RESPIRATORY SYSTEM



The Respiratory Organs

• Nose
• Pharynx
• Larynx
• Trachea
• Bronchi
• Bronchioles
• Lungs
Human Respiratory System

Figure 10.1


The Process of Respiration Includes:

• Moving air in and out of the lungs
• Exchanging gases between air and blood
• Exchanging gases between blood and
body cells
• The use of oxygen and production of
carbon dioxide by the cells
NOSE

• contains two nostrils, openings that enter the

nasal cavities

• nasal cavities are narrow canals separated from
one another by a median septum
• the surface area of the cavity walls in increased
by bone projections called conchae (concha)

• the lacrimal (tear) glands in the upper lateral
corner of the orbit drain into the nasal cavities by
way of tear ducts. This is why crying produces a
runny nose
NOSE

• paranasal sinuses are air-filled spaces

within the skull, inflammation of this
membrane is called sinusitis. If
passageways to the sinuses are blocked a
partial vacuum is created, causing a sinus
headache

• the nasal cavities are separated from the
oral cavity (mouth) by the hard and soft
palates, and they empty into the
nasopharynx
NOSE

• when we swallow, the uvula, a posterior

extension of the soft palate, moves back
and blocks the nasopharynx so that food
does not ordinarily enter the nose


PHARYNX

• commonly called the throat, connects the
nasal and oral cavities to the larynx
Human Respiratory System

Figure 10.1
 LARYNX

• at the top of the larynx is a variable-sized

opening called the glottis

• when food is being swallowed, a flap of
tissue called the epiglottis covers the glottis
so that no food passes into the larynx

• also called the voice box because the
vocal cords are inside the larynx
 LARYNX

• when air passes through the glottis, the

vocal cords vibrate producing sound

• at the time of puberty, the growth of the
larynx and vocal cords is much more rapid
and accentuated in the male than in
female, causing the male to have a more
prominent adam's apple and a deeper
voice
LARYNX

• the voice breaks in the young male due to

his inability to control the longer vocal
cords. these changes cause the male voice
to have a lower pitch

• the high or low pitch of the voice is
regulated when speaking and singing by
changing the tension on the vocal cords
LARYNX

• the greater the tension , as when the glottis

becomes more narrow, the higher the pitch

• when glottis is wider, the pitch is lower

• the loudness or intensity of the voice
depends upon the amplitude of the
vibrations (degree to which vocal cords
vibrate)
Human Respiratory System

Figure 10.1
TRACHEA

• commonly called the windpipe

• wall of trachea contains C-shaped hyaline
cartilage rings that prevent it from
collapsing and hold it open for the passage
of air
Human Respiratory System

Figure 10.1
 BRONCHI AND BRONCHIOLES

• The bronchi are small air passages,

composed of hyaline cartilage, that extend
from the trachea to the bronchioles. There are
two bronchi in the human body that branch off
from the trachea. The bronchi are lined with
mucous membranes that secrete mucus and
cilia that sweep the mucus and particles up
and out of the airways.
Human Respiratory System

Figure 10.1
 Alveoli
Have a very thin membrane that allows rapid
diffusion of oxygen and carbon dioxide between
capillary blood and alveolar air spaces.
Lined with surfactant to prevent alveolar
collapse.
20
Alveoli Are The Site Of Gas Exchange

» clustered at the ends of terminal

bronchioles
» make up the bulk of lung tissue
» their primary function is the exchange of
gases between themselves and the blood

21
 Surfactant
Essential fluid that lines the alveoli and smallest
bronchioles.
Reduces surface tension of the lung allowing the
oxygen and carbon dioxide across the
membrane.
Lack of Surfactant
 Lack of Surfactant
Premature infants can have Respiratory Distress
Syndrome due to immaturity of lungs.
Persons with Chronic Obstructive Pulmonary
Disease (COPD).
Components of the Upper
Respiratory Tract

Figure 10.2
Upper Respiratory Tract

• mouth
• nasal cavity
• pharynx
• larynx

26
 Upper Respiratory Tract
Functions

■ Passageway for respiration

■ Receptors for smell
■ Filters incoming air to filter larger foreign
material
■ Moistens and warms incoming air
■ Resonating chambers for voice
Components of the Lower
Respiratory Tract

