1.

Introduction to Respiratory Physiology

2. Functional anatomy
3. The respiratory pump and lung Volumes

Introduction

The respiratory system is composed of

➢ the lungs,
➢ the conducting airways,
➢ the parts of the central nervous system concerned with the control of the muscles of respiration, and
➢ the chest walls. The chest wall consists of the muscles of respiration— such as the diaphragm, the intercostal muscles, and the
abdominal muscles—and the rib cage.
STRUCTURE OF THE RESPIRATORY SYSTEM
➢ Air enters the respiratory system through the nose or mouth. Air entering through the nose is filtered, heated to body temperature,
and humidified as it passes through the nose and nasal conchae.
➢ The upper airways are shown in Figure 10–1.
➢ Air breathed through the nose enters the airways via the nasopharynx and through the mouth via the oropharynx. It then passes
through the glottis and the larynx and enters the tracheobronchial tree.
➢ After passing through the conducting airways, the inspired air enters the alveoli, where it comes into contact with the mixed venous
blood in the pulmonary capillaries.

The Alveolar-Capillary Unit

➢ The alveolar-capillary unit is the site of gas exchange in the lung.
➢ The alveoli, estimated number is about 300 million in the adult and are almost completely enveloped in pulmonary capillaries.
➢ The pulmonary alveolus is a sac roughly 0.2 to 0.5 mm in diameter.
➢ These alveoli are located at the ends of the air passageways in the lungs.
➢ Each alveolus is in turn surrounded by a nest of blood capillaries supplied by small branches of the pulmonary artery and drain into
the pulmonary vein.
 Key facts about alveoli
Function Exchange of oxygen and carbon-dioxide through the respiratory membrane

Alveolar cells Type I pneumocyte (squamous alveolar cells with thin membrane; allow
gas exchange)
Type II pneumocyte (repair alveolar epithelium, secrete pulmonary
surfactant)
Alveolar macrophages
Respiratory membrane Squamous alveolar cells
Basement membrane
Capillary endothelium

Alveolar Cell types

1. Type I pneumocytes
➢ The major cell type found on the alveolar surface, covering about 95% of the surface area, are thin, broad cells known as squamous
(type I) alveolar cells, also known as type I pneumocytes.
➢ The thin walls of these cells allow for rapid gas diffusion between the air and blood, and therefore allow for gas exchange to occur.
➢ The other 5% of the surface area of an alveolus is covered by round to cuboidal great (type II) alveolar cells.
➢ Although type II alveolar cells cover less surface area, they greatly outnumber the squamous alveolar cells.

2. Type II pneumocytes
➢ The type II alveolar cells (also known as type II pneumocytes) have two functions:
1. to repair the alveolar epithelium when squamous cells are damaged, and
2. to secrete pulmonary surfactant. Surfactant is composed of phospholipids and protein, and coats the alveoli and smallest
bronchioles, which prevents the pressure buildup from collapsing the alveoli when one exhales.
3. Alveolar macrophages
➢ The most numerous of all cells in the lung are the alveolar macrophages (dust cells), which drift through the alveolar lumens and the
connective tissue between them clearing up debris through phagocytosis.
➢ These macrophages “eat” the dust particles that escape from mucus in the higher parts of the respiratory tract, as well as other
debris that is not trapped and cleared out by the mucus. If your lungs are infected or bleeding, the macrophages also function to
phagocytize bacteria and loose blood cells.
Respiratory membrane

Respiratory membrane is the area of the alveolar-capillary unit responsible for gas exchange and it is a barrier between alveolar air and blood

Structure
• Alveolar cells
o Type I – simple squamous cells- site of gas exchange
o Type II – simple cuboidal cell- secrets surfactant
• Basement membrane
o Alveolar cells basement memb.
o Capillary endothelial cell basement memb.
• Pulmonary Capillary endothelial cells

The thickness of the respiratory membrane is 0.5- 1 um. This is the distance of travel of the respiratory gases between the alveoli and blood.

Clinical

• Thick respiratory membrane

o > 3 um
o Means larger distance of gas diffusion
o This alters the gas exchange process, affecting ventilation- perfusion leading to abnormal gas exchange
o Decreased PO2 and increased PCO2- Hypoxemia
• Thicker rep. memb ∞ 1/ gas exchange
• Causes- left side heart failure, pneumonia

• Thin respiratory membrane

o Small distance for diffusion

o < 0.5 um
o Increase gas exchange process- respiratory alkalosis- Increased PO2 and decreased PCO2

Muscles of Breathing

1. Inspiration
2. Expiration

A. Muscles of Inspiration

➢ Involves the flow of air from the environment into the lung alveoli
➢ This involves the expansion of thoracic cavity volume and lowers intrathoracic pressure, which decreases alveolar pressure below
atmospheric. "Negative pressure."
➢ Normally no true intrathoracic space. Only about 15-25 ml pleural fluid; 10-30µ thick.

