
(1) Arytenoid cartilages o and the rima glottidis, the space between them
§ The most important of the paired cartilages • The closing of the larynx in this way during swallowing
because they influence changes in position and routes liquids and foods into the esophagus and keeps
tension of the vocal folds à true vocal cords for them out of the larynx and airways.
speech • When small particles of dust, smoke, food, or liquids pass
(2) Cuneiform cartilages into the larynx, a cough reflex occurs, usually expelling
(3) Corniculate cartilages the material.
• The extrinsic muscles of the larynx connect the
cartilages to other structures in the throat;
• The intrinsic muscles connect the cartilages to one
another.

CRICOID CARTILAGE
• The cricoid cartilage is a ring of hyaline cartilage that
forms the inferior wall of the larynx.
• It is attached to the first ring of cartilage of the trachea by
the cricotracheal ligament.
• The thyroid cartilage is connected to the cricoid cartilage
by the cricothyroid ligament.
• The cricoid cartilage is the landmark for making an
emergency airway called a tracheotomy
o (creating a hole in the cricoid or thyroid cartilage,
placing a tube or tracheostomy tube in the hole so
that the patient can breathe).

THYROID CARTILAGE
• The thyroid cartilage (Adam’s apple) consists of two Cuneiform
fused plates of hyaline cartilage that form the anterior cartilages
wall of the larynx.
• It gives it a triangular shape. Corniculate
• It is present in both males and females but is usually cartilages
larger in males due to the influence of male sex hormones
on its growth during puberty.
• Thyrohyoid membrane à the ligament that connects Arytenoid
the thyroid cartilage to the hyoid bone is called the cartilages
thyrohyoid membrane.

EPIGLOTTIS
• The epiglottis is a large, leaf-shaped piece of elastic
cartilage that is covered with epithelium.
• The “stem” of the epiglottis is the tapered inferior portion
that is attached to the anterior rim of the thyroid cartilage
and hyoid bone.

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ARYTENOID CARTILAGES • When the muscles contract, they pull the elastic
• The paired arytenoid cartilages are triangular pieces of ligaments tight and stretch the vocal folds out into the
mostly hyaline cartilage located at the posterior, airways so that the rima glottidis is narrowed.
superior border of the cricoid cartilage. • If air is directed against the vocal folds, they vibrate and
• Considered the most important produce sounds (phonation) by setting up sound waves
• They form synovial joints with the cricoid cartilage and in the column of air in the pharynx, nose, and mouth.
have a wide range of mobility. • The greater the pressure of air, the louder the sound.
• It is also responsible for modulation or speech since their • During speech modulation or talking, the true vocal folds
contraction influences voice production with the vocal do not totally close. There is a very narrow opening for air
cords. to pass through, when air passes through and a vibration
occurs which then produces sound.
CORNICULATE CARTILAGES • When the intrinsic muscles of the larynx contract, they
pull on the arytenoid cartilages, which causes them to
• The paired corniculate cartilages are horn-shaped pivot and slide.
pieces of elastic cartilage • Contraction of the posterior cricoarytenoid muscles, for
• Located at the apex of each arytenoid cartilage. example, moves the vocal folds apart (abduction),
thereby opening the rima glottidis.
CUNEIFORM CARTILAGES • By contrast, contraction of the lateral cricoarytenoid
• The paired cuneiform cartilages, club-shaped elastic muscles moves the vocal folds together (adduction),
cartilages, are anterior to the corniculate cartilages thereby closing the rima glottidis.
• They support the vocal folds and lateral aspects of the • Other intrinsic muscles can elongate (and place tension
epiglottis. on) or shorten (and relax) the vocal folds.
• Pitch – is controlled by the tension on the vocal folds.
• The lining of the larynx superior to the vocal folds is • If they are pulled taut by the muscles, they vibrate more
nonkeratinized stratified squamous epithelium. rapidly, and a higher pitch results.
• The lining of the larynx inferior to the vocal folds is • Decreasing the muscular tension on the vocal folds
pseudostratified ciliated columnar epithelium causes them to vibrate more slowly and produce lower-
consisting of ciliated columnar cells, goblet cells, and pitch sounds.
basal cells. • Due to the influence of androgens (male sex hormones),
• The mucus produced by the goblet cells helps trap dust vocal folds are usually thicker and longer in males than in
not removed in the upper passages. females, and therefore they vibrate more slowly. This is
• The cilia in the upper respiratory tract move mucus and why a man’s voice generally has a lower range of pitch
trapped particles down toward the pharynx; the cilia in the than that of a woman.
lower respiratory tract move them up toward the pharynx.
TRACHEA
STRUCTURES OF VOICE PRODUCTION • The trachea or windpipe
• It is a tubular passageway for air
• It is about 12 cm (5 in.) long and 2.5 cm (1 in.) in
diameter.
• It is located anterior to the esophagus and extends from
the larynx to the superior border of the fifth thoracic
vertebra (T5), where it divides into right and left primary
bronchi.
• The layers of the tracheal wall, from deep to superficial,
are the:
(1) Mucosa
(2) Submucosa
(3) Hyaline cartilage
(4) Adventitia (composed of areolar connective tissue).

