The Respiratory System

Respiration External & internal

◦ Respiration: process of gas respiration…
exchange between External respiration is the process
atmosphere and body cells
of inhaling oxygen into the lungs,
◦ Consists of and exhaling carbon dioxide. That
◦ Ventilation process includes the ventilation of
◦ Gas exchange between the lungs and the exchange of air
blood and lungs Ventilating the lungs in the lungs and blood within the
◦ Gas transport in the capillaries of the alveoli of the
bloodstream lungs.
◦ Gas exchange between
the blood and body cells Internal respiration is the
◦ Cellular respiration
metabolic process by which
living cells use blood flowing
through the capillaries,
absorbing the oxygen
(O2 )they need and releasing
the carbon dioxide (CO2)they
create.
Functions of the Respiratory System
1. Regulation of blood pH. The respiratory system can
alter blood pH by changing blood CO2 levels.
2. Voice production. Air movement past the vocal cords
makes sound and speech possible.
3. Olfaction. The sensation of smell occurs when
airborne molecules are drawn into the nasal cavity.
4. Innate immunity. The respiratory system
protects against some microorganisms and other
pathogens, such as viruses, by preventing them from
entering the body and by removing them from
respiratory surfaces
5. Protects the body from dehydration and temperature
fluctuations
Anatomy of the Respiratory System
◦ Upper Respiratory Tract (nose, nasal cavity, sinuses, and pharynx)
◦ Lower Respiratory Tract (larynx, trachea, bronchial tree, and lungs)

Keep in mind, however, that upper and lower

respiratory tract are not official anatomical terms.
Rather, they are arbitrary divisions for the
purposes of discussion, and some anatomists
define them differently.
Even though air frequently passes through the oral
cavity, the oral cavity is considered part of the
digestive system, not the respiratory system
 Upper Respiratory Tract
(nose, nasal cavity, sinuses, and pharynx)
Nose down to you Throat
NOSE
The nose consists of the external nose and the nasal cavity. The external nose is the visible structure that forms a
prominent feature of the face. Most of the external nose is composed of hyaline cartilage, although the bridge of
the external nose consists of bone.

The nares or nostrils, are the external openings of the

nose.
Nostril hair filters air coming into the nose.
The nasal septum (cartilage) is a partition dividing the
nasal cavity into right and left parts. Each cavity is
divided into 3 air passages: the superior, middle, and
inferior conchae which are the openings into the
pharynx. (lined with mucus)
The nose has 5 functions:
1. It serves as an air passageway.
2. It warms and moistens inhaled air.
3. Its cilia and mucous membrane trap dust, pollen,
bacteria, and foreign matter.
4. It contains olfactory receptors, which smell odors.
5. It aids in phonation and the quality of voice.
vestibule
The Nose…
The conchae passages lead to the passageway called
the pharnyx. Here, the ear is connected to the
sinuses, the ears through the eustachian tubes, and
even the eyes through the nasolacrimal ducts.

The palatine (palate) bones and maxilla(upper jaw bone) separate

the nasal cavities from the mouth cavity. Cilia (hairs) line the
mucous membrane.
Posterior to the nose
Cavity has passageways
Many processes occur in the nose and nasal
cavity including:
(1) The coarse hairs just inside the nares and
the mucus produced by the goblet cells
trap large dust particles. About 1 qt. of
mucous is produced daily.
(2) Cilia sweep the debris-laden mucus toward
the pharynx, where it is swallowed. The
acid in the stomach kills any bacteria that
were trapped by the mucus.
(3) Air is warmed by the blood vessels
underlying the mucous epithelium. It is
humidified by moisture in the mucous
epithelium.
SINUSES
The paranasal sinuses are air-filled spaces
within bone. They include the maxillary,
frontal, ethmoidal, and sphenoidal sinuses,
each named for the bones in which they are
located. The paranasal sinuses open into the
nasal cavity and are lined with a mucous
membrane. They reduce the weight of the
skull, produce mucus, and influence the quality
of the voice by acting as resonating chambers.
Sinusitis is inflammation of the mucous
membrane of a sinus, especially one or more of
the paranasal sinuses.
Viral infections, such as the common cold, can
cause mucous membranes to become inflamed
and swollen and to produce excess mucus.
PHARYNX
The pharynx is the correct term for the throat. It is a muscular and membranous tube that is about 5 inches
long, extending downward from the base of the skull. It eventually becomes the esophagus.
The nasopharynx is behind the nose; the oropharynx is
behind the mouth; the laryngopharynx is behind the
larynx.
Food and air pass through
Helps produce speech sounds
The pharynx…
There are 7 openings
into the pharynx.
In the nasopharynx,
there are two openings
from the eustachian
tubes of the ear , and
two openings from the
posterior nares of the
nose .
In the oropharnyx is
one opening from the
mouth .
The pharynx…
The pharynx also contains 3 pairs of tissues
that are part of the lymphatic system:
1. the pharyngeal tonsils… the adenoids
2. the palatine tonsils 3.
the lingual tonsils
The pharynx has 3 functions:
1. serves as a passageway for air
2. serves as a passageway for food
3. aids in phonation by changing its shape.
 Lower Respiratory Tract
(larynx, trachea, bronchial tree, and lungs)
LARYNX
◦ Between pharynx and trachea
◦ Functions:
It has three main functions:
(1) maintains an open airway,
(2) protects the airway during
swallowing by preventing
particles from entering trachea
and
(3) produces the voice since it
holds the vocal cords. The
larynx consists of nine cartilage
structures: three singles and
three paired
 The larynx…
The larynx, commonly called the voicebox, is located
at the upper end of the trachea, below the root of the
tongue and hyoid bone. It is lined with mucous
membrane.

The larynx contains vocal cords, which produce sound.

Short, tense vocal cords produce high notes; long relaxed vocal
cords produce low notes.
 The larynx… Epiglottis
We can see several of the
cartilage structures of the Thyroid
cartilage
larynx in this side view:
1. The thyroid cartilage or
Adam’s apple is usually
larger in the male,
allowing longer vocal
Cricoid
cords and contributing to cartilage
a deeper male voice
2. The epiglottis covers the entrance of the
larynx while swallowing, to avoid choking
3. The cricoid cartilage contains the vocal cords
 Epiglottic cartilage
Hyoid bone

Thyroid cartilage

Cricoid cartilage

Trachea

Hyoid bone

Epiglottic cartilage

Thyroid cartilage

Cricoid cartilage

Trachea
Vocal cords
◦ Two pairs
◦ Changing tension controls pitch
◦ Changing force of air controls loudness

Epiglottis
TRACHEA
The trachea, or windpipe, allows air to flow into the lungs. It is a membranous tube attached to the larynx. It
consists of connective tissue and smooth muscle, reinforced with 16–20 C-shaped pieces of hyaline cartilage. The
adult trachea is about 1.4–1.6 centimeters (cm) in diameter and about 10–11 cm long. It begins immediately
inferior to the cricoid cartilage, which is the most inferior cartilage of the larynx. The trachea projects through the
mediastinum and divides into the right and left primary bronchi at the level of the fifth thoracic vertebra. The
esophagus lies immediately posterior to the trachea.
C-shaped cartilages form the anterior and lateral sides of the trachea. Because the tracheal rings do not
completely surround the entire trachea, the posterior wall of the trachea is devoid of cartilage. Instead it contains
an elastic, ligamentous membrane and bundles of smooth muscle. Contraction of the this smooth muscle can
narrow the diameter of the trachea, which aids in the cough reflex.
Sensory receptors detect the foreign substance, and action potentials travel along the vagus nerves to the medulla
oblongata, where the cough reflex is triggered. During coughing, the smooth muscle of the trachea contracts,
decreasing the trachea’s diameter. As a result, air moves rapidly through the trachea, which helps expel mucus
and foreign substances. Also, the uvula and soft palate are elevated, so that air passes primarily through the oral
cavity.
 The trachea… The trachea or windpipe is a smooth,
muscular tube leading from the larynx to the
main bronchi. Extends into thoracic cavity
and it separates into right and left bronchi

C-shaped rings of
Trachea cartilage provide
20 cartilage rings prevent protection on the
crushing of the trachea front and sides
The trachea…

The trachea is the passageway for air to and from the lungs. It is lined with
cilia (hairs), which sweep foreign matter out of the pathway. It is only about
1 inch in diameter and 4 ½ inches long.
TRACHEA
The lungs…
The lungs are two spongy organs
located in the thorax. They
consist of elastic tissue, filled
with an interlacing network of
tubes and sacs that carry air and
blood vessels that carry blood.

