T H E R E S P I R AT O R Y S Y S T E M A N D H O M EO S T A S I S The respiratory system contributes to homeostasis by providing for the exchange of gases²oxygen and carbon dioxide²between the atmospheric

air, blood, and tissue cells. It also helps adjust the pH of body fluids. Your body¶s cells continually use oxygen (O2) for the metabolic reactions that release energy from nutrient molecules and produce ATP. At the same time, these reactions release carbon dioxide (CO2). Because an excessive amount of CO2 produces acidity that can be toxic to cells, excess CO2 must be eliminated quickly and efficiently. The cardiovascular and respiratory systems cooperate to supply O2 and eliminate CO2. The respiratory system provides for gas exchange intake of O2 and elimination of CO2 and the cardiovascular system transports blood containing the gases between the lungs and body cells. Failure of either system disrupts homeostasis by causing rapid death of cells from oxygen starvation and buildup of waste products. In addition to functioning in gas exchange, the respiratory system also participates in regulating blood pH, contains receptors for the sense of smell, filters inspired air, produces sounds, and rids the body of some water and heat in exhaled air. Like the digestive and urinary systems that will be covered in subsequent chapters, in the respiratory system there is an extensive area of contact between the external environment and capillary blood vessels. This area of contact allows the body to constantly renew and replenish the internal fluid environment that surrounds and nourishes every body cell.

The respiratory system consists of the nose, pharynx (throat), larynx (voice box), trachea (windpipe), bronchi, and lungs. Its parts can be classified according to either structure or function. Structurally, the respiratory system consists of two parts: (1) The upper respiratory system includes the nose, pharynx, and associated structures. (2) The lower respiratory system includes the larynx, trachea, bronchi, and lungs. Functionally, the respiratory system also consists of two parts: (1) The conducting zone consists of a series of interconnecting cavities and tubes both outside and within the lungs. These include the nose, pharynx, larynx, trachea, bronchi, bronchioles, and terminal bronchioles; their function is to filter, warm, and moisten air and conduct it into the lungs. (2) The respiratory zone consists of tissues within the lungs where gas exchange occurs . These include the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli; they are the main sites of gas exchange between air and blood.

Pharynx The pharynx (FAIR-inks), or throat, is a funnel-shaped tube about 13 cm (5 in.) long that starts at the internal nares and extends to the level of the cricoid cartilage, the most inferior cartilage of the larynx (voice box). The pharynx lies just posterior to the nasal and oral cavities, superior to the larynx, and just anterior to the cervical vertebrae. Its wall is composed of skeletal muscles and is lined with a mucous membrane. Contraction of the skeletal muscles assists in deglutition (swallowing). The pharynx functions as a passageway for air and food, provides a resonating chamber for speech sounds, and houses the tonsils, which participate in immunological reactions against foreign invaders.

The pharynx can be divided into three anatomical regions: (1) Nasopharynx, (2)Oropharynx, and (3) laryngopharynx. The muscles of the entire pharynx are arranged in two layers, an outer circular layer and an inner longitudinal layer. The superior portion of the pharynx, called the nasopharynx, lies posterior to the nasal cavity and extends to the soft palate. The soft palate, which forms the posterior portion of the roof of the mouth, is an arch-shaped muscular partition between the nasopharynx and oropharynx that is lined by mucous membrane. There are five openings in its wall: two internal nares, two openings that lead into the auditory (pharyngotympanic) tubes (commonly known as the eustachian tubes), and 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 dustladenmucus. The nasopharynx is lined with pseudostratified ciliated columnar epithelium, and 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. The intermediate portion of the pharynx, the oropharynx, lies posterior to the oral cavity and extends from the soft palate inferiorly to the level of the hyoid bone. It has only one opening into it, the fauces (FAW-se¯z _ throat), the opening from the mouth. This portion of the pharynx has both respiratory and digestive functions, serving as a common passageway for air, food, and drink. Because the oropharynx is subject to abrasion by food particles, it is lined with nonkeratinized stratified squamous epithelium. Two pairs of tonsils, the palatine and lingual tonsils, are found in the oropharynx. The inferior portion of the pharynx, the laryngopharynx (larin_-go¯-FAIR-inks), or hypopharynx, begins at the level of the hyoid bone. At its inferior end it opens into the esophagus (food tube) posteriorly and the larynx (voice box) anteriorly. Like the oropharynx, the laryngopharynx is both a respiratory and a digestive pathway and is lined by nonkeratinized stratified squamous epithelium.

Larynx The larynx (LAIR-inks), or voice box, is a short passageway that connects the laryngopharynx with the trachea. It lies in the midline of the neck anterior to the esophagus and the fourth through sixth cervical vertebrae (C4±C6). The wall of the larynx is composed of nine pieces of cartilage. Three occur singly (thyroid cartilage, epiglottis, and cricoid cartilage), and three occur in pairs (arytenoid, cuneiform, and corniculate cartilages). Of the paired cartilages, the arytenoids cartilages are the most important because they influence changes in position and tension of the vocal folds (true vocal cords for speech). The extrinsic muscles of the larynx connect the cartilages to other structures in the throat; the intrinsic muscles connect the cartilages to one another.

