Pulmonary Anatomy and

Physiology
The major purpose of breathing is to supply O2 and to
remove CO2 from cells
Four major functions to achieve this goal:
1. Pulmonary ventilation: movement of air into and out
of lungs
2. Diffusion of O2 and CO2 between the alveoli and the
blood
3. Transport of O2 and CO2 in the blood to and from
cells
4. Control of ventilation

Once the O2 is transferred to the cells it is utilized to

metabolize various food molecules involving a
series of enzymatic reactions. During this process
there is release of energy which is stored in the
form of ATP-This process is called cellular
respiration.
From the time of birth until our death we
breath continuously at a rate of 12-15
breaths/min. However, breathing can
change in response to alterations in
blood chemistry.

Breathing and gas exchange can

increase 20-fold to meet the body’s
energy demands during periods of
need such as exercise.
I. BASIC ANATOMY:.
The lungs are composed of 2 treelike structures:
1. Vascular tree: consists of arteries and veins
connected by capillaries
2. Airway tree: consists of hollow branching tubes that
conduct air from the environment to site of gas
exchange to the blood.
Conducting Zone: (in descending order): Nose (conchae)-
Pharynx-Larynx-Trachea-Bronchi-Bronchioles:
A. Functions to:
1. Warm and humidify the air
2. Distribute air to the lungs
3. Defense system (remove dust and bacteria)
B. Supplied by separate circulatory system bronchial
circulation-part of the systemic circulation.
C. Trachea and bronchi lined with ciliated, mucous coated
epithelium that aid in clearing passageway. Cilia beat
toward the pharynx.
-Epithelium rests on smooth muscle (can constrict or
dilate independent of the lung) and is supported by
cartilage.
D. Bronchioles: Lack cartilage, simple cuboidal
epithelium, volume depends on lung volume.
-have sensory cells sensitive to stretch and irritants
**NO GAS EXCHANGE TAKES PLACE IN THE
CONDUCTING ZONE-DEAD SPACE
Respiratory Zone: Alveolar duct and alveolar sacs.
A. SITE OF GAS EXCHANGE
B. Has it’s own circulation: the pulmonary circulation
-in order to match ventilation, follows and branches
along with the pulmonary tree.
-pulmonary artery from right ventricle supplies
nutrients to the alveolar walls
-capillary surface area nearly as great as the
alveolar surface area
-can increase from 70 ml (normal) to 200 ml
(exercise) recruitment
-capillaries also cover several alveoli, increase
time of exposure of red blood cells to alveolar
gas
C. Terminal Respiratory Unit: functional
exchange unit of lungs
Greatly increases surface area: 60,000
terminal respiratory units, each with
5000 alveoli and 250 alveolar ducts.
II. VENTILATION:
Main purpose is to maintain an optimal concentration
of O2 and CO2 in the alveolar gas.
How do we move air into and out of the lungs.
1. The lungs are housed in an airtight cavity, the
thoracic cavity, that is separated from the abdomen
by a large dome-shaped muscle, the diaphragm.
Lungs conform to the thoracic cavity by contact of
fluid lined pleura:
visceral pleura: covers the lungs
parietal pleura: lines the thoracic cavity
2. The anterior portion of the thoracic cavity is
bounded by the ribs. The external and internal
intercostal muscles lie between the ribs. The ribs
are hinged on one side to the vertebral column and
on the other to the sternum.
A. Inspiration:
The primary inspiratory muscle is the diaphragm. The
diaphragm is a skeletal muscle and is innervated by the
phrenic nerve. The diaphragm contracts during every
inspiration.
-contraction of the diaphragm increases the vertical
diameter of the thoracic cavity.
Voluntary muscles
The external intercostals raise the rib cage and increase the
anterior-posterior diameter of the thoracic cavity.
Accessory muscles
Active during forced breathing. These include the scalene
muscles of the neck. The sternocleidomastoids insert on
the top of the sternum. These muscles elevate the upper
rib cage during heavy breathing such as during exercise.
B. Expiration:
During normal tidal breathing at the end of inspiration
the diaphragm relaxes, and expiration is a passive
process. The natural recoil tendency of the lungs
and chest wall cause deflation of the lungs.
-elastic fibers
-surface tension