Each lung is divided into lobes,

the right lung into 3 lobes and
the left lung into 2. The left lung
has an indentation called the
cardiac depression or notch…
for placement of the heart.
 The base of the lungs rest
The lungs… on the diaphragm, a
muscular wall separating
the thorax from the
abdominal cavity. It is
involved in respiration,
drawing downward in the
chest during inhalation,
and pushing upward
during exhalation.
Tidal volume refers to the amount
of air inhaled or exhaled during
normal breathing… about 500 ml.
Total lung capacity is 3.6-9.4 liters
in an average male.
The lungs…
Pathogens, white cells
and immune proteins
present during an
infection may cause the
air sacs to become
inflamed and filled with
fluid.

This is characteristic of pneumonia. If both lungs are

involved, it is termed as double pneumonia.
If someone is unconscious, it’s possible to aspirate
stomach contents into the lungs, causing aspiration
pneumonia.
.
BRONCHI
The bronchi are the two main
branches at the bottom of the
trachea, providing passageway for
air to the lungs. The trachea divides
into the right bronchus and the left
bronchus, and then divides further
into the bronchial tree.

As the branches of the bronchial tree get

smaller, the 2 primary bronchi become
bronchioles, and then very small alveolar
ducts.
The left bronchi is smaller than the right
bronchi, because room is needed to
accommodate the heart.
If a foreign body is inhaled or aspirated (drawn by
suction), it usually lodges in the larger right bronchi
(as shown in this Xray) or enters the right lung.
The bronchi…

In the presence of infection, the bronchi sometimes become inflamed,

resulting in a diagnosis of bronchitis.
BRONCHIAL TREE
◦ Branched tubes leading from trachea to alveoli
◦ Starts with two main bronchi (right and left….each leads to a lung)
◦ Bronchi lead to BRONCHIOLES

Bronchioles lead to alveolar ducts, which lead

to alveolar sacs, then end in alveoli
The lungs… At the end of each bronchiole are
the alveoli. The lungs contain
about 300 million alveoli sacs,
which are the air cells where the
exchange of oxygen and carbon
dioxide takes place with the
capillaries. .

Deoxygenated blood comes

in and drops off CO2;
oxygenated blood goes out.
 Pulmonary
Blood flow venule
Intralobular bronchiole

Pulmonary
arteriole
Smooth muscle Blood flow

Alveolus

Pulmonary
Capillary network on
artery
surface of alveolus
Pulmonary
vein
Terminal
bronchiole
Respiratory
bronchiole
Alveolar
duct
Alveolar
sac
Alveoli
 ALVEOLI
◦ Alveoli (hollow sacs) are small air-filled chambers
where the air and the blood come into close contact
with each other. The alveoli become so numerous that
the alveolar duct wall is little more than a succession
of alveoli. The alveolar ducts end as two or three
alveolar sacs, which are chambers connected to two
or more alveoli. There are about 300 million alveoli
in the lungs.
◦ Gas exchange between blood and air takes place in
the respiratory membrane of the lungs. It is formed
mainly by the walls of the alveoli and the surrounding
capillaries. To facilitate the diffusion of gases, the
respiratory membrane is very thin; it is thinner than a
sheet of tissue paper. The respiratory membrane
consists of two layers of simple squamous epithelium,
including secreted fluids, called alveolar fluid, and
separating spaces.
 Larynx

Trachea
Right superior (upper) lobe
Left superior
(upper) lobe
Right main (primary)
bronchus

Lobar (secondary)
bronchus

Segmental (tertiary)
bronchus
Terminal bronchiole
Right inferior (lower) lobe

Left inferior
(lower) lobe
Right middle lobe

Respiratory bronchiole

Alveolar duct

Alveolus
 RESPIRATORY MEMBRANE OF THE LUNGS

 where gas exchange between the air

and blood takes place

 It is very thin to facilitate the diffusion

of gases

 formed mainly by the walls of the

alveoli and the surrounding capillaries
 RESPIRATORY MEMBRANE OF THE LUNGS
Consists of 6 LAYERS:
1. Thin layer of fluid lining the
alveolus
2. Alveolar epithelium – composed
of simple squamous epithelium
3. Basement membrane of the
alveolar epith.
4. Thin interstitial space
5. Basement membrane of the
capillary endothelium
6. Capillary endothelium – simple
squamous epith.
PLEURAL CAVITIES
The lungs are contained within the thoracic cavity. In
addition, each lung is surrounded by a separate pleural
(relating to the ribs) cavity. Each pleural cavity is lined
with a serous membrane called the pleura. The pleura
consists of a parietal and a visceral part. The parietal
pleura lines the walls of the thorax,diaphragm, and
mediastinum. The visceral pleura covers the surface of
the lungs. The parietal pleura is continuous with the
visceral pleura.
The pleural cavity, between the parietal and visceral
pleurae, is filled with a small volume of pleural fluid
produced by the pleural membranes.
The pleural fluid performs two functions:
(1) It acts as a lubricant, allowing the visceral and
parietal pleurae to slide past each other as the
lungs and thorax change shape during respiration,
and
(2) it helps hold the pleural membranes together.
LYMPHATIC SUPPLY
The lungs have two lymphatic supplies: the superficial
lymphatic vessels and the deep lymphatic vessels. The
superficial lymphatic vessels are deep to the visceral
pleura. They drain lymph from the superficial lung
tissue and the visceral pleura.
The deep lymphatic vessels follow the bronchi. They
drain lymph from the bronchi and associated connective
tissues. No lymphatic vessels are located in the walls of
the alveoli. Both the superficial and deep lymphatic
vessels exit the lungs at the main bronchi.
Phagocytic cells within the lungs phagocytize most
carbon
particles and other debris from inspired air and move
them to the lymphatic vessels. In older people, the
surface of the lungs can appear gray to black because of
the accumulation of these particles, especially if the
person smoked or lived primarily in a city with air
pollution. Other materials, such as cancer cells from the
lungs, can also spread to other parts of the body through
the lymphatic vessels
BREATHING MECHANISM
◦ Ventilation - or breathing, is the
process of moving air into and out of
the lungs.
Composed of two parts:
◦ Inspiration , or inhalation, is the
movement of air into the lungs
◦ Expiration, or exhalation, is the
movement of air out of the lungs.
Ventilation is regulated by changes in
thoracic volume, which produce changes
in air pressure within the lungs
Changing Thoracic Volume
- the muscles associated with the ribs are
responsible for ventilation
Inspiration
◦ Flow of air into lungs
◦ Diaphragm and intercostal muscles
contract
◦ The size of the thoracic cavity
increases
◦ Increase in volume of cavity =
decrease in pressure so air flows from
high to low pressure
Exhalation
◦ Air leaving lungs
◦ Largely a passive process
which depends on natural
lung elasticity
◦ As muscles relax, air is
pushed out of lungs
Pressure Changes and Airflow
Two physical principles govern the flow of air into and
out of the lungs:

1. Changes in volume result in changes in pressure. As

the volume of a container increases, the pressure within
the container decreases. The opposite is also true. As the
volume of a container decreases, the pressure within the
container increases. In the same way, the muscles of
respiration change the volume of the thorax and therefore
the pressure within the thoracic cavity also changes.
2. Air flows from an area of higher pressure to an area
of
lower pressure. If the pressure is higher at one end of a
tube than at the other, air or fluid flows from the area of
higher pressure toward the area of lower pressure. The
greater the pressure difference, the greater the rate of
airflow. Air flows through the respiratory passages
because of pressure differences between the outside of
the body and the alveoli inside the body. These pressure
differences are produced by changes in thoracic volume
The volume and pressure changes responsible for
one cycle of inspiration and expiration can be
described as follows:
1. At the end of expiration, alveolar pressure,
which is the air pressure within the alveoli, is
equal to atmospheric pressure, which is the
air pressure outside the body. No air moves
into or out of the lungs because alveolar
pressure and atmospheric pressure are equal.
2. During inspiration, the volume of the
thoracic cavity increases when the muscles of
inspiration contract. The increased thoracic
volume decreases the pressure in the alveoli
below atmospheric pressure. Air flows into
the alveoli
3. At the end of inspiration, the thorax and
alveoli stop expanding and airflow stops.
4. During expiration, the thoracic cavity volume
decreases. Consequently, alveolar pressure
increases above atmospheric pressure, and air
flows out of the alveoli.
 Intra-alveolar
Intra-alveolar
pressure
pressure
(760 mm Hg)
(758 mm Hg)

Diaphragm
Lung Recoil
During normal expiration, thoracic volume and
lung volume decrease because of lung recoil, the
tendency for an expanded lung to decrease in
size. Lung recoil is due to the elastic properties of
its tissues and because the alveolar fluid has
surface tension. Surface tension exists because
the oppositely charged ends of water molecules
are attracted to each other. As the water
molecules pull together, they also pull on the
surface tension, property of a liquid surface displayed by its
alveolar walls, causing the alveoli to recoil and acting as if it were a stretched elastic membrane .
become
smaller.