The thyroid cartilage (Adam¶s apple) consists of two fused plates of hyaline cartilage that form the anterior wall of the larynx and give it a triangular shape. It is present in both males and females but is usually larger in males due to the influence of male sex hormones on its growth during puberty. The ligament that connects the thyroid cartilage to the hyoid bone is called the thyrohyoid membrane. The epiglottis (epi- _ over; glottis _ tongue) is a large, leafshaped piece of elastic cartilage that is covered with epithelium. The ³stem´ of the epiglottis is the tapered inferior portion that is attached to the anterior rim of the thyroid cartilage and hyoid bone. The broad superior ³leaf´ portion of the epiglottis is unattached and is free to move up and down like a trap door. During swallowing, the pharynx and larynx rise. Elevation of the pharynx widens it to receive food or drink; elevation of the larynx causes the epiglottis to move down and form a lid over the glottis, closing it off. The glottis consists of a pair of folds of mucous membrane, the vocal folds (true vocal cords) in the larynx, and the space between them

called the rima glottidis (RI¯-ma GLOT-ti-dis). The closing of the larynx in this way during swallowing routes liquids and foods into the esophagus and keeps them out of the larynx and airways. When small particles of dust, smoke, food, or liquids pass into the larynx, a cough reflex occurs, usually expelling the material. The cricoid cartilage (KRI¯ -koyd _ ringlike) 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. The paired arytenoid cartilages (ar_-i-TE¯ -noyd _ ladlelike) are triangular pieces of mostly hyaline cartilage located at the posterior, superior border of the cricoid cartilage. They form synovial joints with the cricoid cartilage and have a wide range of mobility. The paired corniculate cartilages (kor-NIK-u--lat _ shaped like a small horn), horn-shaped pieces of elastic cartilage, are located at the apex of each arytenoid cartilage. The paired cuneiform cartilages (KU--ne--i-form _ wedge-shaped), clubshaped elastic cartilages anterior to the corniculate cartilages, support the vocal folds and lateral aspects of the epiglottis. The lining of the larynx superior to the vocal folds is nonkeratinized stratified squamous epithelium. The lining of the larynx inferior to the vocal folds is pseudostratified ciliated columnar epithelium consisting of ciliated columnar cells, goblet cells, and basal cells. The mucus produced by the goblet cells helps trap dust not removed in the upper passages. The cilia in the upper respiratory tract move mucus and trapped particles down toward the pharynx; the cilia in the lower respiratory tract move them up toward the pharynx.

TRACHEA Lying more or less in midline, in the lower part of neck and in the superior mediastinium, upper and is continous with larynx and lower end divides into right and left principle bronchi. Trachea is 10-15 cm in length and external diameter is 2 cm in male and 1.5 cm in female. Trachea has a fibroelastic wall supported by a cartilaginous skeleton formed by C shaped rings. is a cartilaginous and membranous tube, extending from the lower part of the larynx, on a level with the sixth cervical vertebra, to the upper border of the fifth thoracic vertebra, where it divides into the two bronchi, one for each lung. Upper end of trachea lies at lower border of cricoids cartilage opposite of 6th cervical vertebrae, and lower end at thoracic 4th vertebrae. Relations 1. Anteriorly a. Manibarium sternii b. Sternothyroid nuscle c. Thymus d. Left brachiocephalic and left common carotid artery. e. Some lymph nodes 2. Posteriorly a. Esophagus b. Vertebral column

3. Right side a. Right vagus and azygous vein 4. Left side a. Left common carotid artery and left subclavian artery. Blood supply 1. Artery : inferior thyroid artery 2. Vein : brachiocephalic vein 3. Lymphatic drainage : pretracheal and paratracheal lymphnodes.


y y y y y

Lungs are the pair of respiratory organ situated in thoracic cavity. Right and left lung is separated by mediastinium. Texture ± spongy Colour ± in young brown, adults molted black due to deposition of carbon particles. Weight ± right lung 600gm, left lung 550gms. Shape ± Conical.

Apex Blunt and lies above level of anterior rib. Reaches 1-2 cm above medial 1/3rd of clavicle. Covered by cervical pleura and suprapleural membrane. Grooved by subclavian artery and vein. Base Semilunar and concave Rests on dome of diaphragm. Right sided dome is higher than left. BORDERS y Anterior border Thin, shorter than posterior border, shows a wide cardiac notch below the 4th costal cartilage. y Posterior border Thick and ill defined, it extends from C7-T10. y Inferior border Seperates the base from costal and medial surface. y Costal surface Large and convex y Medial surface Divided in Posterior medial surface or mediastinial surface.

DIFFERENCE BETWEEN RIGHT AND LEFT LUNG RIGHT LUNG 2 fissure and 3 lobes Anterior border is straight Larger and heavier in weight Shorter and broader 1 bronchial artery arises from 3rd posterior intercostal artery of from left bronchial artery. LEFT LUNG 1 fissure and 2 lobes Ant. Border is interrupted by cardiac notch Smaller and lighter in weight Longer and narrower 2 bronchial artery arises from descending thoracic aorta

Veinous drainage There are 2 bronchial veins on each side. The right bronchial vein drain into azygous vein. The left bronchial vein drain either into left superior intercostal vein or into hemiazygous vein. Lymphatic drainage 1. Superficial vessels drain into peripheral lung tissue lying beneath pulmonary pleura these vessels reach the hilum. 2. Deep lymphatics drain the bronchial tree, pulmonary vessels and connective tissue septa. They drain into bronchopulmonary nodes. Nerve supply 1. Parasympathetic nerve fibers are derived from vagus nerve a. Motor nerve to bronchial muscles and on stimulation causes bronchospasm. b. Sensory nerves are responsible for stretch reflex of lungs and cough reflex. 2. Sympathetic nerve fibers are derived from 2nd ± 5th spinal segments.

