Human Anatomy and Physiology

The Respiratory System

BASKORO SETIOPUTRO
 Basic functions of the respiratory
system:
• Gas exchange – supply oxygen to aerobic tissues in the
body and remove carbon dioxide as a waste product
1. Pulmonary ventilation - the physics of getting air in-
to and out- of the lungs (ventilation).
2. External respiration - gas exchange between the lungs
and blood (oxygen loading and CO2 unloading).
3. Transport of respiratory gases - movement of blood
(thus gases) from the lungs to the cell and tissues.
4. Internal respiration – gas exchange between the
capillaries and the tissues (oxygen unloading and CO2
loading).
 Functional anatomy of the respiratory
• Conducting system:
Zone:Rigid conduits
for air to reach site of
gas exchange
– nose
– nasal cavity
– pharynx
– larynx
– trachea
– bronchi
• Respiratory Zone: site
of gas exchange
– respiratory
bronchioles
– alveolar ducts
 The conducting zone
• Nose
– Airway
– moistens and
warms air
– filters inspired air
– resonating
chamber for
speech
– olfaction
• paranasal sinuses
– frontal, sphenoid,
ethmoid and
maxillary bones
– warm and
moisten air
 The conducting zone
• Pharynx
– connects the
nasal cavity and
mouth to the
larynx and
esophagus
– common
pathway for food
and air (throat)
– Nasopharynx
– Oropharynx
– laryngopharynx
 The conducting zone
Laryngopharynx – common passage way for food and air
Larynx – voice box
The conducting zone
 The conducting zone

• Trachea
– Windpipe
– forming two
primary bronchi
at midthorax
– mucosa –
pseudostratified
epithelium
(goblet cells)
– submucosa –
connective
tissue
– seromucous
glands – mucous
 The conducting zone
• Adalah tabung fleksibel dengan panjang kira-kira 10 cm
dengan lebar 2,5 cm.
• Trachea berjalan dari cartilago cricoidea kebawah pada bagian
depan leher dan dibelakang manubrium sterni, berakhir
setinggi angulus sternalis (taut manubrium dengan corpus
sterni) atau sampai kira-kira ketinggian vertebrata torakalis
kelima dan di tempat ini bercabang menjadi dua bronckus
(bronchi).
• Trachea tersusun atas 16 - 20 lingkaran tak- lengkap yang
berupan cincin tulang rawan yang diikat bersama oleh
jaringan fibrosa dan yang melengkapi lingkaran disebelah
belakang trachea, selain itu juga membuat beberapa jaringan
otot.
 The conducting zone
Bronchi
Bronchial tree
• left and right primary
bronchi
– formed by divisions of
the trachea
• secondary bronchi
(lobar)
– inside the lungs
– 3 on the right
– 2 on the left
• tertiary bronchi
(segmental)
• 20-25 orders of
branching air ways
• bronchioles (under 1
mm in diameter
The conducting zone
Bronchioles
• bronchioles (under 1 mm in diameter)
• terminal bronchioiles (less than 0.5 mm)
The conducting zone
• Cartilage:
– rings
– irregular plates
– no cartilage in bronchioles
– replaced by elastic fibers
• Epithelium:
– pseudostratified (ciliated)
– columnar (ciliated)
– cuboidal in terminal bronchioles (no cilia)
• Smooth Muscle:
– increases as tubes get smaller
 The respiratory zone
Respiratory Zone:
• Respiratory bronchioiles
• Alveoli (300 million)
• Alveolar ducts
• Alveolar sacs
Gas Exchange:
• respiratory membrane
 The respiratory zone
Respiratory Zone:
Respiratory membrane (air-blood barrier) or
(Alveolar-capillary membrane) is composed of:
• simple squamous epithelial cells (Type I cells)
• cobweb of pulmonary capillaries
Primary function is gas exchange
• Type II cells (cuboidal)surfactant
• elastic fibers
• alveolar pores allow for pressure equalization
between alveoli
• alveolar macrophages(dust cells)
 Lungs and Pleural Coverings
Pleural Coverings:
• double layered serosa
• parietal pleura lines the thoracic wall
• pulmonary or visceral pleura which covers the lung
surface
• pleural cavity is the space between the two layers
• pleural fluid fills the cavity
 Blood Supply and Innervation of the
Lungs
Blood supply:
• Pulmonary circulation
• Bronchial circulation
Pulmonary arteries from the right side of the heart supply
blood to the lungs.
– pulmonary arteries branch profusely along with the bronchi
– pulmonary capillary networks surrounding alveoli
– pulmonary veins form post alveoli to carry oxygenated blood
back to the heart
Bronchial arteries come from the aorta and enter the lung at
the hilus
– the bronchial arteries run along the branching bronchi and
supply lung tissue except the alveoli
– bronchial veins drain the bronchi but most moves into the
pulmonary circulation
Blood Supply and Innervation of the
Lungs
Innervation:
• parasympathetic motor fibers (some
sympathetic fibers)
• visceral sensory fibers
Enter the lung through the pulmonary
plexus on the lung root
– parasympathetic fibers – constrict the air
tubes
– sympathetic fibers – dilate air tubes
Respiratory Physiology
 Overall function
• Movement of gases
• Gas exchange
• Transport of gas (oxygen and carbon dioxide)
 Respiratory Control System