Two factors keep the lungs from collapsing:

(1) surfactant and
(2) pressure in the pleural cavity
Surfactant
Surfactant (surface acting agent) is a mixture of
lipoprotein molecules produced by secretory cells of the
alveolar epithelium. The surfactant molecules form a single
layer on the surface of the thin fluid layer lining the alveoli,
reducing surface tension. Without surfactant, the surface tension
causing the alveoli to recoil can be ten times greater than when
surfactant is present.
Thus, surfactant greatly reduces the tendency of the lungs to
collapse.
Infant respiratory distress syndrome (IRDS) is caused by
too little surfactant. IRDS, also called hyaline membrane
disease, is common in premature infants because surfactant is
not produced in adequate quantities until about the seventh
month of gestation.
Thereafter, the amount produced increases as the fetus matures.
Pregnant women who are likely to deliver prematurely can be
given cortisol, which crosses the placenta into the fetus and
stimulates surfactant synthesis
Pleural Pressure
When pleural pressure, the pressure in the pleural cavity, is less
than alveolar pressure, the alveoli tend to expand. Normally, pleural
pressure is lower than alveolar pressure. Pleural pressure is lower
than alveolar pressure because of a suction effect caused by fluid
removal by the lymphatic system and by lung recoil.
This difference in pressures—lower pleural pressure than alveolar
pressure—keeps the alveoli expanded.
If you have flown on a plane, or have been to the mountains,
you may have experienced a situation similar to that which keeps
the alveoli expanded. At higher altitudes, the atmospheric pressure is much lower
than at sea level. If a bottle of liquid (such as
shampoo) normally kept at sea level is rapidly taken to a high altitude, it will
“explode.” Because there is not as much force on the
outside of the bottle at high altitude, it expands. Similarly, because
the pleural pressure pulls the pleura away from the outside of the
alveoli, the pressure on the alveoli is lower. The lower pressure
allows the alveoli to expand.
When pleural pressure is lower than alveolar pressure, the
alveoli tend to expand. This expansion is opposed by the tendency
of the lungs to recoil. Therefore, the alveoli expand when the pleural pressure is
low enough that lung recoil is overcome. If
the pleural pressure is not low enough to overcome lung recoil,
the alveoli collapse, as is the case with a pneumothorax
Respiratory Volumes and Capacities
Spirometry is the process of measuring volumes
of air that move into and out of the respiratory system, and the
spirometer is the device that measures these respiratory
volumes.

Measurements of the respiratory volumes can

provide information about the health of the lungs. Respiratory
volumes are measures of the amount of air movement during
different portions of ventilation, whereas respiratory capacities
are sums of two or more respiratory volumes. The total volume
of air contained in the respiratory system ranges from 4 to 6 L.
Volumes
Values of respiratory Capacities, the sum of two or
1. Tidal volume is the volume of air inspired or
more pulmonary volumes
expired with each breath. At rest, quiet breathing
1. Functional residual capacity is the expiratory
results in a tidal volume of about 500 milliliters (mL).
reserve volume plus the residual volume. This is the
2. Inspiratory reserve volume is the amount of air
amount of air remaining in the lungs at the end of a
that can be inspired forcefully beyond the resting tidal
normal expiration (about 2300 mL at rest).
volume (about 3000 mL).
2. Inspiratory capacity is the tidal volume plus the
3. Expiratory reserve volume is the amount of air that
inspiratory reserve volume. This is the amount of air
can be expired forcefully beyond the resting tidal
a person can inspire maximally after a normal
volume (about 1100 mL).
expiration (about 3500 mL at rest).
4. Residual volume is the volume of air still remaining
3. Vital capacity is the sum of the inspiratory reserve
in the respiratory passages and lungs after maximum
volume, the tidal volume, and the expiratory reserve
expiration (about 1200 mL)
volume. It is the maximum volume of air that a
person can expel from the respiratory tract after a
maximum inspiration (about 4600 mL).
4. Total lung capacity is the sum of the inspiratory
and expiratory reserves and the tidal and residual
volumes (about 5800 mL). The total lung capacity is
also equal to the vital capacity plus the residual
volume
GAS EXCHANGE
During gas exchange oxygen moves from the lungs to
the bloodstream. At the same time carbon dioxide
passes from the blood to the lungs. This happens in the
lungs between the alveoli and a network of tiny blood
vessels called capillaries, which are located in the walls
of the alveoli.
 GAS EXCHANGE
 GAS EXCHANGE - Gas exchange bet. air and blood occurs
in the respiratory membrane
 DEAD SPACE – the parts of the resp. passageways where gas
exchange bet. air and blood does not occur.

1. RESPIRATORY MEMBRANE THICKNESS - Increases

in the thickness of the respiratory membrane result in
decreased gas exchange.
2. SURFACE AREA - Small decreases in surface area
adversely affect gas exchange during strenuous exercise.
When the surface area is decreased to 1/3 or 1/4 of normal,
gas exchange is restricted under resting conditions.
3. PARTIAL PRESSURE - is the pressure exerted by a
specific gas in a mixture of gases, such as air.
 DIFFUSION OF GASES IN THE LUNGS

 O2 diffuses from a higher partial

pressure in the alveoli to a lower pp
in the pulmonary capillaries.

 CO2 diffuses from a higher partial

pressure in the pulmonary capillaries
to a lower pp in the alveoli.
 DIFFUSION OF GASES IN THE TISSUES

 O2 diffuses from a higher pp in the

tissue capillaries to a lower pp in the
tissue spaces.

 CO2 diffuses from a higher pp in the

tissues to a lower pp in the capillaries.
GAS TRANSPORT IN THE BLOOD OXYGEN TRANSPORT