Bronchial tree
y y y y y Trachea divides at the level of lower border of 4th thoracic vertebrae into primary principal bronchi one for each lung. The right principal bronchus is 2.5 cm long, short, wide and more in line with trachea. The let principal bronchus is 5 cm long, longer, narrower, more oblique. o Each principal bronchus enters the lung through hilum and divides into secondary lobar bronchi, one for each lobe of lung 3 lobar bronchii on left side and 2 lobar bronchii on right side. o Each lobar bronchii divides into tertiary or segmental bronchi, 1 for each bronchopulmonary segment. There are 10 bronchopulmonary segment on each side of lung. o The segmental bronchii divides repeatedly in very small branches called terminal bronchioles. o Terminal bronchioles divides into respiratory bronchioles. o Each terminal bronchiole aerates a smallpar of lung called as pulmonary unit. It consists of alveolar duct, atria, air saccules, pulmonary alveoli.

Bronchopulmonary segment
y y Pyramidal in shape with its apex directed towards the root of lung. Each segment is surrounded by connective tissue which is continous on the surface with pulmonary pleura. Thus bronchopulmonary segment are independent respiratory unit.

Relation to pulmonary artery The branches of pulmonary artery accompany the bronchii. The artery lies dorsolateral to the bronchus. Thus each segment has its own separate artery. Relation to pulmonary vein The pulmonary vein do not accompany the bronchii or pulmonary artery. They run in the intersegmental planes. Thus each segment has more than one vein and each vein drain more than one segment.

FUNCTIONAL ANATOMY OF RESPIRATORY TRACT Respiratory tract is the anatomical structure through which air moves in and out. It consists ot nose, pharynx, larynx, trachea, bronchi and lungs. Pleura Each lung is enclosed by a bilayered serous membrane called pleura or pleural sac. The two layers of pleura are the visceral and parietal layers. Visceral (inner) layer is attached firmly to the surtace of the lungs. At hilum, it is continuous with paritetal (outer) layer, which is attached to the wall of the thoracic cavity. The narrow space in between the two layers of pleura is called intrapleural space or pleural cavity. This space contains a thin film of serous fluid called pleural fluid. It is secreted by the visceral layer of the pleura. It functions as the lubricant to prevent friction between two layers. It is involved in the creating negative pressure called intrapleural pressure within intrapleural space. In some pathological conditions, the pleural cavity expands with accumulation of air (pneumothorax), wa (hydrothorax), blood (hemothorax) or pus (Pyothorax) Tracheobronchial Tree

The trachea and bronchi are together called traches. bronchiat tree. It forms a part of air passage. The trachea biturcates into two main or primaj bronchi called right and left bronchi. Each primsi bronchus enters the lungs and divides into lobar secondary bronchi. The secondary bronchi divide is segmental or tertiary bronchi. In right lung, there are ts tertiary bronchi and, in left lung, there are eight tertiary bronchi. The tertiary bronchi divide several times w reduction in length and diameter into many generatior of bronchiotes. When the diameter of bronchiols becomes 1 mm or less, it is called terminal bronchi Terminal bronchiole continues or divides into respirate bronchiole, which has a diameter of 0.5 mm. Generally, the respiratory tract is divided into two par upper respiratory tract and lower respiratory tract. Upper Respiratory Tract Upper respiratory tract includes all the structures frei nose up to vocal cords. Vocal cords are the folds mucous membrane within larynx that vibrates to produi the voice. Lower Respiratory Tract Lower respiratory tract includes trachea, bronchi and lungs. 1. DEFENSE MECHANISM Lungs play important role in the immunological defense system of the body. The defense functions of the lungs are performed by their own defenses and by the presence of various types of cells in the mucous membrane lining the alveoli of lungs. These cells are leukocytes, macrophages, mast cells, natural killer cells and dendritic cells. y Lung¶s Own Defenses The epithelial cells lining the air passage secrete some innate immune factors called defensins and cathelicidins. These substances are the antimicrobial peptides which play an important role in lung¶s natural defenses. Defense through Leukocytes The leukocytes, particularly the neutrophils and lymphocytes present in the alveoli of lungs provide defense mechanism against bacteria and virus. The neutrophils kill the bacteria by phagocytosis. Lymphocytes develop immunity against bacteria. Defense through Macrophages Macrophages engulf the dust particles and the pathogens, which enter the alveoli and thereby act as scavengers in lungs. Macrophages are also involved in the development of immunity by functioning as antigen presenting cells. When foreign organisms invade the body, the macrophages and other antigen presenting cells kill them. Later, the antigen from the organisms is digested into polypeptides. The polypeptide products are presented to T lymphocytes and B lymphocytes by the macrophages. Macrophages secrete interleukins, tumor necrosis factors (TNF) and chemokines . Interleukins and TNF activate the general immune system of the body. Chemokines attract the white blood cells towards the site of any inflammation. Defense through Mast Cell Mast cell is a large tissue cell resembling the basophil. The mast cell produces the hypersensitivity reactions like allergy and anaphylaxis (Chapter 17). It secretes heparin, histamine, serotonin and hydrolytic enzymes. Defense through Natural Killer Cell Natural killer (NK) cell is a large granular cell, considered as the third type of lymphocyte. Usually NK cell is present in lungs and other lymphoid organs. Its granules contain hydrolytic enzymes, which destroy the micro organisms. NK cell is said to be the first line of defense in specific immunity particularly against viruses. It destroys the viruses and the viral infected or damaged cells, which may form the tumors. It also- destroys the malignant cells and prevents development of cancerous tumors. The NK cells secrete interferons and the tumor necrosis factors.






Defense through Dendritic Cells Dendritic cells in the lungs play important role in immunity. Along with macrophages, these cells function as antigen presenting cells.