MUCOSA
• The mucous membrane of the larynx forms two pairs of
folds: • The mucosa of the trachea consists of an epithelial layer
o Ventricular folds (false vocal cords) à a superior of pseudostratified ciliated columnar epithelium and
pair an underlying layer of lamina propria that contains
o Vocal folds (true vocal cords) à an inferior pair elastic and reticular fibers.
• Rima vestibuli à The space between the ventricular • Pseudostratified ciliated columnar epithelium consists of
folds is known as the rima vestibuli ciliated columnar cells and goblet cells that reach the
• Rima glottidis à space between vocal folds or true luminal surface, plus basal cells that do not;
vocal cords • It provides the same protection against dust as the
• The laryngeal sinus (ventricle) is a lateral expansion of membrane lining the nasal cavity and larynx.
the middle portion of the laryngeal cavity inferior to the
ventricular folds and superior to the vocal folds SUBCMUCOSA
• When the ventricular folds are brought together, they • The submucosa consists of areolar connective tissue
function in holding the breath against pressure in the that contains seromucous glands and their ducts.
thoracic cavity, such as might occur when you strain to lift • The 16–20 incomplete, horizontal rings of hyaline
a heavy object cartilage resemble the letter C, are stacked one above
• Deep to the mucous membrane of the vocal folds, which another, and are connected together by dense
is lined by nonkeratinized stratified squamous connective tissue.
epithelium, bands of elastic ligaments are stretched • They may be felt through the skin inferior to the larynx.
between pieces of rigid cartilage like the strings on a • The open part of each C-shaped cartilage ring faces
guitar. posteriorly toward the esophagus and is spanned by a
• Intrinsic laryngeal muscles attach to both the rigid fibromuscular membrane.
cartilage and the vocal folds.

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• Within this membrane are transverse smooth muscle

fibers, called the trachealis muscle, and elastic
connective tissue that allow the diameter of the trachea
to change subtly during inhalation and exhalation, which
is important in maintaining efficient airflow.
• The solid C-shaped cartilage rings provide a semirigid
support so that the tracheal wall does not collapse inward
(especially during inhalation) and obstruct the air
passageway.
• The adventitia of the trachea consists of areolar
connective tissue that joins the trachea to surrounding
tissues.

BRONCHI

LUNGS
• The lungs (lightweights, because they float) are paired
cone-shaped organs in the thoracic cavity.
• They are separated from each other by the heart and
other structures in the mediastinum, which divides the
thoracic cavity into two anatomically distinct chambers.
• As a result, if trauma causes one lung to collapse, the
other may remain expanded.
• At the superior border of the fifth thoracic vertebra (T5), • Each lung is enclosed and protected by a double-layered
the trachea divides into: serous membrane called the pleural membrane.
o a right primary bronchus, which goes into the right o Superficial layer à called the parietal pleura, lines
lung, and the wall of the thoracic cavity;
o a left primary bronchus, which goes into the left o Deep layer à the visceral pleura, covers the lungs
lung themselves
• The right primary bronchus is more vertical, shorter, • Between the visceral and parietal pleurae is a small
and wider than the left. space, the pleural cavity, which contains a small amount
• As a result, an aspirated object is more likely to enter and of lubricating fluid secreted by the membranes.
lodge in the right primary bronchus than the left. • This pleural fluid reduces friction between the
• Like the trachea, the primary bronchi contain incomplete membranes, allowing them to slide easily over one
rings of cartilage and are lined by pseudostratified another during breathing.
ciliated columnar epithelium. • Pleural fluid also causes the two membranes to adhere
• At the point where the trachea divides into right and left to one another just as a film of water causes two glass
primary bronchi, an internal ridge called the carina, is microscope slides to stick together, a phenomenon called
formed by a posterior and somewhat inferior projection of surface tension.
the last tracheal cartilage. • Separate pleural cavities surround the left and right lungs.
• The mucous membrane of the carina is one of the most • Inflammation of the pleural membrane, called pleurisy or
sensitive areas of the entire larynx and trachea for pleuritis, may in its early stages cause pain due to friction
triggering a cough reflex. between the parietal and visceral layers of the pleura.
• Widening and distortion of the carina is a serious sign • If the inflammation persists, excess fluid accumulates in
because it usually indicates a carcinoma of the lymph the pleural space, a condition known as pleural effusion.
nodes around the region where the trachea divides. (tubig sa baga)
• There are certain conditions that would fill up the spaces
• On entering the lungs, the primary bronchi divide to form in the pleural cavity. It could either be air, called
smaller bronchi—the secondary (lobar) bronchi, one for pneumothorax or accumulation of blood in the pleural
each lobe of the lung. cavity, called hemothorax.
• (The right lung has three lobes; the left lung has two.) • Air in the pleural cavities, most commonly introduced in a
• The secondary bronchi continue to branch, forming still surgical opening of the chest or as a result of a stab or
smaller bronchi, called tertiary (segmental) bronchi, gunshot wound, may cause the lungs to collapse (tension
that divide into bronchioles. pneumothorax or in some cases spontaneous
• Bronchioles in turn branch repeatedly, and the smallest pneumothorax).
ones branch into even smaller tubes called terminal • This collapse of a part of a lung, or rarely an entire lung,
bronchioles. This extensive branching from the trachea is called atelectasis.
resembles an inverted tree and is commonly referred to • The goal of treatment is the evacuation of air (or blood)
as the bronchial tree. from the pleural space, which allows the lung to reinflate.
• Primary bronchi à secondary bronchi à tertiary bronchi
à bronchioles à terminal bronchioles

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• Thus, the lungs do not completely fill the pleural cavity in

this area.
• Removal of excessive fluid in the pleural cavity can be
accomplished without injuring lung tissue by inserting a
needle anteriorly through the seventh intercostal
space, a procedure called thoracentesis.
• The needle is passed along the superior border of the
lower rib to avoid damage to the intercostal nerves and
blood vessels. Inferior to the seventh intercostal space
there is danger of penetrating the diaphragm.