 OXYHEMOGLOBIN – hemoglobin with

oxygen bound to its heme groups

 MORE OXYGEN IS RELEASED FROM

HEMOGLOBIN IF (FOUR FACTORS):
1. Partial pressure for O2 is low
2. Partial pressure for CO2 is high
3. pH is low
4. Temperature is high
 GENERATION OF RHYTHMIC
BREATHING
involves the integration of stimuli that start and stop inspiration
1. Starting inspiration
 medullary respiratory center constantly receives stimulation
from many sources, such as receptors that monitor blood gas
levels
2. Increasing inspiration
 Once begins, more and more neurons are activated.
 result is progressively stronger stimulation of the respiratory
muscles (2 sec)
3. Stopping inspiration
 neurons responsible for stopping inspiration
 receive input from the pontine respiratory neurons, stretch
receptors in the lungs, and probably other sources
RHYTHMIC BREATHING (Nervous Control)
The normal rate of breathing in adults is between 12 and 20 breaths per minute. In
children, the rates are higher and may vary from 20 to 40 per minute. The rate of
breathing is determined by the number of times respiratory muscles are stimulated.
The basic rhythm of breathing is controlled by neurons within the medulla oblongata
that stimulate the muscles of respiration. An increased depth of breathing results from
stronger contractions of the respiratory muscles caused by recruitment of muscle fibers
and increased frequency of stimulation of muscle fibers
The medullary respiratory center consists of two dorsal respiratory groups, each
forming a longitudinal column of cells located bilaterally in the dorsal part of the
medulla oblongata, and two ventral respiratory groups, each forming a longitudinal
column of cells located bilaterally in the ventral part of the medulla oblongata. The
dorsal respiratory group is primarily responsible for stimulating contraction of
the diaphragm. The ventral respiratory group is primarily responsible for
stimulating
the external intercostal, internal intercostal, and abdominal muscles. A part of the
ventral respiratory group, the pre-Bötzinger complex, is now known to establish
the basic rhythm of breathing.
The pontine respiratory group is a collection of neurons in the pons. It has
connections with the medullary respiratory center and appears to play a role in
switching between inspiration and expiration
RHYTHMIC BREATHING RESPIRATORY AREAS IN THE
BRAINSTEM
MEDULLARY RESPIRATORY CENTER – establishes
rhythmic breathing
1. DORSAL RESPIRATORY GROUPS (2) – primarily
responsible for stimulating contraction of the diaphragm.
2. VENTRAL RESPIRATORY GROUPS (2) – primarily
responsible for stimulating the external and internal
intercostal, and abdominal muscles.
• PRE-BOTZINGER COMPLEX – establish the basic
rhythm of breathing
• PONTINE RESPIRATORY GROUP – is a collection of
neurons in the pons. - It plays a role in switching between
inspiration and expiration.
 NERVOUS CONTROL OF BREATHING
 HIGHER - BRAIN CENTERS – allow voluntary
control of breathing.
 HERING-BREUER REFLEX – supports rhythmic
respiratory movements by limiting the extent of
inspiration
 action potentials have an inhibitory influence on the
respiratory center and result in expiration.
 As expiration proceeds, the stretch receptors are no
longer stimulated, and the decreased inhibitory
effect on the respiratory center allows inspiration to
begin again.
 TOUCH, THERMAL, PAIN RECEPTORS – can
stimulate breathing
Chemical Control of Breathing
During cellular respiration, the body’s cells
consume O2and produce CO2. The primary
function of the respiratory system is to add O2 to
the blood and to remove CO2 from the blood.
Surprisingly, the level of CO2, not O2, in the blood
is the major driving force regulating breathing.
Even a small increase in the CO2level
(hypercapnia), such as when holding your breath,
results in a powerful urge to breathe.
The mechanism by which CO2 in the blood
stimulates breathing involves the change in pH that
accompanies an increase in CO2 levels. Receptors
in the medulla oblongata called chemoreceptors are
sensitive to small changes in H+ concentration.
Although O2 levels are not the major driving force of
breathing, there are O2-sensitive chemoreceptors in the
carotid and aortic bodies. When blood O2 levels
decline to a low level (hypoxia) such as during
exposure to high altitude, emphysema, shock, and
asphyxiation, the aortic and carotid bodies are strongly
stimulated. They send action potentials to the
respiratory center and produce an increase in the rate
and depth of breathing, which increases O2 diffusion
from the alveoli into the blood.
 CHEMICAL CONTROL OF BREATHING
 HYPERCAPNIA – a greater than normal amount of CO2
in the blood
 CARBON DIOXIDE – major chemical regulator of
breathing
 CHEMORECEPTORS (in medulla oblongata) – respond
to changes in blood pH
 If blood CO2 levels decrease, such as during more rapid
breathing, blood pH will increase (become more basic)
 homeostatic mechanism is that the medullary
chemoreceptors signal a decreased breathing rate, which
retains CO2 in the blood.
 More CO2 in the blood causes H+ levels to increase,
which causes blood pH to decrease to normal levels.
 CHEMICAL CONTROL OF BREATHING
 CHEMORECEPTORS (in carotid and aortic
bodies) – respond to changes in blood O2.
 send action potentials to the respiratory center
and produce an increase in the rate and depth of
breathing
 which increases O2 diffusion from the
alveoli into the blood.

 HYPOXIA – a condition when blood O2 declines

to a low level
Vital signs…
Vital signs, are essential elements
for determining an individual’s state
of health, include temperature,
pulse, respiration, and blood
pressure. A deviation from normal
of any or all of the vital signs
indicates a state of illness, and can
be used by the physician in a
The normal respiration rate for a 5-
diagnosis, prognosis (prospects of
year-old is 20-25 breaths per minute;
survival and recovery), and
for someone 15 years or older is 12-20
treatment.
breaths per minute. Your respiration
rate is the number of times you
breathe in a minute.
What is a Respiratory Pattern?
A patient’s respiratory pattern refers to the rate, depth, and
rhythm at which they are breathing.

In a healthy patient at rest, the respiratory rate should be 12-20

breaths per minute, with passive exhalation and a normal
rhythm.

Again, this is known as Eupnea (i.e., normal breathing).

The normal breath sound is called Vesicular Breath Sound

 Abnormal Respiratory Patterns
When a patient’s breathing deviates from normal, it is considered to be an abnormal
respiratory pattern.
Tachypnea
Tachypnea is an abnormal breathing pattern characterized by rapid breathing. It is defined as a
respiratory rate that is greater than 20 breaths per minute.

Tachypnea does not have a single specific cause, but it is often seen in patients who are
struggling to breathe, such as those with heart failure, COPD, or pneumonia.

Some other common causes of tachypnea include:

• Sepsis • It also can happen in people who are obese

• Hypoxemia or in infants who have problems breathing.
• Diabetic ketoacidosis
• Carbon monoxide poisoning
• Pulmonary embolism
• Asthma
• Pleural effusion
Tachypnea is treated based on the underlying cause. For example, if hypoxemia is present, the
patient may benefit from receiving supplemental oxygen.
Bradypnea
Bradypnea is the opposite of tachypnea and is defined as a respiratory rate of
fewer than 12 breaths per minute.

As with tachypnea, bradypnea does not have a single specific cause, but it is
often seen in patients who are sedated or have a central nervous system
disorder. It can mean your body isn’t getting enough oxygen.

Bradypnea can be a sign of a condition that affects your metabolism or another

problem, like sleep apnea, carbon monoxide poisoning, or a drug overdose.

Some other common causes of bradypnea include:

• Drug overdose
• Hypothyroidism
• Brain injury
Bradypnea is treated based on the underlying cause. For example, if the patient
is breathing slower than normal due to a drug overdose, naloxone (Narcan®)
may be indicated to reverse the effects of the drug.
Apnea
Apnea is a term that refers to the absence of spontaneous breathing. Therefore, the breathing pattern for
apnea appears as a flat line because the patient is not performing inhalation or exhalation. It is
synonymous to respiratory arrest.

This means that there is no effort or movement of the inspiratory muscles, and the volume of the lungs
does not change.

Apnea can cause severe complications throughout the body because, without breathing, the tissues and
organs are unable to obtain the oxygen that is required for survival.

Some of the common causes of apnea include:

• Cardiac arrest
• Severe brain trauma
• Neuromuscular disorders
• Central nervous system disorders
• Narcotic overdose
Apnea can also occur voluntarily by breath-holding, and it can be mechanically induced by choking or
strangulation.

The treatment for apnea often involves intubation and mechanical ventilation.
Sleep apnea is a potentially serious sleep
disorder in which breathing repeatedly
stops and starts. If you snore loudly and
feel tired even after a full night's sleep, you
might have sleep apnea.
The main types of sleep apnea are:
1. Obstructive sleep apnea (OSA), which
is the more common form that occurs
when throat muscles relax and block
the flow of air into the lungs
2. Central sleep apnea (CSA), which
occurs when the brain doesn't send
proper signals to the muscles that
control breathing
3. Treatment-emergent central sleep
apnea, also known as complex sleep
apnea, which happens when someone
has OSA — diagnosed with a sleep
study — that converts to CSA when
receiving therapy for OSA
Symptoms
The symptoms of obstructive and central sleep apneas overlap, sometimes making
it difficult to determine which type you have. The most common symptoms of
obstructive and central sleep apneas include:
• Loud snoring.
• Episodes in which you stop breathing during sleep — which would be
reported by another person.
• Gasping for air during sleep.
• Awakening with a dry mouth.
• Morning headache.
• Difficulty staying asleep, known as insomnia.
• Excessive daytime sleepiness, known as hypersomnia.
• Difficulty paying attention while awake.
• Irritability.
Continuous Positive Airway Pressure
Dyspnea
This is when you feel “short of breath,” like your body can’t get enough air. It’s a common symptom of many
heart and lung problems, and it can be a sign of something serious, like an asthma attack or heart attack. Get
medical help right away if you’re short of breath very suddenly.