2. MAINTENANCE OF WATER BALANCE Respiratory tract plays a role in water loss mechanism. During expiration, water evaporates through the expired air and some amount of body water is lost by this process. 3. REGULATION OF BODY TEMPERATURE During expiration, along with water, heat is also lost fr the body. Thus, respiratory tract plays a role in heat loss mechanism. 4. REGULATION OF ACID BASE BALANCE Lungs play a role in maintenance of acid base balance of the body by regulating the carbon dioxide content in blood. Carbon dioxide is produced during various metabolic reactions in the tissues of the body. When it enters the blood, carbon dioxide combines with water form carbonic acid. Since carbonic acid is unstable and splits into hydrogen and bicarbonate ions. CO2+H2O   H2CO3H*+HCO The entire reaction is reversed in lungs when carbon dioxide is removed from blood into the alveoli of lung. H* + HCO   H2C03   CO2 + H20 As carbon dioxide is a volatile gas, it is practically blown out by ventilation. When metabolic activities are accelerated, m amount of carbon dioxide is produced in the tissues and the concentration of hydrogen ion is also increased leading to reduction in pH. The increased hydrogen concentration causes increased pulmonary ventilation i.e. hyperventilation by acting through various mechanisms like chemoreceptor s in aortic and ca bodies and in medulla of the brain to hyperventilation, the excess of carbon dioxide removed from the body fluids and the pH is brought bi to normal.

5. ANTICOAGULANT FUNCTION Mast cells in lungs secrete heparin, Heparin is anticoagulant and it prevents the intravascular clotting. 6. SECRETION OF ANGIOTENSIN CONVERTING ENZYME

Endothelial cells of the pulmonary capillaries secrete the angiotensin converting enzyme (ACE). It converts the angiotensin I into active angiotensin II which pIays important role in the regulation of ECF volume and bIood pressure
7. SYNTHESIS OF HORMONAL SUBSTANCES Lung tissues are also known to synthesieze the hormonal substances, prostaglandins, acetylcholine and serotonin which have many physiological actions in body including regulation of blood pressure.


Respiratory protective reflexes are the reflexes that protect the lungs and air passage from foreign particles. The respiratory process is modified by these reflexes order to eliminate the foreign particles or to prevent entry of these particles into the respiratory tract. The respiratory protective reflexes are:

1. COUGH REFLEX Cough is a modified respiratory process characterized by forced expiration. It is the protective reflex that occurs because of irritation of respiratory tract and some other areas such as external auditory canal. Causes

Cough is produced mainly by irritant agents. It is also produced by several disorders such as cardiac disorders (congestive heart failure), pulmonary disorders chronic obstructive pulmonary disease COPD), and tumor in thorax which may exert pressure on larynx, trachea, bronchi, or lungs. Mechanism Cough begins with deep inspiration followed by forced expiration with closed glottis. This increases the intrapleural pressure above 100 mm Hg. Then, glottis opens suddenly with explosive outflow of air at a high velocity. The velocity of the airflow may reach 960 km/hr. It causes expulsion of irritants out of the respiratory act. Reflex Pathway The receptors that initiate the cough are situated in several locations such as nose, paranasal sinuses, larynx, pharynx, trachea, bronchi, pleura, diaphragm, pericardium, stomach, external auditory canal and tympanic membrane. Afferent nerve fibers pass via vagus, trigeminal, glossopharyngeal, and phrenic nerves. The center for cough reflex is in the medulla oblongata. The efferent nerve fibers arising from the meduIlary center pass through the vagus, phrenic, and spinal motor nerves. These nerve fibers activate the primary and accessory respiratory muscles.
2. SNEEZING REFLEX Sneezing is also a modified respiratory process characterized by forced expiration. It is a protective reflex caused by irritation of nasal mucous membrane. Causes Irritation of the nasal mucous membrane occurs because of dust particles, debris, mechanical obstruction of the airway, and excess fluid accumulation in the nasal passages. Mechanism Sneezing starts with deep inspiration, followed by forceful expiratory effort with opened glottis resulting in expulsion of irritant agents out of respiratory tract.

Reflex Pathway Sneezing is initiated by the irritation of nasal mucous membrane, the olfactory receptors and trigeminal nerve endings present in the nasal mucosa. Afferent nerve fibers pass

through the trigeminal and olfactory nerves. The sneezing center is in medulla oblongata. It is located diffusely in spinal nucleus of trigeminal nerve, nucleus sotitarius and the reticular formation of medulla. The efferent nerve fibers from the medullary center pass via tngeminal, facial, glossopharyngeal, vagus and intercostal nerves. These nerve fibers activate the pharyngeal, tracheal and respiratory muscles.

Accessory lnspiratory Muscles Sternocleidomastoid, scaleni, anterior serrati, elevators of scapulae and pectorals are the accessory inspiratory muscles. Inspiratory Muscles Primary expiratory muscles are internal intercostal muscles, which are innervated by intercostal nerves. Accessory expiratory muscles are the abdominal muscles. MOVEMENTS OF THORACIC CAGE Inspiration causes enlargement of thoracic cage. Thoracic cage enlarges because of increase in all diameters, viz. anteroposterior, transverse and vertical diameters, Increase in anteroposterior and transverse diameters occurs due to the elevation of ribs. The vertical diameter of thoracic cage is increased by the descent of diaphragm. In general, the change in the size of thoracic cavity occurs because of the movements of four units of structures. y y y y Thoracic lid Upper costal series Lower costal series Diaphragm.

1. Thoracic Lid Movement of thoracic lid increases the anteroposterior diameter of thoracic cage. The thoracic lid is formed by manubrium sterni and the 1st pair of ribs. It is also called thoracic operculum. Due to the contraction of scaleni muscles, the first ribs move upwards to a more horizontal position. This increases the anteroposterior diameter of the thoracic cage. 2. Upper Costal Series Movement of upper costal series increases the anteroposterior and transverse diameter of the thoracic cage.

