Lesson 5

Respiratory Disease, Lung Cancer

 Anatomy of Respiratory System
• Structurally it consists
of:

Upper respiratory
tract: includes the
nose, pharynx, and
associated structures
 Anatomy
• Lower respiratory tract: includes the trachea,
bronchi, and lungs
 Airways
• The larynx becomes the
trachea which divides
into right and left
bronchi
• These bronchi will
divide in the lungs and
end at the terminal sacs
are called alveoli
 Alveoli
• Each alveolus has two
types of cells:

• Type I which is main

surface for gas
exchange

• Type II which secretes

surfactant
 Surfactant
Surfactant is a chemical
which decreases surface
tension of the fluid inside
the alveolus, so it
prevents the alveolus
from collapsing during
breathing;
helps it to retain its shape
throughout breathing
 Respiratory function
• The cardiovascular
and respiratory
systems cooperate to
supply O2 and
eliminate CO2
• cardiovascular
system transports
blood containing the
gases between the
lungs and body cells
 Exchange of gases
• The exchange of O2
and CO2 between the
air spaces in the
lungs and the blood
takes place by
diffusion across the
alveolar and capillary
walls
 Neural control of respiration
• Respiration is controlled
by structures in both
the medulla oblongata
and the pons parts of
the brainstem
 Medulla Oblongata
• The medulla contains
the “medullary rhythm
centre” which dictates
the pattern and rhythm
of our breathing
• It tells us when to
inhale and exhale
 Pons
• The pons contains 2
important structures:
1) The pneumotaxic
centre

2) The apneustic centre

 How it works:
• The medulla turns on
the pneumotaxic centre
which causes
inspiration

• The medulla then turns

on the apneustic centre
which INHIBITS the
pneumotaxic centre,
causing expiration
 How it works:
A way to think about it is like this:

• Pneumo means “lung”

• Apneu means “no lung”

• So the apneustic centre shuts off lung

inspiration and as there is nothing else we can
do, we therefore expire!
 Some respiratory symptoms
• Cough
• Dyspnea (difficulty
breathing)
• Sputum (production of
pus/mucous)
• Hemoptysis (bloody
sputum)
• Wheezing (noisy
breathing)
3 main types of respiratory disease
1) When the airways are
obstructed, but the
lung parenchyma
(tissue) is normal
(e.g. asthma, bronchitis,
COPD (chronic obstructive
pulmonary disorders))
 3 main types of respiratory diseases
2) When the airways are
normal but there is defect
in lung parenchyma
(tissue)

(e.g. pneumonia, lung

cancer, infection, T.B)
 3 main types of respiratory diseases
3) When the airways are
normal and the lung
tissue are normal, but
breathing muscles are
compromised
(e.g. breathing muscles or
diaphragm issues)
 Oxygenation disorders
• This is occurs when
respiratory system can
not compensate
enough oxygenation.
• Main complication of
this disorder is Hypoxia
(decreased O2) or more
severe is Anoxia (no O2)
 Oxygenation disorders
• In chronic and moderate type of respiratory
disorders the hypoxia usually ends with right
ventricular failure
• Can result in death
 Lung Compliance
• Compliance: how much
effort is required to
expand your lungs and
chest
 Lung Compliance
• Lungs normally have high
compliance and expand
easily because elastic
fibres in the lung tissue are
easily stretched and
surfactant in the alveolar
fluid reduces surface
tension
 Airway resistance
• The rate of airflow
through the
airways depends
on the pressure
differences and
resistance
• The walls of the
airways,
especially the
bronchioles, offer
some resistance
to the normal flow
of air in and out of
the lungs
 Airway resistance
• Situations that can
cause increased
respiratory resistance:
• Asthma
• Swelling of mucous
membranes from
allergy or infection
• Lung disease
 Breathing Patterns
Eupnoea – normal,
good unlaboured
breathing
Aka quiet breathing
 Breathing Patterns
• Diaphragmatic
breathing – deep
(abdominal)
breathing; outward
movement of the
abdomen due to the
contraction and
descent of the
diaphragm
 Hyperventilation
• Hyperventilation
(increased breathing)
• may cause abnormally
low levels of carbon
dioxide in the blood and
lead to dizziness, light-
headedness, weakness,
unsteadiness
 Hyperventilation causes
• Anxiety
• Drugs
• Head injury
• Stroke
 Breathing patterns
• Costal breathing –
shallow (chest)
breathing; upward
and outward
movements of the
chest due to
contraction of the
external intercostal
muscles
 Hypoventilation
Hypoventilation:
decreased breathing