It also can happen if you’re at high altitudes, in poor physical health, or are obese. In those cases, your doctor
might recommend special breathing exercises, or they may give you oxygen.
Several types of dyspnea happen only when your body is in a certain position. They
include:

• Orthopnea, when you feel short of breath when you lie down. It often happens in
people who have heart failure, when blood can build up in their lungs if they lie down.
Sitting up or standing usually eases the problem.
• A similar condition called paroxysmal nocturnal dyspnea can make you feel so short
of breath that you wake up in the middle of the night. This is also a symptom of heart
failure.
• Trepopnea is a kind of dyspnea that happens when you lie on a certain side. It might
happen when you lie on your left side but not on your right -- or the other way around.
• Platypnea is a rare type of dyspnea that makes you feel short of breath when you’re
standing up. Lying down makes you feel better.
Hyperpnea
This is when you’re breathing in more air but not
necessarily breathing faster. It can happen during
exercise or because of a medical condition that
Hyperpnea is an abnormal breathing pattern characterized by an
makes it harder for your body to get oxygen, like
increased depth of breathing with or without an increase in rate.
heart failure or sepsis (a serious overreaction by
Therefore, the blood gas values of a patient with hyperpnea are
your immune system).
normal.

The most common causes of hyperpnea include:

• Exercise
• High altitude
• Anemia
• Asthma
• Acute lung injury
• COPD
Treatment for hyperpnea is usually not necessary; however, in
some cases, such as with high altitude sickness, supplemental
oxygen may be indicated.
Hypopnea
Hypopnea is an abnormal respiratory pattern characterized by a decrease in depth of breathing with or without
a decrease in rate. This can result in hypoxemia and an increase in PaCO2.

This breathing pattern is often associated with obstructive sleep apnea and is caused by a partial obstruction of
the upper airway.

Hypopnea is often treated with continuous positive airway pressure (CPAP), which is a device that uses
positive pressure to help prevent the obstruction.

Apneustic Breathing
Apneustic breathing is an abnormal respiratory pattern characterized by a deep and gasping inspiration with a
pause at full inspiration, followed by a brief, partial expiration.

This pattern is often seen in patients who’ve experienced severe brain damage to the upper medulla or pons
caused by a stroke or trauma. It is also seen in patients with a hypoglycemic coma or those with profound
hypoxemia.

Apneustic breathing is caused by basilar artery occlusion and usually has a poor prognosis.
Agonal Breathing
Agonal breathing is an abnormal respiratory pattern
characterized by intermittent gasping and labored breathing.

It is caused by a preterminal brainstem reflex and eventually

progresses to complete apnea. This breathing pattern often
occurs during the final breaths before death.

Some of the most common causes of agonal breathing include:

• Cerebral ischemia
• Extreme hypoxemia
• Anoxia
• Agonal breathing may also occur during cardiac arrest or
cardiogenic shock, where labored respirations may persist
after the cessation of the patient’s heartbeat.

This type of respiration occurs in approximately 40% of cardiac

arrest cases that take place outside of the hospital setting.
Treatment is focused on resuscitation and support.
Ataxic Breathing
Ataxic breathing is an abnormal respiratory pattern characterized by irregular respirations with abnormal
pauses and periods of apnea.

This means that the patient will have a variable respiratory rate, breathing cycle, and inconsistent tidal
volumes with both small and large breaths. The periods of apnea occur abruptly and sporadically
throughout the breathing cycle.

This breathing pattern often occurs when there is damage to the medullary respiratory center in the brain,
which is caused by:

• Head trauma
• Traumatic brain injury
• Brain tumor
• Increased intracranial pressure
This pattern is generally a sign that a patient is in critical condition with a poor prognosis. Therefore,
treatment is focused on supporting the patient and managing any underlying causes.
Paradoxical Breathing
Paradoxical breathing is an abnormal respiratory pattern characterized by an inward movement of the chest
wall during inhalation followed by an outward movement during exhalation.

This breathing pattern is associated with a decreased pressure gradient that fails to stimulate normal
breathing and can result in respiratory failure.

It can result from diaphragmatic fatigue or paralysis; however, it’s most commonly associated with trauma
or an injury to the chest wall.

For example, a flail chest is a traumatic injury where a portion of the rib cage is fractured and becomes
detached. When this occurs, the flail section moves in the opposite direction, which is known as a
paradoxical movement.

This abnormal pattern may also occur in infants and children as a sign of respiratory distress.
Cheyne-Stokes Breathing
Cheyne-Stokes breathing is an abnormal respiratory pattern that is
characterized by periods of shallow and deep breathing, separated by
brief periods of apnea.

This breathing pattern is often seen in patients who are in a comatose

state and is caused by a lack of oxygen to the brain. Some other causes
include:

• Increased intracranial pressure According to research, Cheyne Strokes

• Traumatic brain injury breathing can happen while you’re awake, but
• Stroke is more common during sleep. It may happen
• Heart failure more during non-rapid eye movement
• Hyponatremia (NREM) sleep than rapid eye movement
• Brain tumor (REM) sleep.
The treatment for Cheyne-Stokes breathing involves reversing the
underlying cause. In some cases, noninvasive ventilation (NIV) is When Cheyne Stokes occurs during sleep, it’s
indicated (e.g., CPAP). considered a form of central sleep apnea with
People who are dying often experience Cheyne Stokes breathing. This
an extended period of fast breathing
is a natural effect of the body’s attempt to compensate for changing
(hyperventilation). Central sleep apnea causes
carbon dioxide levels. While it may be distressing to those who
you to stop breathing briefly and increases the
witness it, there’s no evidence Cheyne Stokes is stressful for the
levels of carbon dioxide in your body.
person experiencing it.
Kussmaul Breathing
Kussmaul breathing is an abnormal respiratory pattern that is
characterized by deep and rapid breathing. This is often seen in
patients with metabolic acidosis.

The treatment for Kussmaul breathing involves treating the

underlying cause of the patient’s acid-base imbalance.

Biot’s Breathing
Biot’s breathing is a chaotic respiratory pattern that is
characterized by irregular periods of deep, shallow, fast, and
slow breathing. This pattern eventually turns into agonal
breathing, which then leads to apnea.

Biot’s breathing is often seen in patients with an acute

neurological disease that results in damage to the medulla or
pons in the brain.

This can occur due to a stroke, trauma, or severe intracranial

hypertension.
Other Irregular Breathing Patterns
Shallow Breathing
Shallow breathing is a type of abnormal respiration in which the patient takes shallow, quick breaths.

This type of breathing can result in hypoventilation and lead to hypercapnia, which is an accumulation of carbon
dioxide in the blood.

Some of the most common causes of shallow breathing include:

• Anxiety disorders
• Panic attacks
• Asthma
• Pneumonia
• Shock
• Pulmonary edema
Treatment for shallow breathing depends on the underlying cause. For example, if the patient has asthma, the
treatment may involve inhaled bronchodilators to help open up the airways.
Sighing Air trapping
Sighing is a breathing pattern characterized by an Air trapping is an abnormal respiratory pattern in which
involuntary inspiration that is deeper and longer air gets trapped in the lungs, and it becomes difficult to
than a normal tidal volume breath. exhale.

Sighing plays an important role in preventing This can result in hyperinflation of the lungs, which often
atelectasis because the inhalation of a larger breath leads to respiratory distress. Air trapping is often seen in
helps open the alveoli, preventing a collapse. obstructive lung diseases, such as:

While this is a normal part of respiration, excessive • Asthma

sighing can be a sign of an underlying respiratory • COPD
condition. • Chronic bronchitis
• Emphysema
It can also occur as a response to an emotional • Bronchiolitis obliterans syndrome
trigger, such as anxiety. Air trapping is not considered to be a disease but rather a
symptom of an underlying condition. Therefore, the
treatment for air trapping depends on the underlying
cause.
Sighing Air trapping
Sighing is a breathing pattern characterized by an Air trapping is an abnormal respiratory pattern in which
involuntary inspiration that is deeper and longer air gets trapped in the lungs, and it becomes difficult to
than a normal tidal volume breath. exhale.

Sighing plays an important role in preventing This can result in hyperinflation of the lungs, which often
atelectasis because the inhalation of a larger breath leads to respiratory distress. Air trapping is often seen in
helps open the alveoli, preventing a collapse. obstructive lung diseases, such as:

While this is a normal part of respiration, excessive • Asthma

sighing can be a sign of an underlying respiratory • COPD
condition. • Chronic bronchitis
• Emphysema
It can also occur as a response to an emotional • Bronchiolitis obliterans syndrome
trigger, such as anxiety. Air trapping is not considered to be a disease but rather a
symptom of an underlying condition. Therefore, the
treatment for air trapping depends on the underlying
cause.
Asthmatic Breathing
Asthmatic breathing is a respiratory pattern caused by
narrowing of the airways due to inflammation. This can lead to
wheezing, chest tightness, and shortness of breath.