LOBES, FISSURES, AND LOBULES

• The lungs extend from the diaphragm to just slightly

superior to the clavicles and lie against the ribs anteriorly
and posteriorly.
• The broad inferior portion of the lung, the base, is • One or two fissures divide each lung into lobes.
concave and fits over the convex area of the diaphragm. • Both lungs have an oblique fissure, which extends
• The narrow superior portion of the lung is the apex. inferiorly and anteriorly;
• The surface of the lung lying against the ribs, the costal • The right lung also has a horizontal fissure.
surface, matches the rounded curvature of the ribs. • The oblique fissure in the left lung separates the
• The mediastinal (medial) surface of each lung contains superior lobe from the inferior lobe.
a region, the hilum, through which bronchi, pulmonary • In the right lung, the superior part of the oblique fissure
blood vessels, lymphatic vessels, and nerves enter and separates the superior lobe from the inferior lobe; the
exit. inferior part of the oblique fissure separates the inferior
o These structures are held together by the pleura and lobe from the middle lobe, which is bordered superiorly
connective tissue and constitute the root of the by the horizontal fissure.
lung. • Each lobe receives its own secondary (lobar)
• Medially, the left lung also contains a concavity, the bronchus.
cardiac notch, in which the heart lies. • Thus, the right primary bronchus gives rise to three
• Due to the space occupied by the heart, the left lung is secondary (lobar) bronchi called the:
about 10% smaller than the right lung. o Superior secondary (lobar) bronchi
• Although the right lung is thicker and broader, it is also o Middle secondary (lobar) bronchi
somewhat shorter than the left lung because the o Inferior secondary (lobar) bronchi
diaphragm is higher on the right side, accommodating • The left primary bronchus gives rise to superior and
the liver that lies inferior to it. inferior secondary (lobar) bronchi.
• The lungs almost fill the thorax. • Within the lung, the secondary bronchi give rise to the
• The apex of the lungs lies superior to the medial third of tertiary (segmental) bronchi, which are constant in both
the clavicles and is the only area that can be palpated. origin and distribution— there are 10 tertiary bronchi in
• The anterior, lateral, and posterior surfaces of the lungs each lung.
lie against the ribs. • The segment of lung tissue that each tertiary bronchus
• The base of the lungs extends from the sixth costal supplies is called a bronchopulmonary segment.
cartilage anteriorly to the spinous process of the tenth • Bronchial and pulmonary disorders (such as tumors or
thoracic vertebra posteriorly. abscesses) that are localized in a bronchopulmonary
• The pleura extends about 5 cm (2 in.) below the base segment may be surgically removed without seriously
from the sixth costal cartilage anteriorly to the twelfth rib disrupting the surrounding lung tissue.
posteriorly.

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ALVEOLI

• Each bronchopulmonary segment of the lungs has many

small compartments called lobules;
• Each lobule is wrapped in elastic connective tissue
and contains a lymphatic vessel, an arteriole, a venule,
and a branch from a terminal bronchiole.

• Around the circumference of the alveolar ducts are

numerous alveoli and alveolar sacs.
• An alveolus is a cup-shaped outpouching lined by simple
squamous epithelium and supported by a thin elastic
basement membrane;
• An alveolar sac consists of two or more alveoli that share
a common opening.
• The walls of alveoli consist of two types of alveolar
epithelial cells: Type I and Type II alveolar cells

ALVEOLAR CELLS
Type I alveolar cells Type II alveolar cells
• More numerous and • also called septal cells
thin • are fewer in number
• They are simple • are found between type I
squamous epithelial alveolar cells
cells • rounded or cuboidal
• They form a nearly epithelial cells with free
continuous lining of the surfaces containing
alveolar wall microvilli
• Function: the main • Function: secrete
sites of gas exchange alveolar fluid, which
keeps the surface
between the cells and
the air moist
• Included in the alveolar fluid is surfactant – a complex
mixture of phospholipids and lipoproteins.
• Terminal bronchioles subdivide into microscopic • Surfactant à lowers the surface tension of alveolar fluid,
branches called respiratory bronchioles. which reduces the tendency of alveoli to collapse.
• As the respiratory bronchioles penetrate more deeply into o Usually, premature babies do not have surfactant,
the lungs, the epithelial lining changes from simple it is an indication of fetal lung maturity.
cuboidal to simple squamous. o Two surfactants:
• Respiratory bronchioles in turn subdivide into several (2– (1) Sphingomyelin
11) alveolar ducts. (2) Lecithin
• The respiratory passages from the trachea to the alveolar o There is greater lecithin than sphingomyelin. The
ducts contain about 25 orders of branching; branching ration is two is to one. So, for 2 lecithin, there is 1
from the trachea into primary bronchi is called first-order sphingomyelin. They are the ones who are
branching, from primary bronchi into secondary bronchi responsible for providing surface tension.
is called second-order branching, and so on down to o For newborn patients or neonates, they are given
the alveolar ducts. synthetic surfactant. A tube is inserted down the
• Terminal bronchioles à respiratory bronchioles à baby’s throat and pour the surfactant. Prior to giving
alveolar ducts birth, steroid injections are given to hasten FLM.

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 TRANS: Respiratory System

• Associated with the alveolar wall are alveolar

macrophages (dust cells), phagocytes that remove fine
dust particles and other debris from the alveolar spaces.
• Also present are fibroblasts that produce reticular and
elastic fibers.
• Underlying the layer of type I alveolar cells is an elastic • ALL arteries à carry oxygenated blood; that is why
basement membrane. they are bright red in color
• On the outer surface of the alveoli, the lobule’s arteriole • ALL veins à carry deoxygenated blood; usually darker
and venule disperse into a network of blood capillaries or dark red to dark blue
that consist of a single layer of endothelial cells and • The only exception are pulmonary arteries. They are the
basement membrane. only arteries that carry deoxygenated blood towards the
lungs so that they can be oxygenated.
• The only veins in the body that carry oxygenated blood
are pulmonary veins. (Towards the left side of the heart
until it is pumped into the systemic circulation.)