Pump handle movement The upper costal series is constituted by 2nd to 6th pair of ribs. The contraction of external intercostal muscles causes elevation of these ribs and upward and forward movement of sternum. This movement is called pump handle movement, It increases anteroposterior diameter of the thoracic cage. Bucket handle movement Simultaneously, the central portions of these ribs (arches of ribs) move upwards and outwards to a more horizontal position. This movement is called bucket handle movement and it increases the transverse diameter of thoracic cage. 3. Lower Costal Series Movement of lower costal series increases the transverse diameter of the thoracic cage. Bucket handle movement

It is formed by the 7th to 10th pair of ribs. These ribs also show bucket handle movement by swinging outward and upward. This movement increase transverse diameter of the thoracic cage. The 11th and 12th pairs of ribs are the floating ribs, which are not involved in changing the size of thoracic cage. 4. Diaphragm Movement of diaphragm increases the vertical diameter of thoracic cage. Normally, before inspiration diaphragm is dome-shaped with convexity facing upwards. During inspiration, due to the contraction, the muscle fibers are shortened. But, the central tendinous portion is drawn downwards so the diaphragm is flattened. Flattening of diaphragm increases the vertical diameter of the thoracic cage.

During inspiration, due to the enlargement of thoracic cage, the negative pressure is increased in the thoracic cavity. It causes expansion of the lungs. During expiration the thoracic cavity decreases in size to the preinspiral position. The pressure in the thoracic cage also comes back to the preinspiratory level. It compresses the Lung tissues so that, the air is expelled out of lungs. Collapsing Tendency of Lungs During expiration when air is expelled out, the lungs are expected to collapse. But it does not happen. The lungs are under constant threat to collapse even under resting conditions because of certain factors. Factors causing Collapsing Tendency of Lungs Two factors are responsible for the collapsing tendency of lungs 1. Elastic property of lung tissues 2. Surface tension Elastic property of lung tissues: The elastic tissues Iungs show constant recoiling tendency and try to collapse the lungs. Surface tension: It is the tension exerted on the surface of the alveolar membrane by the fluid secreted from alveolar epithelium. fortunately, there are some factors which save the lungs from collapsing.

Factors preventing Collapsing Tendency of Lungs
In spite of the elastic property of the lungs and the surface tension in the alveoli of lungs, the collapsing tendency of lungs is prevented by two factors: y The intrapleural pressure: It is the pressure in the pleural cavity which is always negative. Because of negativity, it keeps the lungs expanded and prevents the collapsing tendency of lungs produced by the elastic tissues. The surfactant. It is a substance secreted in alveolar epithelium. It reduces surface tension prevents the collapsing tendency produced by surface tension.


It is a surface acting material or agent that is responsible for lowering the surface tension of a fluid. The surfactant that lines the epithelium of the alveoli in lungs is known as pulmonary surfactant and it decreases the surface tension on the alveolar membrane.

Source of secretion of pulmonary surfactant 1. Type II alveolar epithelial cells in the lungs, which are called surfactant secreting alveolar cells or pneumocytes. The characteristic feature of these cells is the presence of microvilli on their alveolar surface. 2. Clara cells, which are situated in the bronchioles. These cells are also called bronchiolar exocrine cells.

FUNCTIONS OF SURFACTANT 1. The surfactant reduces the surface tension in the alveoli of lungs and prevents the collapsing tendency of lungs. Surfactant acts by the following mechanism: The phospholipid molecule in the surfactant has two portions. One portion of the molecules is hydrophilic. This portion dissolves in water and lines the alveoli. The other portion is the hydrophobic portion which is directed towards the alveolar air. This surface of the phospholipid along with other portion spreads over the alveoli and reduces the surface tension. SPB and SP-C play active role in this process. 2. The surfactant is responsible for stabilization of the alveoli, which is necessary to withstand the collapsing tendency. 3. It plays an important role in the inflation of lungs after birth. In fetus, the secretion of surfactant begins after the third month. Until birth, the lungs are solid and not expanded. Soon after birth, the first breath starts because of the stimulation of respiratory centers by hypoxia and hypercapnea. Although the respiratory movements are attempted by the infant, the lungs tend to collapse repeatedly. And, the presence of surfactant in the alveoli prevents the lungs from collapsing. 4. Another important function of surfactant is its role in defense within the lungs against infection and inflammation. The hydrophilic proteins SP-A and SP-D destroy the bacteria and viruses by means of opsonization. These two proteins also control the formation of inflammatory mediators.

Two types of pressures are exerted in the thoracic cavity and the lungs during the process of respiration. 1. Intrapleural pressure or intrathoracic pressure 2. lntra-alveolar pressure or intrapulmonary pressure

1. INTRAPLEURAL PRESSURE / INTRATHORACIC PRESSURE The intrapleural pressure is the pressure existing in pleural cavity, that is, in between the visceral and parietal layers of pleura. It is exerted by the suction of fluid that lines the pleural cavity. It is also called intrathoracic pressure since it is exerted in the whole of thoracic cavity. NORMAL VALUES Respiratory pressures are always expressed in relation to atmospheric pressure which is 760 mm Hg. Under physiological conditions, the intrapleural pressure is always negative. The normal values are: y y y y y At the end of normal inspiration: -6 mm Hg (760 ² 6 = 754 mm Hg) At the end of normal expiration: -2 mm Hg (760 ²2 = 758 mm Hg) At the end of forced inspiration: -30 mmHg At the end of forced inspiration with closed glottis Muller¶s maneuver : -70 mm Hg At the end of forced expiration with closed glottis Valsalva maneuver : + 50 mm Hg