Cerebral Cortex

Mechanoreceptors Respiratory center-Medulla Chemoreceptors

Nerve Impulses
Spinal Cord
Force, Nerve Impulses
displacement Respiratory Muscles

Lung & Chest Wall

Ventilation
Respiratory membrance
Diffusion
Pco2, Po2, pH
Perfusion-----> Blood
 Respiratory Centers
• Located in brain stem
– Dorsal & Ventral Medullary group
– Pneumotaxic & Apneustic centers
• Affect rate and depth of ventilation
• Influenced by:
– higher brain centers
– peripheral mechanoreceptors
– peripheral & central chemoreceptors
 Controls of rate and depth of
respiration
• Arterial PO2
– When PO2 is VERY low, ventilation increases
• Arterial PCO2
– The most important regulator of ventilation, small
increases in PCO2, greatly increases ventilation
• Arterial pH
– As hydrogen ions increase, alveolar ventilation increases,
but hydrogen ions cannot diffuse into CSF as well as CO2
 EXERCISE
• Neural signals (rate & depth)
• PCO2 (PO2 and pH)
• Cardiac Output
• Maximal Hb saturation
• Dilate airways
 Muscles of Ventilation
• Inspiratory muscles-
– increase thoracic cage volume
• Diaphragm, External Intercostals, SCM,
• Ant & Post. Sup. Serratus, Scaleni, Levator Costarum
• Expiratory muscles-
– decrease thoracic cage volume
• Abdominals, Internal Intercostals, Post Inf. Serratus,
Transverse Thoracis, Pyramidal
 Movement of air in/out of lungs
• Considerations
– Pleural pressure
• negative pressure between parietal and visceral pleura
that keeps lung inflated against chest wall
• varies between -5 and -7.5 cmH2O (inspiration to
expiration
– Alveolar pressure
• subatmospheric during inspiration
• supra-atmospheric during expiration
– Transpulmonary pressure
• difference between alveolar P & pleural P
• measure of the recoil tendency of the lung
• peaks at the end of inspiration
 PULMONARY VENTILATION
• BOYLE’S LAW
• Gas pressure in closed container is inversely
proportional to volume of container
• Pressure differences and Air flow
 Pressures
• Atmospheric pressure – 760 mm Hg
• Intrapleural pressure – 756 mm Hg – pressure
between pleural layers
• Intrapulmonary pressure – varies, pressure
inside lungs
 Inspiration/Inhalation
• Diaphragm & Intercostal muscles
• Increases volume in thoracic cavity as muscles
contract
• Volume of lungs increases
• Intrapulmonary pressure decreases
 Expiration/Exhalation
• Muscles relax
• Volume of thoracic cavity decreases
• Volume of lungs decreases
• Intrapulmonary pressure increases (763 mm
Hg)
• Forced expiration is active
Abm1s3_1.rm
 Factors that influence pulmonary air
flow
• F = P/R
• Diameter of airways, esp. bronchioles
• Sympathetic & Parasympathetic NS
 Surface Tension
• Lung collapse
• Surface tension tends to oppose alveoli
expansion
• Pulmonary surfactant reduces surface tension
 Patterns of Breathing
• Eupnea
– normal breathing (12-17 B/min, 500-600 ml/B)
• Hyperpnea
–  pulmonary ventilation matching  metabolic
demand
• Hyperventilation ( CO2)
–  pulmonary ventilation > metabolic demand
• Hypoventilation ( CO2)
–  pulmonary ventilation < metabolic demand
 Patterns of breathing (cont.)
• Tachypnea
–  frequency of respiratory rate
• Apnea
– Absense of breathing. e.g. Sleep apnea
• Dyspnea
– Difficult or labored breathing
• Orthopnea
– Dyspnea when recumbent, relieved when
upright. e.g. congestive heart failure, asthma,
lung failure
 Static Lung Volumes
• Tidal Volume (500ml)
– amount of air moved in or out each breath
• Inspiratory Reserve Volume (3000ml)
– maximum vol. one can inspire above normal
inspiration
• Expiratory Reserve Volume (1100ml)
– maximum vol. one can expire below normal
expiration
• Residual Volume (1200 ml)
– volume of air left in the lungs after maximum
expiratory effort
 Static Lung Capacities
• Functional residual capacity (RV+ERV)
– vol. of air left in the lungs after a normal expir.,
balance point of lung recoil & chest wall forces
• Inspiratory capacity (TV+IRV)
– max. vol. one can inspire during an insp effort
• Vital capacity (IRV+TV+ERV)
– max. vol. one can exchange in a resp. cycle
• Total lung capacity (IRV+TV+ERV+RV)
– the air in the lungs at full inflation
spirograph.sw f
Matching Alveolar air flow with blood
flow
• Pulmonary vessels
– Vessels can constrict in areas where oxygen flow is
low
• Respiratory passageways
– Airways can dilate where carbon dioxide levels are
high
 Gas Exchange
• Partial Pressure
– Each gas in atmosphere contributes to the entire
atmospheric pressure, denoted as P
• Gases in liquid
– Gas enters liquid and dissolves in proportion to its partial
pressure
• O2 and CO2 Exchange by DIFFUSION
– PO2 is 105 mmHg in alveoli and 40 in alveolar capillaries
– PCO2 is 45 in alveolar capillaries and 40 in alveoli
 Partial Pressures
• Oxygen is 21% of atmosphere
• 760 mmHg x .21 = 160 mmHg PO2
• This mixes with “old” air already in alveolus to
arrive at PO2 of 105 mmHg
 Partial Pressures
• Carbon dioxide is .04% of atmosphere
• 760 mmHg x .0004 = .3 mm Hg PCO2
• This mixes with high CO2 levels from residual
volume in the alveoli to arrive at PCO2 of 40
mmHg
 Gas Transport
• O2 transport in blood
• Hemoglobin – O2 binds to the heme group on
hemoglobin, with 4 oxygens/Hb
• PO2
• PO2 is the most important factor determining
whether O2 and Hb combine or dissociate
• O2-Hb Dissociation curve
 Gas Transport
• pH
• CO2
• Temperature
 Gas Transport
• CO2 transport
• 7% in plasma
• 23% in carbamino compounds (bound to
globin part of Hb)
• 70% as Bicarbonate
 Carbon Dioxide
• CO2 + H2O <->H2CO3<->H+ + HCO3-
• Enzyme is Carbonic Anhydrase
• Chloride shift to compensate for bicarbonate
moving in and out of RBC
 Defenses of Respiratory System
• Respiratory membrane represents a major source of
contact with the environment with a separation of .5
microns between the air & the blood over a surface
area of 50-100 sq. meters
• The average adult inhales about 10000 L air/day
– Inert dust
– Particulate matter
• Plant & animal
– Gases
• Fossil fuel combustion
– Infectious agents
• Viruses & bacteria
 Defense Mechanisms
• Protect tracheobronchial tree & alveoli from
injury
• Prevent accumulation of secretions
• Repair
 Depression of Defense Mechanisms