The most common causes of asthma respirations include the

following triggers:

• Allergens
• Exercise
• Cold air
• Respiratory infections
• Certain medications
• When a trigger occurs, the airways become inflamed and
narrowed, making it difficult to breathe. The treatment for
asthma respirations depends on the severity of the
symptoms.

In mild cases, the use of bronchodilators can help to ease the

symptoms. In severe cases, ventilatory support may be
indicated.
Hyperventilation
Hyperventilation is a type of abnormal respiration characterized by an increase in the rate and depth of breathing. This
results in a decrease in the levels of carbon dioxide in the blood, which results in respiratory alkalosis.

Some of the most common causes of hyperventilation include:

• Anxiety disorders
• Panic attacks
• Severe pain
• Lung infections
• COPD
• Asthma
• Myocardial infarction
• Diabetic ketoacidosis
• Head injuries
• Hyperventilation syndrome
The treatment for hyperventilation depends on the underlying cause. In some cases, such as during a panic attack,
simply slowing down the breathing can help to ease the symptoms.

In other cases, such as with COPD or asthma, the use of oxygen or bronchodilators may be necessary.
Hypoventilation
Hypoventilation is a type of respiratory depression characterized by a decrease in the rate and depth of breathing. This
results in an increase in the levels of carbon dioxide in the blood, which results in respiratory acidosis.

Some of the most common causes of hypoventilation include:

Stroke
Brainstem injury
Drug overdose
Hypocapnia
Obesity hypoventilation syndrome
Neuromuscular diseases
Chest wall deformities
Obstructive sleep apnea
The treatment for hypoventilation depends on the underlying cause. In some cases, supplemental oxygen may be all
that is needed. In other cases, mechanical ventilation may be required.
Newborn Breathing Patterns
The first few days after birth, it is
common for newborns to have
irregular breathing patterns. This
is due to the fact that they are
adjusting to breathing outside of
the womb.
Most newborns will establish a
regular breathing pattern within a
few days. However, some may
experience apnea spells, which
are periods where they stop
breathing for 10 seconds or more.
It is also important to remember
that newborns breathe faster than
adults. They typically take 40-60
breaths per minute
Types of Abnormal Newborn Respiratory Patterns
If a newborn is in respiratory distress, they may experience one or
more of the following irregular breathing patterns:
• Tachypnea – breathing rate of more than 60 breaths per minute
• Bradypnea – breathing rate of fewer than 40 breaths per minute
• Apnea – period without breathing of 10 seconds or longer
• Retractions – infant’s chest pulls in with each breath
• Grunting – sound an infant makes with each breath
• Nasal flaring – widening of the nostrils with each breath
The treatment for irregular breathing patterns in newborns will
depend on the underlying cause. If the cause is unknown, the infant
may be observed for a period of time to see if the breathing pattern
improves on its own.
In some cases, supplemental oxygen may be necessary. If the infant
is having difficulty maintaining adequate oxygen levels, they may
need to be intubated and placed on a mechanical ventilator.
Mouth Breathing
Mouth breathing is a common respiratory pattern, especially in children. This technique is often used when the nose is
obstructed, making it difficult to breathe through the nose.

Mouth breathing can also occur as a result of problems with the autonomic nervous system, such as cerebral palsy. In
some cases, mouth breathing can lead to sleep apnea.

While mouth breathing is not necessarily an abnormal breathing pattern, it can be problematic if it progresses to other
respiratory problems.

Treatment for mouth breathing usually involves addressing the underlying cause, such as nasal obstruction.
Pursed-Lip Breathing
Pursed-lip breathing is a breathing pattern that is often performed to ease shortness of breath. This technique
involves exhaling through pursed lips, which creates resistance and helps decrease the rate breathing.

Pursed-lip breathing can help to improve ventilation and gas exchange, as well as reduce the work of breathing.

It’s a common breathing pattern in patients with COPD, as it can ease symptoms of dyspnea by prolonging the
expiratory portion.

Diaphragmatic Breathing
Diaphragmatic breathing, also known as “belly breathing” or “abdominal breathing,” is a breathing pattern that is
helpful in taking deep breaths.

This technique involves contracting the diaphragm, expanding the stomach, and performing deep inhalations.

This results in a decreased respiratory rate, which increases the amount of blood that is available for perfusion and
gas exchange.
What are breath sounds?
Breath sounds come from the lungs when you breathe in and out. A person can hear these sounds using a
stethoscope or simply when breathing.

Sometimes, irregular breath sounds might indicate a health issue involving your lungs, such as:

• obstruction
• inflammation
• infection
• fluid in the lungs
• asthma
Listening to breath sounds is an important part of diagnosing many different medical conditions.

If your doctor thinks you might have an issue

with your lungs, the type and location of certain
breathing sounds can help them figure out what
might be behind it.
Wheezing
This high-pitched whistling noise can happen when you’re breathing in or out. It’s usually a sign that something is making your airways
narrow or keeping air from flowing through them.

Two of the most common causes of wheezing are lung diseases called chronic obstructive pulmonary disease (COPD) and asthma. But
many other issues can make you wheeze, too, including:

• Allergies
• Bronchitis or bronchiolitis
• Emphysema
• Epiglottitis (swelling of the top flap of your windpipe)
• Gastroesophageal reflux disease (GERD)
• Heart failure
• Lung cancer
• Sleep apnea
• Pneumonia
• Respiratory syncytial virus (RSV)
• Vocal cord problems
• An object stuck in your voice box or windpipe
You can also start wheezing if you smoke or as a side effect of some medications. It’s not always serious, but if you have trouble
breathing, are breathing really fast, or your skin turns a bluish color, see your doctor.

If you start wheezing suddenly after an insect bite or after eating food you may be allergic to, go to the emergency room right away.
Crackling (Rales)
This is a series of short, explosive sounds. They can also sound like bubbling, rattling, or clicking. You’re
more likely to have them when you breathe in, but they can happen when you breathe out, too.

You can have fine crackles, which are shorter and higher in pitch, or coarse crackles, which are lower.
Either can be a sign that there’s fluid in your air sacs.

They can be caused by:

• Pneumonia
• Heart disease
• Pulmonary fibrosis
• Cystic fibrosis
• COPD
• Lung infections, like bronchitis
• Asbestosis, a lung disease caused by breathing in asbestos
• Pericarditis, an infection of the sac that covers your heart
Stridor
This harsh, noisy, squeaking sound happens with every breath. It can be high or low, and it’s usually a sign
that something is blocking your airways. Your doctor can typically tell where the problem is by whether your
stridor sounds happen when you breathe in or out. It’s not always serious, but it sometimes can be a sign of a
life-threatening problem that needs medical attention right away.

You may get stridor if you have:

• Laryngomalacia (softening of the vocal cords in babies)

• Paralyzed vocal cord
• Narrow voice box
• Unusual growth of blood vessels (hemangioma) just below your vocal cords
• Croup
• Infection of your trachea (windpipe)
• Epiglottitis (when the “lid” of cartilage that covers your windpipe swells and blocks the flow of air to your
lungs)
You can also have stridor if an object gets stuck in your windpipe. You might need surgery to fix that
problem.
Rhonchi
These low-pitched wheezing sounds sound like snoring and usually happen when you breathe out. They can
be a sign that your bronchial tubes (the tubes that connect your trachea to your lungs) are thickening
because of mucus.

Rhonchi sounds can be a sign of bronchitis or COPD.

Whooping
This high-pitched gasp typically follows a long bout of coughing. If you hear a “whoop” when you breathe
in, it may be a symptom of whooping cough (pertussis), a contagious infection in your respiratory system.

Pleural Friction Rub

The membranes that cover the walls of your chest cavity and the outer surface of your lungs are called
pleura. If they get inflamed and rub together, they can make this rough, scratchy sound.

It can be a sign of pleurisy (inflammation of your pleura), pleural fluid (fluid on your lungs), pneumonia, or
a lung tumor.
Mediastinal Crunch
This sound, also called Hamman’s sign, tells your doctor that air is trapped in the space between your lungs
(called the mediastinum). It’s a crunchy, scratchy sound, and it happens in time with your heartbeat. That’s
because your heart movements shift the trapped air and cause the scratching sounds.