• Return of the oxygenated blood to the heart occurs by

way of the four pulmonary veins, which drain into the
left atrium.
• A unique feature of pulmonary blood vessels is their
constriction in response to localized hypoxia (low O2
level).
• In all other body tissues, hypoxia causes dilation of blood
vessels to increase blood flow.
• In the lungs, however, vasoconstriction in response to
hypoxia diverts pulmonary blood from poorly ventilated
areas of the lungs to well-ventilated regions.
o This phenomenon is known as ventilation–
perfusion coupling because the perfusion (blood
flow) to each area of the lungs matches the extent of
ventilation (airflow) to alveoli in that area.
• Bronchial arteries, which branch from the aorta, deliver
oxygenated blood to the lungs. This blood mainly
perfuses the muscular walls of the bronchi and
bronchioles.
• Connections exist between branches of the bronchial
arteries and branches of the pulmonary arteries,
however; most blood returns to the heart via pulmonary
veins.
• The exchange of O2 and CO2 between the air spaces in • Some blood, however, drains into bronchial veins,
the lungs and the blood takes place by diffusion across branches of the azygos system, and returns to the heart
the alveolar and capillary walls, which together form the via the superior vena cava.
respiratory membrane.
• Extending from the alveolar air space to blood plasma, PULMONARY VENTILATION
the respiratory membrane consists of four layers: • The process of gas exchange in the body, called
respiration, has three basic steps:
1. A layer of type I and type II alveolar cells and
associated alveolar macrophages that constitutes 1. Pulmonary ventilation (breathing)
the alveolar wall § It is the inhalation (inflow) and exhalation
(outflow) of air and involves the exchange of air
2. An epithelial basement membrane underlying the between the atmosphere and the alveoli of the
alveolar wall lungs.
3. A capillary basement membrane that is often fused 2. External (pulmonary) respiration
to the epithelial basement membrane § It is the exchange of gases between the alveoli
4. The capillary endothelium of the lungs and the blood in pulmonary
capillaries across the respiratory membrane.
• Despite having several layers, the respiratory § In this process, pulmonary capillary blood gains
membrane is very thin—only 0.5 um thick, about one- O2 and loses CO2.
sixteenth the diameter of a red blood cell—to allow rapid 3. Internal (tissue) respiration
diffusion of gases. § It is the exchange of gases between blood in
• It has been estimated that the lungs contain 300 million systemic capillaries and tissue cells. In this step
alveoli, providing an immense surface area of 70 m2 (750 the blood loses O2 and gains CO2.
ft2)—about the size of a racquetball court—for gas § Within cells, the metabolic reactions that
exchange. consume O2 and give off CO2 during the
production of ATP are termed cellular
BLOOD SUPPLY TO THE LUNGS respiration.
• The lungs receive blood via two sets of arteries:
o pulmonary arteries • In pulmonary ventilation, air flows between the
o bronchial arteries atmosphere and the alveoli of the lungs because of
• Deoxygenated blood passes through the pulmonary alternating pressure differences created by contraction
trunk, which divides into a left pulmonary artery that and relaxation of respiratory muscles.
enters the left lung and a right pulmonary artery that • The rate of airflow and the amount of effort needed for
enters the right lung. (The pulmonary arteries are the breathing is also influenced by alveolar surface tension,
only arteries in the body that carry deoxygenated blood.) compliance of the lungs, and airway resistance.

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PRESSURE CHANGES DURING PULMONARY EXTERNAL INTERCOSTALS

VENTILATION • The next most important muscles of inhalation are the
• Air moves into the lungs when the air pressure inside external intercostals.
the lungs is less than the air pressure in the atmosphere. • When these muscles contract, they elevate the ribs.
• Air moves out of the lungs when the air pressure inside • As a result, there is an increase in the anteroposterior and
the lungs is greater than the air pressure in the lateral diameters of the chest cavity.
atmosphere. • Contraction of the external intercostals is responsible for
about 25% of the air that enters the lungs during normal
INHALATION quiet breathing.
• Breathing in is called inhalation (inspiration).
• Just before each inhalation, the air pressure inside the
lungs is equal to the air pressure of the atmosphere,
which at sea level is about 760 millimeters of mercury
(mmHg), or 1 atmosphere (atm).
• For air to flow into the lungs, the pressure inside the
alveoli must become lower than the atmospheric
pressure. This condition is achieved by increasing or
expanding the size of the lungs.
• Differences in pressure caused by changes in lung
volume force air into our lungs when we inhale and out
when we exhale.
• For inhalation to occur, the lungs must expand, which
increases lung volume and thus decreases the pressure
in the lungs to below atmospheric pressure.
• The first step in expanding the lungs during normal quiet
inhalation involves contraction of the main muscles of
inhalation:
o the diaphragm
o and external intercostals