Figure 10.3
Lower Respiratory Tract

• Trachea
• Bronchi
• Bronchioles
• Lungs

29
 Lower Respiratory Tract

■ Functions:
■ Larynx: maintains an open airway, routes food
and air appropriately, assists in sound production
■ Trachea: transports air to and from lungs
■ Bronchi: branch into lungs
■ Lungs: transport air to alveoli for gas exchange
LUNGS

• contains approximately 300 million alveoli,

very light

• large, cone-shaped organs

• each lung has a narrow and rounded apex
that extends above the level of the clavicle


Lungs

• consist of light, spongy tissue whose volume

is occupied mostly by air-filled spaces
• these irregular cone-shaped organs nearly
fill the thoracic cavity, with their bases
resting on the curved diaphragm
• rigid conducting airways, the bronchi,
connect the lungs to the main airway, the
trachea

32
LUNGS

• the base of each lung is broad and

concave to fit the convex surface of the
diaphragm

• other lung surfaces follow the contours of
the ribs and of the organs present in the
thoracic cavity

• lungs are completely enclosed and by way
of the pleural membranes, adhere to the
walls of the thoracic cavity
Mechanisms of Breathing

Inspiration
- the active phase of breathing
- during this time the diaphragm and
intercostals (rib) muscles contact,
intrapleural pressure decreases even
more, the lungs expand and air rushes in

Expiration
- passive phase of breathing
Four Primary Functions

1. Exchange of gases between the

atmosphere and the blood
- the body brings in O2 for distribution to
the tissues and eliminates CO2 waste
produced by metabolism

2. Homeostatic regulation of body pH
Four Primary Functions

3. Protection from inhaled pathogens and

irritating substances
- like all other epithelia that contact the
external environment, the respiratory
epithelium is well supplied with
mechanisms that trap and destroy
potentially harmful substances before they
can enter the body
Four Primary Functions

4. Vocalization
- air moving across the vocal cords
creates vibrations used for speech, singing
and other forms of communication
Respiratory Cycle

Figure 10.9


Cellular Respiration

• the intracellular reaction of oxygen with
organic molecules to produce carbon
dioxide, water and energy in the form of
ATP
External Respiration

• movement of gases between the environment
and the body's cells

• has four integral processess
a. the exchange of air between the atmosphere
and the lungs. This process is known as
ventilation or breathing

Inspiration (inhalation) is the movement of
air into the lungs
Expiration (exhalation) is the movement of
air out of the lungs


External Respiration

b. The exchange of O2 and CO2 between
the lungs and the blood

c. The transport of oxygen and CO2 by the
blood

d. The exchange of gases between blood
and the cells
• External respiration requires the
coordinated functioning of the respiratory
and cardiovascular system

• The respiratory system consists of
structures involved in ventilation and gas
exchange:
1. The conducting system of passages or
airways, that lead from the external
environment to the exchange surface of the
lungs

2. The alveoli, a series of interconnected sacs
that collectively form the exchange surface,
where oxygen moves from inhaled air to the
blood and carbon dioxide moves from the
blood to air that is about to be exhaled

3. The bones and muscles of the thorax and
abdomen that assist in ventilation
Ventilation

» the first exchange in respiratory physiology

» also known as breathing

44
 Lung Volumes Change During Ventilation

• a person's pulmonary function be

assessed by measuring how much air the
person moves during quiet breathing, then
with maximum effort

• these pulmonary function tests use a
spirometer, an instrument that measures
the volume of air moved with each breath
Lung Volumes

• the air moved during breathing can be

divided into four lung volumes
a. Tidal volume (Vt)
b. Inspiratory Reserve Volume (IRV)
c. Expiratory Reserve Volume (ERV)
d. Residual Volume (RV)
Lung Volumes

• The numerical values represent average

volumes for a 70-kg man

• Males Females
Vt 500 500
IRV 3000 1900
ERV 1100 700
RV 1200 1100
5800ml 4200ml


Instruction in Doing the Test

• A. "Breath quietly"
– the volume of air that moves during a single
inspiration or expiration is known as the tidal
volume. Average tidal volume during quiet
breathing is about 500ml
Instruction in Doing the Test

• B. "Now at the end of a quiet

inspiration, take in as much additional
air as you possibly can"
– the additional volume that is inspire above the
tidal volume represents the inspiratory reserve
volume. In a 70-kg man, this volume is about
3000ml, a sixfold increase over the normal
tidal volume