These crunching sounds can sometimes mean you have a collapsed lung, especially if you also have chest
pain and shortness of breath. They also can be a sign of lung disease like COPD, pneumonia, or cystic
fibrosis.
EFFECTS OF AGING ON THE
RESPIRATORY SYSTEM
Aging affects most aspects of the respiratory
system. Vital capacity, maximum ventilation rates,
and gas exchange decrease with age. However, the
elderly can engage in light to moderate exercise
because the respiratory system has a large reserve
capacity.

With age, mucus accumulates within the respiratory

passageways. The movement of mucus by cilia in
the trachea is less efficient because the mucus
becomes more viscous and the number of cilia and
their rate of movement decrease. As a consequence,
the elderly are more susceptible to respiratory
infections and bronchitis.

Effects on Vital volume and capacity are noticeable

to elderly hence the decline in their respiratory
processes.
SYSTEMS PATHOLOGY
Asthma
Bronchial asthma (or asthma) is a lung disease. Your airways
get narrow and swollen and are blocked by excess mucus.
Medications can treat these symptoms.

It’s a chronic (ongoing) condition, meaning it doesn’t go

away and needs ongoing medical management.

Asthma affects more than 25 million people in the U.S.

currently. This total includes more than 5 million children.
Asthma can be life-threatening if you don’t get treatment.
SYSTEMS PATHOLOGY
What is an asthma attack?
When you breathe normally, muscles around your airways are relaxed, letting air move easily and
quietly. During an asthma attack, three things can happen:

• Bronchospasm: The muscles around the airways constrict (tighten). When they tighten, it
makes your airways narrow. Air cannot flow freely through constricted airways.
• Inflammation: The lining of your airways becomes swollen. Swollen airways don’t let as much
air in or out of your lungs.
• Mucus production: During the attack, your body creates more mucus. This thick mucus clogs
airways.
When your airways get tighter, you make a sound called wheezing when you breathe, a noise
your airways make when you breathe out. You might also hear an asthma attack called an
exacerbation or a flare-up. It’s the term for when your asthma isn’t controlled.
SYSTEMS PATHOLOGY
What types of asthma are there?
Asthma is broken down into types based on the cause and the severity of symptoms. Healthcare providers identify asthma
as:

Intermittent: This type of asthma comes and goes so you can feel normal in between asthma flares.
Persistent: Persistent asthma means you have symptoms much of the time. Symptoms can be mild, moderate or severe.
Healthcare providers base asthma severity on how often you have symptoms. They also consider how well you can do
things during an attack.

Allergic: Some people’s allergies can cause an asthma attack. Allergens include things like molds, pollens and pet dander.
Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather may cause a flare.

Adult-onset: This type of asthma starts after the age of 18.

Pediatric: Also called childhood asthma, this type of asthma often begins before the age of 5, and can occur in infants and
toddlers. Children may outgrow asthma. You should make sure that you discuss it with your provider before you decide
whether your child needs to have an inhaler available in case they have an asthma attack. Your child’s healthcare provider
can help you understand the risks.

In addition, there are these types of asthma:

Exercise-induced asthma: This type is triggered by exercise and is also called exercise-induced bronchospasm.
Occupational asthma: This type of asthma happens primarily to people who work around irritating substances.
Asthma-COPD overlap syndrome (ACOS): This type happens when you have both asthma and chronic obstructive
pulmonary disease (COPD). Both diseases make it difficult to breathe.
SYSTEMS PATHOLOGY
Who can get asthma?
Anyone can develop asthma at any age. People with allergies or people exposed to tobacco smoke are more
likely to develop asthma. This includes secondhand smoke (exposure to someone else who is smoking) and
thirdhand smoke (exposure to clothing or surfaces in places where some has smoked).

Statistics show that people assigned female at birth tend to have asthma more than people assigned male at
birth. Asthma affects Black people more frequently than other races.

What causes asthma?

Researchers don’t know why some people have asthma while others don’t. But certain factors present a
higher risk:

Allergies: Having allergies can raise your risk of developing asthma.

Environmental factors: People can develop asthma after exposure to things that irritate the airways. These
substances include allergens, toxins, fumes and second- or third-hand smoke. These can be especially
harmful to infants and young children whose immune systems haven’t finished developing.
Genetics: If your family has a history of asthma or allergic diseases, you have a higher risk of developing
the disease.
Respiratory infections: Certain respiratory infections, such as respiratory syncytial virus (RSV), can
damage young children’s developing lungs.
SYSTEMS PATHOLOGY
What are common asthma attack triggers?
You can have an asthma attack if you come in contact with substances that irritate you. Healthcare providers call these
substances “triggers.” Knowing what triggers your asthma makes it easier to avoid asthma attacks.

For some people, a trigger can bring on an attack right away. For other people, or at other times, an attack may start hours or
days later.

Triggers can be different for each person. But some common triggers include:

Air pollution: Many things outside can cause an asthma attack. Air pollution includes factory emissions, car exhaust,
wildfire smoke and more.
Dust mites: You can’t see these bugs, but they are in our homes. If you have a dust mite allergy, this can cause an asthma
attack.
Exercise: For some people, exercising can cause an attack.
Mold: Damp places can spawn mold, which can cause problems if you have asthma. You don’t even have to be allergic to
mold to have an attack.
Pests: Cockroaches, mice and other household pests can cause asthma attacks.
Pets: Your pets can cause asthma attacks. If you’re allergic to pet dander (dried skin flakes), breathing in the dander can
irritate your airways.
Tobacco smoke: If you or someone in your home smokes, you have a higher risk of developing asthma. You should never
smoke in enclosed places like the car or home, and the best solution is to quit smoking. Your provider can help.
Strong chemicals or smells. These things can trigger attacks in some people.
Certain occupational exposures. You can be exposed to many things at your job, including cleaning products, dust from
flour or wood, or other chemicals. These can all be triggers if you have asthma.
SYSTEMS PATHOLOGY
What are the signs and symptoms of asthma?
People with asthma usually have obvious symptoms. These signs and symptoms resemble many respiratory
infections:

• Chest tightness, pain or pressure.

• Coughing (especially at night).
• Shortness of breath.
• Wheezing.
With asthma, you may not have all of these symptoms with every flare. You can have different symptoms
and signs at different times with chronic asthma. Also, symptoms can change between asthma attacks.

How do healthcare providers diagnose asthma?

Your healthcare provider will review your medical history, including information about your parents and
siblings. Your provider will also ask you about your symptoms. Your provider will need to know any
history of allergies, eczema (a bumpy rash caused by allergies) and other lung diseases.

Your provider may order spirometry. This test measures airflow through your lungs and is used to diagnose
and monitor your progress with treatment. Your healthcare provider may order a chest X-ray, blood test or
skin test.
SYSTEMS PATHOLOGY
What asthma treatment options are there?
You have options to help manage your asthma. Your healthcare provider may prescribe
medications to control symptoms. These include:

Bronchodilators: These medicines relax the muscles around your airways. The relaxed
muscles let the airways move air. They also let mucus move more easily through the
airways. These medicines relieve your symptoms when they happen and are used for
intermittent and chronic asthma.
Anti-inflammatory medicines: These medicines reduce swelling and mucus production in
your airways. They make it easier for air to enter and exit your lungs. Your healthcare
provider may prescribe them to take every day to control or prevent your symptoms of
chronic asthma.
Biologic therapies for asthma: These are used for severe asthma when symptoms persist
despite proper inhaler therapy.
You can take asthma medicines in several different ways. You may breathe in the medicines
using a metered-dose inhaler, nebulizer or another type of asthma inhaler. Your healthcare
provider may prescribe oral medications that you swallow.
SYSTEMS PATHOLOGY
What should I do if I have a severe asthma attack?
If you have a severe asthma attack, you need to get immediate medical care.

The first thing you should do is use your rescue inhaler. A rescue inhaler uses fast-acting
medicines to open up your airways. It’s different than a maintenance inhaler, which you
use every day. You should use the rescue inhaler when symptoms are bothering you and
you can use it more frequently if your flare is severe.

If your rescue inhaler doesn’t help or you don’t have it with you, go to the emergency
department if you have:

• Anxiety or panic.
• Bluish fingernails, bluish lips (in light-skinned people) or gray or whitish lips or gums
(in dark-skinned people).
• Chest pain or pressure.
• Coughing that won’t stop or severe wheezing when you breathe.
• Difficulty talking.
• Pale, sweaty face.
• Very quick or rapid breathing.
SYSTEMS PATHOLOGY
Can asthma be cured?
No. Asthma can’t be cured, but it can be managed. Children may outgrow asthma as they get
older.

Why is my asthma worse at night?