1. The Diaphragm.
➢ The diaphragm is the primary muscle of inspiration.
➢ During supine eupneic breathing it is responsible for at least 2/3 of the tidal volume.
➢ During eupnea, contraction of the approximately 250 cm2 diaphragm causes its dome to descend 1 to 2 cm into the abdominal cavity,
with little change in its shape, except that the area of apposition decreases in length.
➢ This elongates the thorax and increases its volume.
➢ These small downward movements of the diaphragm are possible because the abdominal viscera can push out against the relatively
compliant abdominal wall.
 ➢ During a deep inspiration the limit of the compliance of the abdominal wall is reached and the indistensible central tendon becomes
fixed against the abdominal contents. After this point contraction of the diaphragm against the fixed central tendon elevates the
lower ribs.

a. Nerve supply: 2 Phrenic nerves - emanate from C- 3, C- 4, and C - 5.

b. "Paradoxical" upward movement if one hemidiaphragm is paralyzed.

2. External and Parasternal Intercostal Muscles

➢ contraction pulls ribs up. Increases antero-posterior diameter of the chest.
➢ Innervation from T -1 to T-11.

3. Accessory muscles
➢ not involved in eupnea but may be called into action during exercise, cough, sneeze, chronic obstructive pulmonary diseases, etc.
➢ Include sternocleidomastoid and Scalene.
➢ Act to raise the upper ribs and the sternum.

B. Muscle of Expiration
➢ Involves the flow of air from the lung alveoli to the environment
➢ Expiration during eupneic breathing is passive.
➢ Relaxation of the inspiratory muscles allows the increased alveolar elastic recoil to decrease the volume of the alveoli, increasing
alveolar pressure above atmospheric pressure.
➢ The muscles of expiration are involved in active expiration: exercise, speech, cough, sneeze, forced expiration, etc.

➢ Internal intercostals - Perpendicular to external intercostals. Action pulls rib cage down and inward.

➢ Muscles of abdominal wall - raise intra-abdominal pressure. Displace diaphragm upward into thorax. Includes rectus abdominis,
internal and external oblique muscles, and transversus abdominis.

The functions of the respiratory system include

• Gas exchange,
• acid-base balance,
• phonation,
• pulmonary defense
• metabolism
• the handling of bioactive materials

Gas Exchange
➢ The exchange of carbon dioxide for oxygen takes place in the lungs.
➢ Fresh air, containing oxygen, is inspired into the lungs through the conducting airways.
➢ The forces needed to cause the air to flow are generated by the respiratory muscles, acting on commands initiated by the central
nervous system.
➢ At the same time, venous blood returning from the various body tissues is pumped into the lungs by the right ventricle of the heart.
This mixed venous blood has a high carbon dioxide content and a low oxygen content.
➢ In the pulmonary capillaries, carbon dioxide is exchanged for oxygen. The blood leaving the lungs, which now has a high oxygen
content and a relatively low carbon dioxide content, is distributed to the tissues of the body by the left side of the heart.
➢ During expiration, gas with a high concentration of carbon dioxide is expelled from the body.

Types of Respiration (Gas exchange)

1. external respiration: exchange of gases between atmosphere and alveoli
2. internal respiration: exchange of gases between blood and cells of the body
3. cellular respiration – utilization of O2/ production of CO2 in the cell metabolism
Atmosphere cells

I. Non-Respiratory Functions of the Lung

1. Defense of the lung. 70m2 exposed surface area. Approximately 10,000 liters/day of air enters the alveoli. Aspiration is also a
problem.

A. Olfaction - olfactory receptors in posterior nasal cavity, not in trachea, bronchi, or alveoli. Can sniff to attempt to detect potentially
dangerous gases. This rapid shallow inspiration brings gases in contact with olfactory sensors without bringing them into the lung.