EXHALATION
• Breathing out is called exhalation (expiration)
• It is also due to a pressure gradient, but in this case the
gradient is in the opposite direction:
o The pressure in the lungs is greater than the
pressure of the atmosphere.
• Normal exhalation during quiet breathing, unlike
inhalation, is a passive process because no muscular
contractions are involved.
• Instead, exhalation results from elastic recoil of the
chest wall and lungs, both of which have a natural
tendency to spring back after they have been stretched.
• Two inwardly directed forces contribute to elastic recoil:
DIAPHRAGM (1) the recoil of elastic fibers that were stretched during
• The most important muscle of inhalation is the inhalation and
(2) the inward pull of surface tension due to the film of
diaphragm, the dome-shaped skeletal muscle that forms
alveolar fluid.
the floor of the thoracic cavity.
o It is innervated by fibers of the phrenic nerves, • Exhalation starts when the inspiratory muscles relax.
which emerge from the spinal cord at cervical levels • As the diaphragm relaxes, its dome moves superiorly
3, 4, and 5 (C3-C5). owing to its elasticity.
o Contraction of the diaphragm causes it to flatten, • As the external intercostals relax, the ribs are
lowering its dome. depressed.
o This increases the vertical diameter of the thoracic • These movements decrease the vertical, lateral, and
cavity. anteroposterior diameters of the thoracic cavity, which
• During normal quiet inhalation, the diaphragm decreases lung volume.
descends about 1 cm (0.4 in.), producing a pressure • In turn, the alveolar pressure increases to about 762
difference of 1–3 mmHg and the inhalation of about 500 mmHg. Air then flows from the area of higher pressure in
mL of air. the alveoli to the area of lower pressure in the
• In strenuous breathing, the diaphragm may descend 10 atmosphere.
cm (4 in.), which produces a pressure difference of 100 • Exhalation becomes active only during forceful
mmHg and the inhalation of 2–3 liters of air. breathing, as occurs while playing a wind instrument or
• Contraction of the diaphragm is responsible for about during exercise.
75% of the air that enters the lungs during quiet • During these times, muscles of exhalation—the
breathing. abdominals and internal intercostals—contract, which
• Advanced pregnancy, excessive obesity, or confining increases pressure in the abdominal region and thorax.
abdominal clothing can prevent complete descent of the • Contraction of the abdominal muscles moves the
diaphragm. inferior ribs downward and compresses the abdominal
viscera, thereby forcing the diaphragm superiorly.

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• Contraction of the internal intercostals, which extend • In the lungs, compliance is related to two principal factors:
inferiorly and posteriorly between adjacent ribs, pulls the elasticity and surface tension
ribs inferiorly. • Decreased compliance is a common feature in pulmonary
• Although intrapleural pressure is always less (>) than conditions that
alveolar pressure, it may briefly exceed atmospheric (1) Scar lung tissue (for example, tuberculosis),
pressure during a forceful exhalation, such as during a - Formation of scars or fibrosis in specific parts of
cough. the lungs especially in the apex
(2) Cause lung tissue to become filled with fluid
OTHER FACTORS AFFECTING PULMONARY (pulmonary edema),
VENTILATION (3) Produce a deficiency in surfactant, or
• Air pressure differences drive airflow during inhalation (4) Impede lung expansion in any way (for example,
and exhalation. paralysis of the intercostal muscles).
• However, three other factors affect the rate of airflow and - Damage to the nerve supply to the specific
the ease of pulmonary ventilation: muscles. There would be a limited lung
(1) Surface tension of the alveolar fluid expansion because the ribs are not able to be
(2) Compliance of the lungs elevated anteriorly and superiorly in order for the
(3) Airway resistance lungs to expand.
o Other conditions that will also limit compliance would
SURFACE TENSION OF ALVEOLAR FLUID be the presence of tumor or mass inside the lung
• A thin layer of alveolar fluid coats the luminal surface of cavity.
alveoli and exerts a force known as surface tension
• In the lungs, surface tension causes the alveoli to assume AIRWAY RESISTANCE
the smallest possible diameter. • The rate of airflow through the airways depends on both
• During breathing, surface tension must be overcome to the pressure difference and the resistance
expand the lungs during each inhalation. • Airflow equals the pressure difference between the
alveoli and the atmosphere divided by the resistance.
• The surfactant (a mixture of phospholipids and • Any condition that narrows or obstructs the airways
lipoproteins) present in alveolar fluid reduces its surface increases resistance, so that more pressure is required to
tension below the surface tension of pure water maintain the same airflow.
• A deficiency of surfactant in premature infants causes • The hallmark of asthma or chronic obstructive pulmonary
respiratory distress syndrome where many alveoli disease (COPD)— emphysema or chronic bronchitis—is
collapse at the end of each exhalation because of the increased airway resistance due to obstruction or
absence of the surfactant. collapse of airways.
o This is why premature babies are not able to sustain o Obstructive and restrictive lungs diseases:
life due to simultaneous collapse of the alveoli. There § Asthma – hyperstimulation of the smooth
would be a limited gas exchange, causing hypoxia, muscles lining (bronchioles – they cause
organ damage, and organ death constriction when they contract); narrow
diameter of airways
COMPLIANCE OF THE LUNGS § COPD – Patients who are chain smokers
• Compliance refers to how much effort is required to develop COPD, a mixture of concomitant
stretch the lungs and chest wall disorders (emphysema and chronic bronchitis);
• High compliance means that the lungs and chest wall no narrow diameter of the airway because of this
expand easily. disorder
• Low compliance means that they resist expansion.
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 TRANS: Respiratory System