Instruction in Doing the Test

• C. "Now stop at the end of a normal
exhalation, then exhale as much air as
you can"
– the amount of air forcefully exhaled after the
end of a normal expiration is the expiratory
reserve volume, which average about 1100ml


Instruction in Doing the Test

• D. The fourth volume cannot be measured
directly. Even if you blow out as much as
you can, air still remains in the lungs and
the airways. The volume of air in the
respiratory system after maximal
exhalation, about 1200ml is called the
residual volume
Measurement of Lung Capacity

Figure 10.10A


Lung Capacity


• the sum of two or more lung volume


Vital
Capacity


• the sum of the inspiratory reserve volume,
expiratory reserve volume and tidal volume
• represents the maximum amount of air that
can be voluntarily moved into or out of the
respiratory system with one breath


Vital Capacity

• to measure vital capacity, a person must
take in as much air as possible then blow it
all out
• decreases with age

• the vital capacity plus the residual volume
yields the total lung capacity
 During breathing, the upper airways
and the bronchi do more than simply serve
as passageways for air. They play an
important role in conditioning air before it
reaches the alveoli.

Conditioning has three components:


Three Components

1. Warming air to body temperature (370), so

that core body temperature will not change
and alveoli will not be damaged by cold air

2. Adding water vapor until the air reaches
100% humidity, so that the moist exchange
epithelium will not dry out

3. Filtering out foreign material, so that
viruses, bacteria and inorganic particles
will not reach the alveoli
 Inhaled air is warmed by the body's
heat and moistened by water evaporating from
the mucosal lining of the airways

under normal circumstances, by the time air
reaches the trachea, it has been conditioned to
100% humidity and 370C

Breathing through the mouth is not nearly as
effective at warming and moistening air as
breathing through the nose
 If you exercise outdoors in very cold
weather, you may be familiar with the ache
in your chest that results from breathing
cold air through your mouth

filtration of air takes place both in the
trachea and in the bronchi. these airways
are lined with ciliated epithelium that
secretes both mucus and a dilute saline
solution
 The cilia are bathed in a watery saline
layer. On top of them lies a sticky layer of
mucus that traps most inhaled particles
larger than 2um

The mucus layer is secreted by goblet
cells in epithelium. The cilia beat with an
upward motion that moves the mucus
continuously toward the pharynx creating
what is called the mucociliary escalator

Mucus contains immunoglobulins that can
disable many pathogens and once the
mucus reaches the pharynx and is
swallowed, stomach acid and enzyme
destroy any remaining microorganisms


Inspiration Occurs when Alveolar Pressure Decreases

• for air to move into the lungs, pressure
inside the lungs must become lower than
the atmospheric pressure

• during inspiration, thoracic volume
increases when certain skeletal muscles of
the rib cage and diaphragm
Inspiration Occurs when Alveolar Pressure Decreases

• when the diaphragm contracts, it loses its

dome shape and drops down toward the
abdomen

• in quiet breathing, the diaphragm moves
about 1.5cm. This movement increases
thoracic volume by flattening its floor

• contraction of the diaphragm causes
between 60% and 75% of the inspiratory
volume change during normal quiet
breathing
Inspiration Occurs when Alveolar Pressure Decreases

• movement of the rib cage creates the

remaining 25-40% of the volume change

• during inhalation, the external intercostals
and scalene muscles contract and pull the
ribs upward and out

• as air continues to flow into the alveoli,
pressure increases until the thoracic cage
stops expanding, just before the end of
inspiration
Inspiration Occurs when Alveolar Pressure Decreases

• air movement continues for a fraction of a

second longer, until pressure inside the
lungs equalizes with atmospheric pressure

• at the end of inspiration, lung volume is at
its maximum for the respiratory cycle, and
alveolar pressure is equal to atmospheric
pressure


Expiration Occurs when Alveolar Pressure exceeds Atmospheric Pressure

• at the end of inspiration, impulses from
somatic motor neurons to the inspiratory
muscles cease and the muscles relax

• elastic recoil of the lungs and thoracic cage
returns the diaphragm and rib cage to their
original relaxed positions


Expiration Occurs when Alveolar Pressure exceeds Atmospheric Pressure

• Because expiration during quiet breathing

involves passive elastic recoil rather than active
muscle contraction, it is called passive
expiration