2. INTRA-ALVEOLAR PRESSURE Intra-alveolar pressure is the pressure existing in the alveoli of the lungs. It is also known as intrapulmonary pressure. Normal Values Normally, intra-alveolar pressure is equal to the atmospheric pressure, which is 760 mmHg. It becomes negative during inspiration and positive during expiration. The normal values are: y y y y y During normal inspiration: - 1 mm Hg (760 - 1 = 759 mm Hg) During normal expiration: + 1 mm Hg (760 + 1 = 761 mm Hg) At the end of inspiration and expiration: Equal to atmospheric pressure (760 mm Hg) During forced inspiration with closed glottis (Mullees maneuver): ²80 mm Hg During forced expiration with closed glottis (Valsalva maneuver): + 100mm Hg


Tidal volume is the volume of air breathed in and out of lungs in a single normal quiet respiration. Tidal volume signifies the normal depth of breathing. Normal Value 500 mL (0.5 liter). 2. INSPIRATORY RESERVE VOLUME (IRV) Inspiratory reserve volume is an additional volume of air that can be inspired forcefully after the end of normal inspiration. Normal Value 3300 mL (3.3 liters). 3. EXPIRATORY RESERVE VOLUME (ERV) Expiratory reserve volume is the additional volume of air that can be expired out forcefully, after normal expiration. Normal Value 1000 mL (1 liter). 4. RESIDUAL VOLUME (RV) Residual volume is the volume of air remaining in the lungs even after forced expiration. Normally, lungs cannot be emptied completely even by forceful expiration. Some quantity of air always remains in u lungs even after the forced expiration. Residual volume is significant because of two reasons: y y It helps to aerate the blood in between breathin and during expiration It maintains the contour of the lungs.

Normal Value 1200 mL (1.2 liter)

Lung capacities are the combination of two or more lung volumes. Lung capacities are of four types: 1. Inspiratory capacity 2. Vital capacity 3. Functional residual capacity 4. Total lung capacity. A. INSPIRATORY CAPACITY (IC)

Inspiratory capacity is the maximum volume of air tt. is inspired after normal expiration (end expirator position). It includes tidal volume and inspiratory reserve volume. IC = TV + IRV = 500 + 3300 = 3800 mL

B. VITAL CAPACITY (VC) It is the maximum volume of air that can be expelled, out forcefully after a deep (maximal) inspiration. capacity includes inspiratory reserve volume, tii volume and expiratory reserve volume. VC = IRV + TV + ERV = 3300 + 500 + 1000 = 4800 ml. Vital capacity is significant physiologically and determination is useful in clinical diagnosis. C. FUNCTIONAL RESIDUAL CAPACITY (FRC) It is the volume of air remaining in the lungs after normal expiration (after normal tidal expiration). Functional dual capacity includes expiratory reserve volume and residual volume. FRC = ERV + RV =1000+1200=2200mL D. TOTAL LUNG CAPACITY (TLC) Total lung capacity is the volume of air present in the lungs after a deep (maximal) inspiration. It includes all the volumes. TLC = IRV + TV + ERV + RV = 3300 + 500 + 1000 + 1200 = 6000 ml


Pulmonary ventilation is a cyclic process, by which fresh air enters the lungs and an equal volume of air leaves the lungs. It is the volume of air moving in and out of lungs per minute in quiet breathing. It is also called respiratory minute volume (RMV). y y Normal value of pulmonary ventilation is 6000 ml (6 liters)/minute. Pulmonary ventilation is the product of tidal volume (TV) and the rate of respiration (RR). It is calculated by the formula:

Pulmonary Ventilation = Tidal volume x Respiratory rate = 500 mL x 12/minute = 6,000 mL/minute

2. ALVEOLAR VENTILATION The alveolar ventilation is the amount of air utilized for gaseous exchange every minute. The alveolar ventilation is different from pulmonary ventilation. In pulmonary ventilation, 6ltr of air moves in and out of lungs in every minute. But the whole volume of air is not utilized for exchange of gases. The volume of air subjected for exchange of gases is the alveolar ventilation. The air trapped in the respiratory passage (dead space) does not take part in gaseous exchange.
Normal value of alveolar ventilation is 4,200 mL (4.2 liters)/minute. Alveolar ventilation = (Tidal volume - Dead space volume) x Respiratory rate = (500 150) x 12

= 4,200 mL (4.2 liters )/minute.

Dead space is defined as the part of the respiratory tract, where gaseous exchange does not take place. The air present in the dead space is called dead space air. The parts of respiratory tract, which form the dead space, are nose, pharynx, trachea, bronchi and branches of bronchi up to terminal bronchioles. These structures serve only as the passage for air movement. Gaseous exchange does not take place in these structures. TYPES OF DEAD SPACE Dead space is of two types: I. Anatomical dead space II. Physiological dead space. 1. Anatomical Dead Space

It is the volume of respiratory tract from nose up to terminal bronchiole. 2. Physiological Dead Space Physiological dead space includes the anatomical dead space plus two additional volumes. These two additional volumes are generally considered as wasted Ventilation The additional volumes included in physiological dead space are: a. The air in the alveoli, which are nonfunctioning. In some of the respiratory diseases, alveoli do not function because of dysfunction or destruction of alveolar membrane. b. The air in the alveoli, which do not receive adequate blood flow. Gaseous exchange does not take place during inadequate blood supply. Normal value of dead space is 150 ml