BREATHING PATTERNS AND MODIFIED Hiccupping • Spasmodic contraction of the

RESPIRATORY MOVEMENTS diaphragm followed by a spasmodic
• Eupnea - normal pattern of quiet breathing; can consist closure of the rima glottidis, which
of shallow, deep, or combined shallow and deep produces a sharp sound on inhalation.
breathing • Stimulus is usually irritation of the
• There is an elevation or increase in the normal respiratory sensory nerve endings of the
rate. gastrointestinal tract.
• Eupnea (normal adult respiratory rate) – 12 to 20 Valsalva • Forced exhalation against a closed
cycles/minute maneuver rima glottidis as may occur during
• Tachypnea – increase of more than 20 periods of straining while defecating.
• Bradypnea – lower than 12
LUNG VOLUMES AND CAPACITIES
• Costal breathing - pattern of shallow (chest) breathing,
• While at rest, a healthy adult averages 12 breaths a
consists of an upward and outward movement of the
minute, with each inhalation and exhalation moving about
chest due to contraction of the external intercostal
500 mL of air into and out of the lungs.
muscles
• Diaphragmatic breathing - deep (abdominal) breathing, • The volume of one breath is called the tidal volume (VT)
consists of the outward movement of the abdomen due to • The minute ventilation (MV)—the total volume of air
the contraction and descent of the diaphragm inhaled and exhaled each minute—is respiratory rate
• Respirations also provide humans with methods for multiplied by constant tidal volume
expressing emotions such as laughing, sighing, and o MV = 12 breaths/min x 500 mL/breath
sobbing. = 6 liters/min
• Respiratory air can be used to expel foreign matter from • A lower-than-normal minute ventilation usually is a sign
the lower air passages through actions such as sneezing of pulmonary malfunction or a pulmonary disorder.
and coughing.
• Respiratory movements are also modified and controlled • Spirometer or respirometer - The
during talking and singing. apparatus commonly used to measure the
volume of air exchanged during breathing
MODIFIED RESPIRATORY MOVEMENTS and the respiratory rate
MOVEMENT DESCRIPTION • The record is called a spirogram.
Coughing • A long-drawn and deep inhalation o The mouthpiece is placed inside the mouth while the
followed by a complete closure of the patient inhales. The balls will rise up when the patient
rima glottidis, which results in a strong inhales with specific measurements (lung volume
exhalation that suddenly pushes the and capacity). Normally, all three balls will rise up. In
rima glottidis open and sends a blast of cases of patients who have pulmonary problems
air through the upper respiratory (only 1-2 balls rise up), they will also be counting how
passages. long the patient could sustain the balls up.
• Stimulus for this reflex act may be a • Tidal volume varies considerably from one person to
foreign body lodged in the larynx, another and in the same person at different times.
trachea, or epiglottis. • In a typical adult, about 70% of the tidal volume (350 mL)
Sneezing • Spasmodic contraction of muscles of actually reaches the respiratory zone of the respiratory
exhalation that forcefully expels air system—the respiratory bronchioles, alveolar ducts,
through the nose and mouth. alveolar sacs, and alveoli—and participates in external
• Stimulus may be an irritation of the respiration.
nasal mucosa. • The other 30% (150 mL) remains in the conducting
Sighing • A long-drawn and deep inhalation airways of the nose, pharynx, larynx, trachea, bronchi,
immediately followed by a shorter but bronchioles, and terminal bronchioles
forceful exhalation.
Yawning • A deep inhalation through the widely
opened mouth producing an
exaggerated depression of the
mandible.
• It may be stimulated by drowsiness, or
someone else’s yawning, but the
precise cause is unknown.
Sobbing • A series of convulsive inhalations
followed by a single prolonged
exhalation.
• The rima glottidis closes earlier than
normal after each inhalation so only a
little air enters the lungs with each
inhalation.
Crying • An inhalation followed by many short
convulsive exhalations, during which • The conducting airways with air that does not undergo
the rima glottidis remains open and the respiratory exchange are known as the anatomic
(respiratory) dead space - 30% (150 mL)
vocal folds vibrate; accompanied by
characteristic facial expressions and • Alveolar ventilation rate is the volume of air per minute
tears. that actually reaches the respiratory zone - 75% (350 mL)
Laughing • The same basic movement as crying,
but the rhythm of the movements and • In the example just given, alveolar ventilation rate would
the facial expressions usually differ be:
from those of crying. Laughing and o 350 mL/breath x 12 breaths/min = 4200 mL/min
crying are sometimes indistinguishable.

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• In general, these volumes are larger in males, taller EXTERNAL AND INTERNAL RESPIRATION
individuals, and younger adults, and smaller in females, • External respiration or pulmonary gas exchange is the
shorter individuals, and the elderly diffusion of O2 from air in the alveoli of the lungs to blood
in pulmonary capillaries and the diffusion of CO2 in the
• By taking a very deep breath, you can inhale a good deal opposite direction.
more than 500 mL. • External respiration in the lungs converts deoxygenated
• This additional inhaled air, called the inspiratory reserve blood (depleted of some O2) coming from the right side
volume, is about 3100 mL in an average adult male and of the heart into oxygenated blood (saturated with O2)
1900 mL in an average adult female that returns to the left side of the heart
• Even more air can be inhaled if inhalation follows forced • As blood flows through the pulmonary capillaries, it picks
exhalation up O2 from alveolar air and unloads CO2 into alveolar air,
• If you inhale normally and then exhale as forcibly as which is exhaled through expiration towards the
possible, you should be able to push out considerably atmosphere.
more air in addition to the 500 mL of tidal volume
• The extra 1200 mL in males and 700 mL in females is
called the expiratory reserve volume
• The FEV1.0 is the forced expiratory volume in 1
second, the volume of air that can be exhaled from the
lungs in 1 second with maximal effort following a maximal
inhalation
• Chronic obstructive pulmonary disease (COPD)
greatly reduces FEV1.0 because COPD increases airway
resistance.
• Even after the expiratory reserve volume is exhaled,
considerable air remains in the lungs because the sub-
atmospheric intrapleural pressure keeps the alveoli
slightly inflated, and some air also remains in the non-
collapsible airways.
• This volume, which cannot be measured by spirometry,
is called the residual volume and amounts to about 1200
mL in males and 1100 mL in females – constant
measurements.
o No matter how hard you forcefully exhale all air in
your lungs, there will always be a residual volume.