• Chronic alcohol is associated with an

increase incidence of bacterial infections
• Cigarette smoke and air pollutants is
associated with an increase incidence of
chronic bronchitis and emphysema
• Occupational irritants is associated with and
increased incidence of hyperactive airways
or interstitial pulmonary fibrosis
 Upper respiratory tract
• Nasal passages protect airways and alveolar
structures from inhaled foreign materials
– Long hairs (vibrassae) in nose (nares) filters out
larger particles
– Mucous coating the nasal mucous membranes
traps particles (>10 microns)
• Moisten air – 650 ml H2O/day
– Nasal turbinates
• Highly vascularized, act as radiators to warm air
 Cough
• Cough
– From trachea to alveoli sensitive to irritants
– Afferents utilize primarily CN X
– Process
• 2.5 L of air rapidly inspired
• Epiglottis closes and vocal chords close tightly
• muscles of expiration contract forcefully which causes
pressure in lungs to rise to 100 mm Hg
• Epiglottis and vocal chords open widely which results in
explosive outpouring of air to clear larger airways at
speeds of 75 – 100 MPH
 Sneeze
• Sneeze reflex
– Associated with nasal passages
– Irritation sends signal over CN V to the medulla
• Response similar to cough, but in addition uvula is
depressed so large amounts of air pass rapidly through
the nose to clear nasal passages
– With sneeze and cough velocity of air escaping
from the mouth & nose has been clocked at
speeds of 75-100 MPH
 Mucociliary elevator
• Clears smaller airways
– Mucous produced by globlet cells in epithelium
and small submucosal glands
– Ciliated epithelium which lines the respiratory
tract all the way down to the terminal bronchioles
moves the mucous to the pharynx
• Beat 1000 X/minute
• Mucous flows at about speed of 1 cm/min
– Swallowed or coughed out
– Cough is ineffective at clearing smaller airways b/c
can’t generate sufficient velocity due to large total
X-sectional area
 Immune reaction in the lung
• Alveolar macrophages
– Capable of phagocytosing intraluminal particles
• Antibodies associated with the mucosa
– IgG- lower respiratory tract
– IgA- dominate in upper respiratory tract
– IgE- predominantly a mucosal antibody