During forced expiration other expiratory muscles

become active
-internal intercostals oppose the external intercostals
and pull the rib cage down.
-abdominal muscles force the contents of the
abdominal cavity up against the diaphragm.
Especially important in coughing, vomiting, etc.
C. Pressures:
Airflow is due to changes in pressure in the thoracic
cavity that are transmitted to the alveoli.
Three important pressures associated with breathing and
airflow:
1. Pleural pressure (PPL): pressure in the pleural fluid
between the lung and chest wall.
2. Alveolar pressure (PA): pressure inside the alveoli.
3. Transmural pressure (PTM): the pressure difference
across the airway or across the lung wall.
-Transpulmonary pressure: alveolar pressure-
pleural pressure. Keeps the lungs from collapsing.
Is always positive during normal breathing.
-Transairway pressure: airway pressure-pleural
pressure. Transairway pressure is important in
keeping the airways open during expiration.
Pressures (cont’d)
Inspiration:
PPL is negative during quiet breathing and becomes
more negative during inspiration. This causes PA to
drop with respect to atmospheric pressure (very
little pressure needed, -1 mmHg)
Expiration:
PPL becomes less negative and PA becomes slightly
positive (+1 mmHg)
During heavy breathing PA can go from -80 to 100
mmHg
Pressures (cont’d)
Pneumothorax: hole in the thoracic cavity, PPL
becomes 0, can no longer generate (-)
pressures in the alveoli.
D. Compliance:
Compliance: the ease with which the lungs can be
distended.
-how well the lung inflates and deflates with a change in
transpulmonary pressure is a function of the elastic
properties of the lung.
Compliance (cont’d)
Pressure-volume relations: elastic properties of the
lungs can be determined by measuring changes in
lung volume that occur with changes in pressure.
Compliance=V/P: volume increase in lungs for each
unit increase in pressure
normal ~0.13L/cm (lungs alone are more
compliant than this, but part of energy must go
to expand the thoracic cage).
Compliance can be measured in human lungs by
measuring the pleural pressure and the volume of
the lungs with a spirometer.

Compliance depends on a number of things:

-elastic properties of lungs
-surface forces inside the alveoli
E. Surface tension:
• Within water the forces on water
molecules attract one another, at the
surface, the attraction is stronger from
molecules under the surface.

The surface of the alveoli are moist, creating an air-

liquid interface in the alveoli, very high surface
tension would make lungs very non-compliant.
Compare to saline filled lung (no air-water
interface) that is much more compliant.

• Surfactant: a special lipoprotein mixture coating

the surface of alveoli.
• -synthesized in alveolar type II cells
• -main ingredient is dipalmitoyl
phosphatidylcholine (DPPC)
• Functions of Surfactant:

• 1. Reduces muscular effort of breathing (makes

lungs more compliant).
• 2. Reduces elastic recoil of the lungs at low
volume (prevents alveoli from collapsing)
• 3. Maintains the equality of size of alveoli during
inflation/deflation
• -as alveoli become smaller decreases
surface tension more, makes smaller
alveoli easier to inflate. As alveoli become
larger increases surface tension, harder
to inflate.
• 4. Responsible for difference in inflation vs
deflation curve.
• -during deflation, surfactant molecules
are squeezed together lowering the
surface tension.
Forced Vital Capacity
The resistance to airflow can not be measured directly,
but must be calculated from the pressure gradient
and airflow during a breath.
One way of indirectly assessing resistance is to look at
the results of a forced expiration into a spirometer:
Forced Vital Capacity (FVC): Large breath from FRC
to TLC and breath out as hard and fast as
possible.
• III. PULMONARY VOLUMES AND CAPACITIES
• Can be measured with a spirometer.(except
RV)

A. Four different volumes

1. Tidal volume (TV): volume of air
inspired and expired with a normal
breath (.500 ml).
2. Inspiratory Reserve Volume (IRV):
extra volume of air that can be inspired
after a normal tidal inspiration (.3000
ml).
3. Expiratory Reserve Volume (ERV):
extra volume of air that can be expired
after a normal tidal expiration (.1100
ml).
4. Residual Volume (RV): volume of air
remaining after a maximal expiratory
effort (.1200 ml). *Can not be removed
from lungs.
III. PULMONARY VOLUMES AND CAPACITIES (cont’d)

B. Four different capacities relating the above volumes

1. Inspiratory Capacity (IC): TV + IRV
2. Functional Residual Capacity (FRC): ERV + RV
amount of air remaining in the lungs at the end of a
normal tidal expiration (lungs at rest). At FRC the
chest wall and lungs are recoiling in equal and
opposite directions.
3. Vital Capacity (VC): IRV + TV + ERV the maximal
amount of usable lung capacity.
4. Total Lung Capacity (TLC): All of the above, maximal
volume to which the lungs can be expanded.

* VC is one of most important of all clinical respiratory

measurements for assessing the progress of disease.
Decrease compliance=decrease VC.
-restrictive diseases (limited expansion)
-large residual volume (COPD)
IV. Alveolar Ventilation
The most important aspect of breathing is to maintain
an optimal concentration of O2 and CO2 in the
alveolar gas.

Minute respiratory volume: total amount of air moved

each minute
TV x Rate: 12 x 500=6000 ml (6L)
TV = 7-10 ml/kgBB

Physiological dead space: Due to non-functioning

alveoli. Is the ADS + non-functional alveoli.
-nearly equal in normal, but in disease PDS can be
10X greater than ADS