• time 2 -4 sec: expiration. As lung and thoracic
volume decrease during expiration, air pressure
in the lungs increases, reaching a maximum of
about 1mmHg above atmospheric pressure.
Alveolar pressure is now higher than atmospheric
pressure, so air flow reverses and air moves out
of the lungs
Expiration Occurs when Alveolar Pressure exceeds Atmospheric Pressure

• time 4 sec: At the end of expiration, air

movement ceases when alveolar pressure
is again equal to atmospheric pressure.
Lung volume reaches its minimum for the
respiratory cycle. At this point, the
respiratory cycle has ended and is ready to
begin again with the next breath
Expiration Occurs when Alveolar Pressure exceeds Atmospheric Pressure

• Active expiration occurs during voluntary

exhalations and when ventilation exceeds 30-40
breaths per minute. (Normal resting ventilation
rate is 12-20 breaths per minute for an adult)

• Active expiration uses the internal intercostals
muscles and abdominal muscles which are not
used during inspiration. These muscles are
collectively called the expiratory muscles
Rate and Depth of Breathing Determines the Efficiency of Breathing

• effectiveness of ventilation can be

estimated by calculating total pulmonary
ventilation, the volume of air moved into
and out of the lungs each minute

• the normal ventilation rate for an adult is
12-20 breaths per minute
Rate and Depth of Breathing Determines the Efficiency of Breathing

• some air that enters the respiratory system

does not reach the alveoli because part of
every breath remains in the conducting
airways, such as the trachea and bronchi

• because the conducting airways do not
exchange gases with the blood, they are
known as the anatomic dead space
Rate and Depth of Breathing Determines the Efficiency of Breathing

• anatomic dead space averages about

150ml

• consider this typical breath that moves
500ml of air during a respiratory cycle:
a. at the end of an inspiration, lung volume
is maximal , and fresh air fills the dead
space
Rate and Depth of Breathing Determines the Efficiency of Breathing

b. The tidal volume of 500ml is exhaled.

However, the first portion of this 500ml to exit
the airways is the 150ml of resh air that had
been in the dead space, followed b 350ml of
"stale" air from the alveoli. Thus even thoguh
500ml of air is exited the alveoli, only 350ml of
that volume left the body. The remaining
150ml of "stale" alveolar air stays in the dead
space
Rate and Depth of Breathing Determines the Efficiency of Breathing

c. At the end of expiration, lung volume is at its

minimum, and stale air from the most recent
expiration fills the anatomic dead space

d. With the next inspiration, 500ml of fresh air
enters the airways. The entering air returns the
150ml of stale air in the anatomic dead space to
the alveoli, followed by the first 350ml of the fresh
air. The last 150ml of inspired fresh air again
remains in the dead space and never reaches he
alveoli
Pulmonary Ventilation
- the volume of air moved into and out
of the lungs each minute

Alveolar Ventilation
- the amount of fresh air that reaches
the alveoli each minute
Maximum Voluntary Ventilation
- involves breathing as deeply and
quickly as possible

Hyperventilation
- alveolar ventilation increases above
normal levels

Hypoventilation
- less fresh air enters the alveoli
Note:
The amount of oxygen that enters the
alveoli with each breath is roughly equal to
the amount of oxygen that enters the blood

The amount of fresh air that enters the
lungs with each breath is only a little more
than 10% of the total lung volume at the
end of inspiration
Normal ventilation Values in Pulmonary Medicine

TOTAL PULMONARY
6 L/min
VENTILATION

TOTAL ALVEOLAR
4.2 - 4.3 L/min
VENTILATION

MAXIMUM VOLUNTARY
125-170 L/min
VENTILATION

RESPIRATION RATE 12 - 20 breaths/min

Effects of Breathing Patterns on Alveolar Ventilation

FRESH AIR TO
VENTILATION TOTAL ALVEOLI (ML)
ALVEOLAR
TIDAL RATE PULMONARY (TIDAL
VENTILATION
VOLUME (BREATHS/ VENTILATION VOLUME-DEAD
(ML/MIN)
MIN) (ML/MIN) SPACE
VOLUME)