Asthma that gets worse at night is sometimes called nighttime asthma or nocturnal asthma. There are no definite reasons
that this happens, but there are some educated guesses. These include:

The way you sleep: Sleeping on your back can result in mucus dripping into your throat or acid reflux coming back up
from your stomach. Also, sleeping on your back puts pressure on your chest and lungs, which makes breathing more
difficult. However, lying face down or on your side can put pressure on your lungs.
Triggers in your bedroom and triggers that happen in the evening: You may find your blankets, sheets and pillows have
dust mites, mold or pet hair on them. If you’ve been outside in the early evening, you may have brought pollen in with
you.
Medication side effects: Some drugs that treat asthma, such as steroids and montelukast, can affect your sleep.
Air that’s too hot or too cold: people. Hot air can cause airways to narrow when you breathe in. Cold air is an asthma
trigger for some
Lung function changes: Lung function lessens at night as a natural process.
Asthma is poorly controlled during the day: Symptoms that aren’t controlled during the day won’t be better at night. It’s
important to work with your provider to make sure your asthma symptoms are controlled both day and night. Treating
nighttime symptoms is very important. Serious asthma attacks, and sometimes deaths, can happen at night.
SYSTEMS PATHOLOGY
Tuberculosis
Tuberculosis is a bacterial infection that is also known as TB. It can be fatal if not treated. TB most often affects your lungs, but
can also affect other organs like your brain.
Tuberculosis is an infectious disease that can cause infection in your lungs or other tissues. It commonly affects your lungs, but it
can also affect other organs like your spine, brain or kidneys. The word “tuberculosis” comes from a Latin word for "nodule" or
something that sticks out.

Tuberculosis is also known as TB. Not everyone who becomes infected with TB gets sick, but if you do get sick you need to be
treated.

If you’re infected with the bacterium (mycobacterium tuberculosis), but don’t have symptoms, you have inactive tuberculosis or
latent tuberculosis infection (also called latent TB). It may seem like TB has gone away, but it’s dormant (sleeping) inside your
body.

If you’re infected, develop symptoms and are contagious, you have active tuberculosis or tuberculosis disease (TB disease).

The three stages of TB are:

Primary infection.
Latent TB infection.
Active TB disease.
How common is tuberculosis?
About 10 million people became ill with TB throughout the world, and about 1.5 million people died from the
disease in 2020. TB was once the leading cause of death in the U.S. but the number of cases fell rapidly in the 1940s
and 1950s after researchers found treatments.

Statistics show that there were 7,860 tuberculosis cases reported in the U.S. in 2021. The national incidence rate is
2.4 cases per 100,000 people.

What causes tuberculosis?

TB is caused by the bacterium Mycobacterium tuberculosis. The germs are spread through the air and usually infect
the lungs, but can also infect other parts of the body. Although TB is infectious, it doesn’t spread easily. You usually
have to spend a lot of time in contact with someone who is contagious in order to catch it.
How is tuberculosis spread?
TB can be spread when a person with active TB disease releases germs into the air through coughing, sneezing,
talking, singing or even laughing. Only people with active pulmonary infection are contagious. Most people
who breathe in TB bacteria are able to fight the bacteria and stop it from growing. The bacterium becomes
inactive in these individuals, causing a latent TB infection.

As many as 13 million people in the U.S. have latent TB. Although the bacteria are inactive, they still remain
alive in the body and can become active later. Some people can have a latent TB infection for a lifetime, without
it ever becoming active and developing into TB disease.

However, TB can become active if your immune system becomes weakened and cannot stop the bacteria from
growing. This is when the latent TB infection becomes active TB. Many researchers are working on treatments
to stop this from happening.
Are there different kinds of tuberculosis?
In addition to active or inactive, you might hear about different kinds of TB, including the most common,
pulmonary (lung) tuberculosis. But the bacterium can also affect other parts of your body besides the lungs,
causing extrapulmonary tuberculosis (or TB outside of the lung). You might also hear about systemic miliary
tuberculosis, which can spread throughout your body and cause:

• Meningitis, an inflammation of your brain.

• Sterile pyuria, or high levels of white blood cells in your urine.
• Pott’s disease, also called spinal tuberculosis or tuberculosis spondylitis.
• Addison’s disease, an adrenal gland condition.
• Hepatitis, a liver infection.
• Lymphadenitis in your neck, also called scrofula or TB lymphadenitis.
What are the signs and symptoms of tuberculosis?
People with inactive TB do not exhibit symptoms. However, they may have a positive skin reaction test or blood
test.

Those with active TB can show any of the following symptoms:

Bad cough (lasting longer than two weeks).

Pain in your chest.
Coughing up blood or sputum (mucus).
Fatigue or weakness.
Loss of appetite.
Weight loss.
Chills.
Fever.
Night sweats.
What kinds of tests are used to diagnose tuberculosis?
There are two kinds of screening tests for TB: the Mantoux tuberculin skin test (TST)
and the blood test, called the interferon gamma release assay (IGRA).

For the TST, a healthcare provider will inject a small amount of a substance called
purified protein derivative (PPD) under the skin of your forearm. After two to three
days, you must go back to the healthcare provider, who will look at the injection site.

For the IGRA, a healthcare provider will draw blood and send the sample to the lab.

Further tests to determine if an infection is active or if your lungs are infected include:

Lab tests on sputum and lung fluid.

Chest X-ray.
Computed tomography (CT) scans.
How do I know if I should get tested for tuberculosis?
You may want to get tested for TB if:

You are a resident or employee in group settings where the risk is high, such as jails, hospices, skilled nursing
facilities, shelters and other healthcare facilities.
You work in a mycobacteriology laboratory.
You’ve been in contact with someone who’s known or suspected to have TB disease.
Your body's resistance to illness is low because of a weak immune system.
You think you might already have TB disease and have symptoms.
You’re from a region or have lived in a region where TB disease is prevalent, such as Latin America, the
Caribbean, Africa, Asia, Eastern Europe and Russia.
You’ve injected recreational drugs.
Your healthcare provider recommends testing.
Others who are at risk for TB include:

People with immature or impaired immune systems, such as babies and children.
People with kidney disease, diabetes, or other chronic (long-term) illness.
People who have received organ transplants.
People being treated with chemotherapy for cancer or other types of treatments for immune system disorders.
How is tuberculosis treated?
TB infection and disease is treated with these drugs:

Isoniazid (Hyzyd®). Multidrug-resistant TB

Rifampin (Rifadin®). (MDR TB) is caused by TB
Ethambutol (Myambutol®). bacteria that are resistant
Pyrazinamide (Zinamide®). to at least isoniazid and
Rifapentine (Priftin®). rifampin, the two most
potent TB drugs. These
You must take all of the medication your provider drugs are used to treat all
prescribes, or not all of the bacteria will be killed. You persons with TB disease
will have to take these medications for as long as you're
told — sometimes up to nine months.

Some forms of TB have become resistant to medications.

It’s very important and likely that your provider will use
more than one drug to treat TB. It’s very important to
finish your entire prescription.
Causes of Drug Resistant TB
Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or
mismanagement include

People do not complete a full course of TB treatment

Health care providers prescribe the wrong treatment (the wrong dose or length of time)
Drugs for proper treatment are not available
Drugs are of poor quality
Drug-resistant TB is more common in people who

Do not take their TB drugs regularly

Do not take all of their TB drugs
Develop TB disease again, after being treated for TB disease in the past
Come from areas of the world where drug-resistant TB is common
Have spent time with someone known to have drug-resistant TB disease

Can tuberculosis be cured?

Yes, TB is curable.
What can you do to prevent spreading tuberculosis?
You usually have to be in contact with someone with active TB for a long time before becoming infected. It helps
to follow infection prevention guidelines like:

• Washing your hands thoroughly and often.

• Coughing into your elbow or covering your mouth when you cough.
• Avoiding close contact with other people.
• Making sure you take all of your medication correctly.
• Not returning to work or school until you’ve been cleared by your healthcare provider.
In the hospital, the most important measures to stop the spread of TB are having proper ventilation and using the
correct types of personal protective equipment.

Is there a vaccine to prevent tuberculosis?

Some countries (but not the U.S.) use a TB vaccine called Bacillus Calmette-Guerin (BCG). The vaccine is
mostly given to children in countries with high rates of TB to prevent meningitis and a serious form of TB called
miliary tuberculosis. The vaccine may make skin tests for TB less accurate.
Salamat!