• If the thoracic cavity is opened, the intrapleural pressure

rises to equal the atmospheric pressure and forces out
some of the residual volume. The air remaining is called
the minimal volume.
o Minimal volume could serve as an indicator during
autopsy.
• Minimal volume provides a medical and legal tool for
determining whether a baby is born dead (stillborn) or
died after birth.
• The presence of minimal volume can be demonstrated by • The changes in the partial pressure of O2 or CO2 in
placing a piece of lung in water and observing if it floats. capillaries (alveolar bed capillary and blood capillary) is
• Fetal lungs contain no air, so the lung of a stillborn baby the reason why exchange of gases is promoted through
will not float in water. the process of diffusion.
• The lungs of a stillborn baby will not float in water. • The left ventricle pumps oxygenated blood into the aorta
and through the systemic arteries to systemic capillaries.
• Inspiratory capacity is the sum of tidal volume and • The exchange of O2 and CO2 between systemic
inspiratory reserve volume capillaries and tissue cells is called internal respiration
o (500 mL+ 3100 mL =3600 mL in males and or systemic gas exchange.
o 500 mL +1900 mL =2400 mL in females) • As O2 leaves the bloodstream, oxygenated blood is
• Functional residual capacity is the sum of residual converted into deoxygenated blood.
volume and expiratory reserve volume • Unlike external respiration, which occurs only in the
o (1200 mL +1200 mL= 2400 mL in males and lungs, internal respiration occurs in tissues throughout
o 1100 mL +700 mL =1800 mL in females). the body.
• Vital capacity is the sum of inspiratory reserve volume, • The PO2 (partial oxygen) of blood pumped into systemic
tidal volume, and expiratory reserve volume capillaries is higher (100 mmHg) than the PO2 in tissue
o (4800 mL in males and cells (40 mmHg at rest) because the cells constantly use
o 3100 mL in females) O2 to produce ATP.
• Total lung capacity is the sum of vital capacity and • Due to this pressure difference, oxygen diffuses out of the
residual volume capillaries into tissue cells and blood PO2 drops to 40
o (4800 mL+ 1200 mL= 6000 mL in males and mmHg by the time the blood exits systemic capillaries.
o 3100 mL +1100 mL =4200 mL in females) • While O2 diffuses from the systemic capillaries into tissue
cells, CO2 diffuses in the opposite direction.
• CO2 diffuses from tissue cells through interstitial fluid into
systemic capillaries until the PCO2 in the blood increases
to 45 mmHg
• Deoxygenated blood returns to the heart and is pumped
to the lungs for another cycle of external respiration.

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• In a person at rest, tissue cells, on average, need only

25% of the available O2 in oxygenated blood; despite its
name, deoxygenated blood retains 75% of its O2 content.
• During exercise, more O2 diffuses from the blood into
metabolically active cells, such as contracting skeletal
muscle fibers.
• Active cells use more O2 for ATP production, causing the
O2 content of deoxygenated blood to drop below 75%.

• The rate of pulmonary and systemic gas exchange

depends on several factors:
o Partial pressure difference of the gases
o Surface area available for gas exchange
o Diffusion distance
o Molecular weight and solubility of the gases
• During quiet breathing, inhalation lasts for about 2
CONTROL OF RESPIRATION seconds and exhalation lasts for about 3 seconds.
• At rest, about 200 mL of O2 are used each minute by • Nerve impulses generated in the inspiratory area
body cells establish the basic rhythm of breathing.
• During strenuous exercise, however, O2 use typically
increases 15- to 20- fold in normal healthy adults, and as PNEUMOTAXIC AREA
much as 30-fold in elite endurance-trained athletes • Although the medullary rhythmicity area controls the
• Several mechanisms help match respiratory effort to basic rhythm of respiration, other sites in the brain stem
metabolic demand. help coordinate the transition between inhalation and
• The size of the thorax is altered by the action of the exhalation.
respiratory muscles, which contract as a result of nerve • In upper pons; transmits inhibitory impulses to the
impulses transmitted to them from centers in the brain inspiratory area.
and relax in the absence of nerve impulses. • The major effect of these nerve impulses is to help turn
• These nerve impulses are sent from clusters of neurons off the inspiratory area before the lungs become too full
located bilaterally in the medulla oblongata and pons of of air.
the brain stem. • In other words, the impulses shorten the duration of
inhalation.
• This widely dispersed group of neurons, collectively • When the pneumotaxic area is more active, breathing
called the respiratory center, can be divided into three rate is more rapid
areas on the basis of their functions:
(1) the medullary rhythmicity area in the medulla APNEUSTIC AREA
oblongata;
• Another part of the brain stem that coordinates the
(2) the pneumotaxic area in the pons; and
transition between inhalation and exhalation is the
(3) the apneustic area, also in the pons
apneustic area in the lower pons
• This area sends stimulatory impulses to the inspiratory
area that activate it and prolong inhalation which results
in a long, deep inhalation.
• When the pneumotaxic area is active, it overrides signals
from the apneustic area
• There are some people who have issues with their
respiratory centers or a disorder called central
hyperventilation syndrome.
o It is often a fatal disorder that occurs during sleep.
o It is congenital but, in some cases, it can later
develop in life especially when there is trauma or
head injury towards the brain stem.
o Also known as Ondine’s curse – the syndrome got
its name from an old German story/ folktale. Ondine
was a young nymph who fell in love with a young
man. She found out that he was unfaithful. She
became very enraged and set a curse on the man.
The curse itself would cause the person to not breath
when he sleeps. During sleep, he is unable to breath.
For the rest of the man’s life, he has never been able
to sleep due to the fear of dying.
o In relation to the syndrome, there is damage to the
apneustic area, there is no way for it to stimulate the
inspiratory center to stimulate breathing.