B. Air conditioning" - the mucosa of the nose, mouth and pharynx has a large surface area and a rich blood supply that humidifies and
heats or cools inspired gases. Surface area of nasal turbinates is approximately 160cm2

C. Filtration and cleansing mechanisms:

1. Filtration
a) Hairs at the inlet filter large particles (particles greater than 10-15 microns in diameter).
b) Contours of the nasal turbinates force inspired air to pass in numerous narrow streams so that solid
particles pass close to either the nasal septum or mucosa of the turbinates. Particles simply impinge
directly on mucosa or settle by gravity. Particles greater than 10µ are almost completely removed in the
nose, along with some smaller ones.
c) Particles between 2 - 10µ usually settle on the mucus-lined walls of the trachea, bronchi, and bronchioles.
d) Particles between 0.3 and 2.0µ and all foreign gases reach the alveolar ducts and alveoli.
e) Particles less than 0.3µ in diameter usually remain as aerosols and are almost entirely expired.
f) Particles removed may include: silica, asbestos, inert dust, bacteria, and toxic gases.

2. Removal of filtered particles:

a. Sneeze or cough: deep inspiration, followed by a forced expiration against a closed glottis and vocal cords then
abrupt opening of glottis and vocal cords. Results in explosive expelling of air --very high flow rates.

b. Cilia - line entire respiratory tract (except part of pharynx, anterior 1/3 of nose, and the terminal respiratory
units). Beating appears to be coordinated such that the sheet of mucus (containing trapped foreign particles)
secreted by goblet cells and mucous glands is propelled toward the pharynx where is it swallowed or
expectorated. Mechanism of control is not well understood. Nerves do not appear to be involved. Inhaled
irritants may slow down or "paralyze" cilia.

c. Must suction the airways of patients unable to cough or clear the airways.

D. Defense mechanisms of the terminal respiratory units

1. Alveolar macrophages - large mononuclear ameboid cells - scavenge the alveolar surface. Contain lysosomes
capable of killing bacteria. Engulf inhaled particles. Many other functions, including secretion of components of
immune and inflammatory responses such as cytokines, arachidonic acid derivatives, enzymes, and growth
 factors. Appear to emigrate to the sheet of mucus on the walls of terminal bronchioles and "ride" up to larger
airways.

2. Other particles may be removed by reaching the mucus sheets by upward movement of the alveolar fluid lining;
penetration into the interstitial space for phagocytosis by tissue histiocytes, and/or entrance into the lymphatic
channels. Particles may also be destroyed by surface enzymes or removed by immunologic reactions.

E. Reflexes from the upper and lower respiratory tracts: cough, sneeze, bronchoconstriction, etc.

F. Overview of pulmonary defense mechanisms

II. Non-respiratory functions of the pulmonary circulation.

A. Reservoir for left ventricle. Contains about 500 ml. blood.

B. Filter to protect the systemic circulation: traps particles that enter mixed venous blood as a result of natural processes, trauma, or
therapeutic measures.

1. More pulmonary capillaries than are necessary for gas exchange in normal resting man.
2. Particles filtered include: small fibrin or blood clots, fat cells, bone marrow, detached cancer cells, gas bubbles,
agglutinated RBC's (esp. sickled), masses of platelets or WBC's, debris in stored blood, and particles in i.v. solutions.
3. Decrease in diffusing capacity is usually transient (e.g. 4-5 days). Mechanisms for particle removal include lytic enzymes
and macrophages.
4. Must filter blood of patients on cardiopulmonary bypass.
C. Fluid exchange and drug absorption.

III. Metabolic functions of the lung.

A. Uptake or conversion by lungs of chemical substances in mixed venous blood

B. Formation of chemical substances in lungs and release for local use.

1. Pulmonary surfactant - formed in Type II alveolar cells.

2. Release of histamine and serotonin from mast cells in response to pulmonary embolism and anaphylaxis - cause
bronchoconstriction and may initiate cardiopulmonary reflexes.

C. Release into blood of substances stored in pulmonary tissues or cells: bradykinin, histamine, serotonin, PGE2, PGF2alpha, heparin
and many other substances are all stored in the lung and may be released. See roles of alveolar macrophages above.

PHONATION
Phonation is the production of sounds by the movement of air through the vocal cords. Speech, singing, and other sounds are produced by
the actions of the central nervous system controllers on the muscles of respiration, causing air to flow through the vocal cords and the mouth.

ACID-BASE BALANCE
In the body, increases in carbon dioxide lead to increases in hydrogen ion concentration (and vice versa) because of the following reaction:
CO2 _ H2O ⇀ ↽ H2CO3 ⇀ ↽ H_ _ HCO3 _
The respiratory system can therefore participate in acid-base balance by removing CO2 from the body. The central nervous system has sensors
for the CO2 and the hydrogen ion levels in the arterial blood and in the cerebrospinal fluid that send information to the controllers of
breathing.