REGULATION OF RESPIRATION Respiration is a reflex process. But it can be controlled voluntarily. Voluntary arrest of respiration (voluntary apnea) is possible but only for a short period of about 40 seconds. However, by practice, breathing can be withheld for a long period. At the end of that period, the person is forced to breathe. Respiration is subjected to variation even under normal physiological conditions. Emotion and exercise increase the rate and force of respiration. Rest and sleep decrease the rate and force of respiration. But the altered pattern of respiration is brought back to normal within a short time by some regulatory mechanisms in the body. The pattern of respiration is regulated by two mechanisms: A. Nervous or neural mechanism B. Chemical mechanism. NERVOUS MECHANISM

Nervous mechanism regulates respiration by reflex process. This mechanism includes respiratory centers, afferent nerves and efferent nerves. RESPIRATORY CENTERS Respiratory centers are group of neurons, which control the rate, rhythm and force of respiration. These centers are bilaterally situated in reticular formation of the brainstem. Depending upon the situation in the brainstem, the respiratory centers are classified into two groups: 1. Medullary centers which are made up of a. Dorsal respiratory group of neurons b. Ventral respiratory group of neurons 2. Pontine centers which are a. Pneumotaxic center b. Apneustic center.

MEDULLARY CENTERS 1. Dorsal Respiratory Group of Neurons Situation Dorsal respiratory group of neurons are diffusely situated in nucleus of tractus solitarius which is present in the upper part of the medulla oblongata. Formerly these neurons were collectively called inspiratory center. All the neurons of dorsal respiratory group are inspiratory neurons which generate inspiratory ramp by the virtue of their autorhythmic property. Function Dorsal group of neurons are responsible for basic rhythm of respiration 2. Ventral Respiratory Group of Neurons Situation Ventral respiratory group of neurons are present in nucleus ambiguous and nucleus retro-ambiguous. These two nuclei are situated in the medulla oblongata anterior and lateral to the nucleus of tractus solitarius. Earlier the ventral group neurons were collectively called expiratory center. Ventral group has both inspiratory and expiratory neurons. The inspiratory neurons are found in the central area of the group. The expiratory neurons are in the caudal and rostral areas of the group. Function

Normally, the ventral group neurons are inactive during quiet breathing and become active during forced breathing. During forced breathing, these neurons stimulate both inspiratory muscles and expiratory muscles. Experimental evidence Electrical stimulation of the inspiratory neurons in ventral group causes contraction of inspiratory muscles and prolonged inspiration. Stimulation of expiratory neurons causes contraction of expiratory muscles and prolonged expiration.

PONTINE CENTERS 1. Pneumotaxic Center Situation :- The pneumotaxiC center is situated in dorsolateral part of reticular formation in upper pons. Ills formed by the neurons of medial parabrachial and subparabrachiat nuclei. The subparabraChial nucleus is also called ventral parabrachial or KUuliker-Fuse nucleus. Function The primary function of pneumotaxic center is to control the medullary respiratory centers, particularly the dorsal group neurons. It acts through apneustic center. The pneumotaxic center inhibits the apneustic center so that the dorsal group neurons are inhibited. Because of this inspiration stops and expiration starts. Thus, the pneumotaxic center influences the switching between inspiration and expiration. The pneumotaxic center increases the respiratory rate by reducing the duration of inspiration. Experimental evidence Stimulation of pneumotaxic center does not produce any typical effect, except slight prolongation of expiration by inhibiting the dorsal respiratory group of neurons through apneustic center. Destruction or inactivation of pneumotaxic center results in apneusis. Apneusis is an abnormal pattern of respiration or breathing irregularity characteTized by prolonged inspiration followed by short, inefficient expiration. 2. APNEUSTIC CENTER Situation :- The apneustic center is situated in reticular formation of lower pons. Function This center increases the depth of inspiration by acting directly on the dorsal group neurons. Experimental evidence

The stimulation of apneustic center causes apneusis.

CONNECTIONS OF RESPIRATORY CENTERS Efferent Pathway The nerve fibers from the respiratory centers leave brainstem and descend in anterior part of lateral columns of spinal cord. These nerve fibers terminate on the motor neurons in the anterior horn cells of cervical and thoracic segments of spinal cord. From the motor neurons of spinal cord two sets of nerve fibers arise: y y Phrenic nerve fibers (C3 ² C5) which supply the diaphragm The intercostal nerve fibers (T1 ² T11) which supply the external intercostal muscles.

Vagus nerve also contains some efferent fibers from the respiratory centers.

Afferent Pathway Impulses from peripheral chemoreceptor¶s and baroreceptors are carried to the respiratory centers by the branches of glossopharyngeal and vagus nerves. Vagal nerve fibers also carry impulses from the stretch receptors of lungs to the respiratory centers. Thus, the respiratory centers receive afferent impulses from different parts of the body and, modulate the movements of thoracic cage and lungs accordingly through efferent nerve fibers.

ROLE OF MEDULLARY CENTERS 1. Rhythmic discharge of inspiratory impulses Dorsal respiratory group neurons are responsible for the normal rhythm of respiration. These neurons maintain the normal rhythm of respiration by rhythmic discharge of impulses (action potentials). These impulses are transmitted to the respiratory muscles by the fibers of phrenic and intercostals nerves. 2. lnspiratory ramp Inspiratory ramp is the pattern of discharge from dorsal respiratory group neurons characterized by steady increase in amplitude of the action potential. The firing of these neurons is not like a sudden outburst and it discharge is also not uniform. To start with,

the amplitude of the action potential is low, It is due to the activation of only few neurons. Later, more and more neurons are activated leading to gradual increase in the amplitude of the action potential in a ramp fashion. The impulses of this type of firing from dorsal group neurons are called inspiratory ramp signals. The impulses from dorsal group neurons are produced continuously but only for a period of 2 sec during which inspiration occurs. After 2 seconds, ramp signals stop abruptly and do not appear for another 3 seconds. The switching off ramp signal causes expiration. At the end of 3 seconds, the inspiratory ramp signals reappear in the same pattern and the cycle is repeated. Normally, during inspiration, the dorsal respiratory group neurons inhibit expiratory neurons of ventral group and during expiration; the expiratory neurons inhibit the dorsal group neurons. Thus, the medullary respiratory centers control each other.