REGULATION OF THE RESPIRATORY CENTER

• The basic rhythm of respiration set and coordinated by
the inspiratory area can be modified in response to inputs
MEDULLARY RHYTHMICITY AREA from other brain regions, receptors in the peripheral
• The function of the medullary rhythmicity area is to control nervous system, and other factors.
the basic rhythm of respiration. • Cortical Influences on Respiration
• There are inspiratory and expiratory areas within the o Because the cerebral cortex has connections with
medullary rhythmicity area the respiratory center, we can voluntarily alter our
pattern of breathing.

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o Voluntary control is protective because it enables us • If there's an increase in blood CO2, so it causes acidity
to prevent water or irritating gases from entering the towards the blood. It will simulate the inspiratory center
lungs. so increasing now inhalation, allowing CO2 to be
o The ability to not breathe, however, is limited by the released through external respiration, and increasing O2
buildup of CO2 and H in the body. towards the blood.
o When you try not to breathe, your brain would • Increasing arterial blood CO2 would cause specific
overpower you to breathe because of the central and peripheral chemoreceptors to signal the
accumulation of CO2 and buildup of H, causing inspiratory area in your medulla oblongata. It will
acidity in the blood. stimulate the muscles of inhalation, the diaphragm and
• Chemoreceptor Regulation of Respiration their external intercostals, to promote ventilation or
o Chemoreceptors detect the changes in chemical hyperventilation to increase in respiration. This will later
levels in the blood. cause a decrease in the arterial blood CO2 because they
o Certain chemical stimuli modulate how quickly and would be released through external respiration and
how deeply we breathe. increase blood O2 levels (negative feedback).
o The respiratory system functions to maintain proper
levels of CO2 and O2 and is very responsive to • Proprioceptor Stimulation of Respiration
changes in the levels of these gases in body fluids. o The main stimulus for these quick changes in
o Chemoreceptors in two locations monitor levels of respiratory effort is input from proprioceptors, which
CO2, H, and O2 and provide input to the respiratory monitor movement of joints and muscles.
center. o Nerve impulses from the proprioceptors stimulate the
• Central chemoreceptors are located in or near the inspiratory area of the medulla oblongata.
medulla oblongata in the central nervous system. o At the same time, axon collaterals (branches) of
o They respond to changes in H concentration or upper motor neurons that originate in the primary
PCO2, or both, in cerebrospinal fluid. motor cortex (precentral gyrus) also feed excitatory
• Peripheral chemoreceptors are located in the aortic impulses into the inspiratory area.
bodies, clusters of chemoreceptors located in the wall of • The Inflation Reflex
the arch of the aorta, and in the carotid bodies, which o Stretch-sensitive receptors called baroreceptors or
are oval nodules in the wall of the left and right common stretch receptors are located in the walls of bronchi
carotid arteries where they divide into the internal and and bronchioles
external carotid arteries o When these receptors become stretched during
overinflation of the lungs, nerve impulses are sent
along the vagus (X) nerves to the inspiratory and
apneustic areas.
o In response, the inspiratory area is inhibited directly,
and the apneustic area is inhibited from activating the
inspiratory area.
o As a result, exhalation begins.
o As air leaves the lungs during exhalation, the lungs
deflate and the stretch receptors are no longer
stimulated.
o Thus, the inspiratory and apneustic areas are no
longer inhibited, and a new inhalation begins.
o This reflex, referred to as the inflation (Hering–
Breuer) reflex, is mainly a protective mechanism for
preventing excessive inflation of the lungs rather
than a key component in the normal regulation of
respiration.
§ This is important because your lungs would
explode if you don’t allow the body to detect
overstretching of your lungs.

OTHER INFLUENCES ON RESPIRATION

• Limbic system stimulation.
o Limbic system is the emotional center of the brain.
o Anticipation of activity or emotional anxiety may
stimulate the limbic system, which then sends
excitatory input to the inspiratory area, increasing the
rate and depth of ventilation.
o Eg. when you see your crush, you hyperventilate or
have a panic attack <33
§ As a first aid, you give a brown paper bag in
order for the CO2 to get back. If there’s too much
hyperventilation, there would be an excessive
release of CO2 until later on metabolic
imbalances would occur, causing the rigidity of
the extremity.
• Temperature.
o An increase in body temperature, as occurs during a
fever or vigorous muscular exercise, increases the
rate of respiration.
o A decrease in body temperature decreases
respiratory rate.
o A sudden cold stimulus (such as plunging into cold
water) causes temporary apnea, an absence of
breathing.

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• Pain.
o A sudden, severe pain brings about brief apnea, but
a prolonged somatic pain increases respiratory rate.
o Visceral pain may slow the rate of respiration.
• Stretching the anal sphincter muscle.
o This action increases the respiratory rate and is
sometimes used to stimulate respiration in a
newborn baby or a person who has stopped
breathing.
o You poke the anus or stretch the anal sphincter.
• Irritation of airways.
o Physical or chemical irritation of the pharynx or
larynx brings about an immediate cessation of
breathing followed by coughing or sneezing (more of
a defense mechanism).
• Blood pressure.
o The carotid and aortic baroreceptors that detect
changes in blood pressure have a small effect on
respiration.
o A sudden rise in blood pressure decreases the rate
of respiration, and a drop in blood pressure increases
the respiratory rate.
o The pons and the medulla are the respiratory
centers.
o People who try to commit suicide through a gunshot
to their head could still survive. You will surely die if
you put the gun inside your mouth and the bullet
passes through the brain stem J

REFERENCE

Tortora – Principles of Anatomy and Physiology, 12th

edition Chapter 23 pp. 875 - 919

Lecture and PPT of Danilo Gallardo Jr., MD, FM, FMCP

PANANGHID SA DAAN SA GAHIMO ^-^ | 1D-MT 17