• Hypoventilation causes
an increase in blood
carbon dioxide level
(hypercapnia) and a
decrease in oxygen
level.
 Hypoventilation causes
• Drugs
• Obesity
• Chest wall
deformities/injuries
• Neurological diseases
like ALS
• COPD
 Hypoventilation effects
– Hypoxia refers to a reduction in oxygen supply to
the tissues
– Hypoxemia refers to low levels of oxygen in the
blood
– Hypercapnia (sometimes referred to as
hypercarbia) refers to excess carbon dioxide in the
blood
 Hypercapnia effects
– Carbon dioxide has a direct vasodilating effect on many
blood vessels and a sedative effect on the nervous
system

• There is headache due to dilation of the

cerebral vessels
• The conjunctiva are hyperemic
• The skin if warm and flushed
• Is progressive somnolence, disorientation, and
if the condition is untreated, coma
 Cheyne-Stoke Breathing
• Cheyne-Stokes
respiration is also
known as periodic
respiration, with cycles
of respiration that are
increasingly deeper
then shallower with
possible periods of
apnea (no breathing at
all)
 Cheyne-Stokes Breathing
• The pattern repeats,
with each cycle usually
taking 30 seconds to 2
minutes.
• These phenomena can
occur during
wakefulness or during
sleep where they are
called the Central sleep
apnea syndrome (CSAS)
 Causes of sleep apnea
• Asthma
• Alcohol
• Drugs
• Smoking

• Can be fatal
 Lung volumes
• A healthy adult
averages 12 breaths
a minute, with each
breath moving about
500mL of air into and
out of the lungs
 Important definitions
Tidal volume:

the amount of air

inhaled and exhaled
during normal, quiet
breathing
 Tidal volume
• only 70% of the tidal
volume actually
reaches the
respiratory zone while
the other 30%
remains in the
conducting airways
 Important definitions
Inspiratory reserve
volume:

• amount of air that can

be forcefully inspired
above a normal
inspiration
 Important definitions
Inspiratory capacity:
• The maximum amount
of air that can inhaled
after a normal
expiration

(normal out then

maximum in)
 Important definitions
Expiratory reserve
volume:
• amount of air that can
be forcefully expired
above a normal
expiration
 Important definitions
Functional residual
capacity:
• The amount of air
remaining in the lungs
after normal expiration
 Important definitions
Vital capacity:
maximum amount of air
that can be fully expired
after the maximum
possible inhalation

(the biggest breath out

after the biggest breath
in)
Summary
 Lung Cancer
• Lung cancer is the
leading cause of
cancer deaths
among men and
women in the United
States
 Lung Cancer
• The increases in lung
cancer incidence and
deaths over the past 50
years have coincided
closely with the increase
in cigarette smoking
over the same period
 Lung Cancer
• Most (about 95%) primary lung tumours arise from
the bronchial epithelium (bronchogenic carcinoma)
– The lung is also a frequent site of metastasis from
cancers in other parts of the body
 Lung Cancer
• Bronchogenic
carcinomas are
aggressive, locally
invasive, and widely
metastatic tumours
that arise from the
epithelial lining of the
major bronchi
 Lung Cancer & Smoking
• The risk for lung cancer
among cigarette smokers
increase with duration of
smoking and the number
of cigarettes smoked per
day
 Other causes
• There is also
evidence that lung
cancer may
aggregate in some
families, maybe due
to a genetic
predisposition
 Other causes
• Industrial hazards
also contribute to the
incidence of lung
cancer
• E.g. asbestos, tar
 Symptoms
• As with other cancers,
lung cancer also
causes nonspecific
symptoms such as
anorexia and weight
loss
• Often the malignancy
develops insidiously
giving little or no
warning of its
presence
 Metastasis
– Metastases already
exist in 50% of
patients presenting
with evidence of lung
cancer, and develop
eventually in about
90% of patients
– The most common
sites of these
metastases are the
brain, bones and liver
 Self Test Questions
• Where can lung cancer spread to?
• What does dyspnea mean?
• What is the tidal volume?
• What is Cheyne Stokes Breathing? What condition is it seen
with?
• Name three risk factors for lung cancer
• What is higher in the blood with hypoventilation: CO2 or
O2?
• What is the purpose of surfactant?
• What percentage of lung cancer patients develop
metastasis?
• What two parts of the brainstem regulate breathing?
 Self Test Questions
• What is the functional residual capacity?
• What do we call the effort required to expand
our lungs?
• What is the vital capacity?
• What are the lung sacs called where gaseous
exchange takes place?
• Are the bronchi upper or lower respiratory
tract?