Significance of inspiratory ramp signals The significance of inspiratory ramp signals is that there is a slow and steady inspiration so that, the filling of lungs with air is also steady. ROLE OF PONTINE CENTERS Pontine respiratory centers regulate the medullar centers. The apneustic center accelerates the activity of dorsal group neurons and the stimulation of this center causes prolonged inspiration. The pneumotaxic center inhibits the apneustic center and restricts the duration of inspiration.

HERING-BREUER REFLEX Hering-Breuer reflex is a protective reflex that restricts the inspiration and prevents over stretching of lung tissues. It is initiated by the stimulation of stretch receptors of air passage. Stretch receptors are the receptors which give response to stretch of the tissues. These receptors are situated on the wall of the bronchi and bronchioles. During inspiration, the lungs expand. This causes retching of lungs and the air passage. So the stretch receptors are stimulated. The impulses from stretch receptors are transmitted by vagal afferent fibers to the respiratory centers. The impulses actually inhibit the dorsal group neurons and so inspiration stops and expiration starts. Thus, the overstretching lung tissues are prevented. However, Hering-Breuer reflex does not operate during quiet breathing. It operates, only when the tidal volume increases beyond 1000 mL.

This reflex is also called Hering-Breuer inflation reflex since it restricts the inspiration and limits the over stretching of lung tissues. The reverse of this reflex is called Hering-Breuer deflation reflex and it takes place during expiration. During expiration as the stretching of lungs is abolished, the deflation of lungs occurs.

IMPULSES FROM BARRORECEPTOR The baroreceptors are the receptors which give response to change in blood pressure. These receptors are also called pressoreceptors. Function The baroreceptors in carotid sinus and arch of aorta give response to increase in blood pressure. Whenever arterial blood pressure increases, baroreceptors are activated and send inhibitory impulses to medulla oblongata. This causes decrease in blood pressure and inhibition of respiration. However, in physiological conditions, the role of baroreceptors in regulation of respiration is insignificant.

CHEMICAL MECHANISM OF RESPIRATION The chemical mechanism of regulation of respiration is operated through the chemoreceptors. The chemoreceptors are the sensory nerve endings, which give response to chemical changes in blood. The chemoreceptors are stimulated by the changes in the chemical constituents of the blood such as: 1. Hypoxia (decreased P02) 2. Hypercapnea (increased PCO2) 3. Increased hydrogen ion concentration. Types of chemoreceptors Chemoreceptors are classified into two groups: 1. Central chemoreceptors 2. Peripheral chemoreceptors.

1. CENTRAL CHEMORECEPTORS The chemoreceptors present in the brain are called the central chemoreceptors. Situation :- Central chemoreceptors are situated in the deeper part of medulla oblongata, close to the dorsal respiratory group of neurons. This area is known as chemosensitive area and the neurons are called chemoreceptors. The chemoreceptors are in close contact with blood and cerebrospinal fluid. Mechanism of Action The central chemoreceptors are connected with respiratory centers particularly the dorsal respiratory group of neurons through synapses. These chemoreceptors act slowly but effectively. The central chemoreceptors are responsible for 70-80% of increased ventilation through chemical regulatory mechanism. The main stimulant for the central chemoreceptors is the increased hydrogen ion concentration. However, if hydrogen ion concentration increases in the blood, it cannot stimulate the central chemoreceptors because, the hydrogen ions from blood cannot cross the blood- brain barrier and blood cerebrospinal fluid barrier

On the other hand, if carbon dioxide increases in the blood, it can easily cross the bloodbrain barrier and blood cerebrospinal fluid barrier and enter the interstitial fluid of brain or the cerebrospinal fluid. There, the carbon dioxide combines with water to form carbonic acid. Since carbonic acid is unstable, it immediately dissociates into hydrogen ion and bicarbonate ion. CO2 + H20   H2C03   H+ + HCO3 The hydrogen ions stimulate the central chemoreceptors. From chemoreceptors, the stimulatory impulse is sent to dorsal respiratory group of neurons causing, increased ventilation (increased rate and force breathing). Because of this, the excess carbon dioxide is washed out and the respiration is brought back to normal. Lack of oxygen does not have significant effect on the central chemoreceptors except that it generally depresses the overall function of brain.

2. PERIPHERAL CHEMORECEPTORS Chemoreceptors present in the carotid and aortic region are called peripheral chemoreceptors. Mechanism of action Reduction in partial pressure of oxygen is the most potent stimulant for the peripheral chemoreceptors. Whenever, the partial pressure of oxygen decreases, the

chemoreceptors are stimulated and send impulses through aortic and Hering¶s nerves. These impulses reach the respiratory centers, particularly the dorsal group of neurons and stimulate them. Dorsal group of neurons send stimulatory impulses to respiratory muscles resulting in increased ventilation. This provides enough oxygen and rectifies the lack of oxygen. The peripheral chemoreceptors are mildly sensitive to the increased partial pressure of carbon dioxide and increased hydrogen ion concentration.