500 (normal) 12 (normal) 6000 350 4200

300 (shalow) 20 (rapid) 6000 150 3000

750 (deep) 8 (slow) 6000 600 4800

Types and Patterns of Ventilation

NAME DESCRIPTION EXAMPLES

NORMAL QUIET
EUPNEA
BREATHING

INCREASED
RESPIRATORY
RATE AND/OR
HYPERPNEA VOLUME IN EXERCISE
RESPONSE TO
INCREASED
METABOLISM


Types and Patterns of Ventilation

INCREASED
RESPIRATORY
EMOTIONAL
RATE AND/OR
HYPERVENTILATION
HYPERVENTILATION VOLUMNE
; BLOWING UP A
WITHOUT BALLOON
INCREASED
METABOLISM

SHALLOW
DECREASED
BREATHING;
HYPOVENTILATION ALVEOLAR
ASTHMA; LUNG
VENTILATION
DISEASE
Types and Patterns of Ventilation

RAPID BREATHING;
USUALLY INCREASED
TACHYPNEA RESPIRATORY RATE PANTING
WITH DECREASED
DEPTH

VOLUNTARY
CESSATION OF BREATH-HOLDING;
APNEA DEPRESSION OF CNS
BREATHING
CONTROL CENTERS

DIFFICULTY VARIOUS
DYSPNEA BREATHING (AIR PATHOLOGIES OR
HUNGER) HARD EXERCISE
Local Control of Arterioles and Bronchioles by Oxygen and Carbon dioxide

GAS BRONCHIOLE PULMONARY SYSTEMIC

COMPOSITION S ARTERIOLES ARTERIOLES

P CO2
DILATE CONSTRICT DILATE
INCREASES
P CO2
CONSTRICT DILATE CONSTRICT
DECREASES
P O2
CONSTRICT DILATE CONSTRICT
INCREASES
P O2
DILATE CONSTRICT DILATE
DECREASES
Three Categories of Problems Result in Low Arterial Oxygen Content

• Inadequate oxygen reaching the alveoli

• Problems with oxygen exchange between
alveoli and pulmonary capillaries

• Inadequate transport of oxygen in the
blood
 If the diffusion of gases between alveoli
and blood is significantly impaired,
hypoxia (a state of too little oxygen)
results. Hypoxia frequently goes hand in
hand with hypercapnia, elevated
concentrations of carbon dioxide or the
presence of excessive amounts of carbon
dioxide in the blood
Normal Blood Values in Pulmonary Medicine

ARTERIAL VENOUS

95mm Hg
P O2 40mm Hg
(85-100)
40mm Hg
P CO2 46mm Hg
(35-45)
7.4
pH 7.37
(7.38-7.42)
Upper Respiratory Tract Infections

Common Colds
- viral infection usually begins as a
scratchy sore throat followed by watery
mucous discharge from the nasal cavities

Influenza
- viral infection usually accompanied by
aches and pains in the joints and fever
 Upper Respiratory Tract Infections

Sinusitis
- infection of the sinuses
- nasal congestion blocks the tiny
openings leading to the sinuses

Otitis media
- bacterial infection of the middle ear
Upper Respiratory Tract Infections

Tonsilitis
- tonsils become inflamed and enlarged

Laryngitis
- infection of the larynx with an
accompanying hoarseness leading to the
inability to talk in an auditory voice
 Lower Respiratory Tract Infections

Bronchitis
- bacterial infection of the bronchi
resulting in a heavy mucus discharge with
persistent coughing (acute)
- constant irritation of the lining of the
bronchi (chronic)

Pneumonia
-caused by bacteria or viruses that
infect the lungs
Lower Respiratory Tract Infections

Asthma
- disease of the bronchi and bronchioles
that is marked by wheezing,
breathlessness and sometimes cough and
expectoration of mucus
Drugs for Asthma and Broncho-
constrictive Disorders
Clinical Manifestations - Asthma
Dyspnea – difficulty breathing
Wheezing
Chest tightness
Cough – chronic cough may be the only
symptom
Sputum production
 Precipitating Factors - Triggers
Viral infections – especially with infants and
young children
Allergies
Smoggy air – smoke from fires
Windy weather – hot and dry Santa Ana winds
Albuterol INH - Nebulizer
 Directions for use of inhaler
Shake well
Exhale (breathe out) through your nose while
keeping mouth shut
Close lips around mouth piece
Take slow, deep breath through the mouthpiece
as you press down on container to release the
medication
Hold breath for 5-10 seconds
Exhale slowly