Chapter 23

Respiratory System
Student Learning Outcomes
After reading this chapter, students should be able to:

23.1A List the structures that comprise the respiratory system.

23.1B Describe the structural and function anatomy of the respiratory system.
23.2A Describe the functions of the respiratory system.
23.3A Describe the anatomy of the respiratory passages, beginning at the nose and
ending with the alveoli.
23.3B State the parts of the respiratory membrane.
23.3C Explain the role of the thoracic wall in respiration.
23.3D Describe the structure of the lungs, including the blood and lymphatic supply.
23.3E Explain the role of the pleura in respiration.
23.4A Explain the role of the muscles of respiration in ventilation.
23.4B Explain partial pressure and its relationship to the concentration of gases in the body.
23.4C List the pulmonary volumes and capacities and define each of them.
23.4D Distinguish between anatomical dead space and physiological dead space.
23.4E Define compliance, minute volume, and alveolar ventilation.
23.5A Describe the changes in alveolar pressure that are responsible for the movement of
air into and out of the lungs.
23.5B Explain how surfactant and pleural pressure prevent the collapse of the lungs and
how changes in pleural pressure cause changes in alveolar volume.
23.5C Describe the partial pressure gradients for O2 and CO2.
23.5D Explain the factors that affect gas movement through the respiratory membrane.
23.6A Contrast fetal hemoglobin with maternal hemoglobin.
23.6B Explain how O2 and CO2 are transported in the blood.
23.6C Explain the CO2 exchange in the lungs and at the tissues.
23.6D Discuss the factors that affect O2 and CO2 transport in the blood.
23.7A Describe the relationship between alveolar ventilation and pulmonary
capillary perfusion.
23.7B Describe the respiratory areas of the brainstem and how they produce a
rhythmic pattern of ventilation.
23.7C Explain how blood pH, CO2 and O2 levels affect ventilation.
23.7D Discuss the Hering-Breuer reflex and its importance.
23.7E Explain how the cerebral cortex and limbic system can affect ventilation.
23.7F Describe the effect of exercise on ventilation.
23.8A Describe the effects of aging on the respiratory system.

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Chapter Outline
23.1 Anatomy of the Respiratory System
1. The respiratory system consists of the external nose, nasal cavity, pharynx, larynx, trachea,
bronchi, and lungs.
23.2 Functions of the Respiratory System
1. Respiration includes ventilation: the movement of air into and out of the lungs,
pulmonary respiration: the exchange of gases between the air and the blood, gas
transport: the transport of gases in the blood, and systemic respiration: the exchange of
gases between the blood and tissues.
2. Other functions of the respiratory system are regulation of blood pH, production of
chemical mediators, voice production, olfaction, and protection against some
microorganisms.
23.3 Structures and Histology of the Respiratory Tract
The Upper Respiratory Tract
1. The nose consists of the external nose and the nasal cavity.
2. The bridge of the nose is bone, and most of the external nose is cartilage.
3. Openings of the nasal cavity
 The nares open to the outside, and the choanae lead to the pharynx.
 The paranasal sinuses and the nasolacrimal duct open into the nasal cavity.
4. Parts of the nasal cavity
 The nasal cavity is divided by the nasal septum.
 The anterior vestibule contains hairs that trap debris.
 The nasal cavity is lined with pseudostratified ciliated columnar epithelium that
traps debris and moves it to the pharynx.
 The superior part of the nasal cavity contains the olfactory epithelium.
5. The nasal cavity serves as a passageway for air; cleans and humidifies air; is the
location for the sense of smell; and, with the paranasal sinuses, functions as a
resonating chamber for speech.
6. The nasopharynx joins the nasal cavity through the internal choanae and contains the
openings to the auditory tube and the pharyngeal tonsils.
7. The oropharynx joins the oral cavity and contains the palatine and lingual tonsils.
8. The laryngopharynx opens into the larynx and the esophagus.
9. Cartilage
Three of the cartilages are unpaired. The thyroid cartilage and cricoids cartilage form
most of the larynx. The epiglottis covers the opening of the larynx during swallowing.
Six of the cartilages are paired. The vocal folds attach to the arytenoids cartilages.
10. The larynx maintains an open air passageway, regulates the passage of swallowed
materials and air, produces sounds, and removes debris from the air.
11. Sounds are produced as the vocal folds vibrate when air passes through the larynx.
Tightening the folds produces sounds of different pitches by controlling the length of
the fold, which is allowed to vibrate.
The Lower Respiratory Tract
1. The trachea connects the larynx to the main bronchi.
2. The trachealis muscle regulates the diameter of the trachea.

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 3. The trachea divides to form two main bronchi, which extend to the lungs. The main
bronchi divide to form lobar bronchi, which divide to form segmental bronchi, which
divide to form bronchioles, which divide to form terminal bronchioles.
4. The trachea to the terminal bronchioles is a passageway for air movement.
 The area from the trachea to the terminal bronchioles is ciliated to facilitate the
removal of inhaled debris.
 Cartilage helps hold the tube system open (from the trachea to the bronchioles).
 Smooth muscle controls the diameter of the tubes (terminal bronchioles).
5. Terminal bronchioles divide to form respiratory bronchioles, which give rise to
alveolar ducts. Air-filled chambers called alveoli open into the respiratory
bronchioles and alveolar ducts. The alveolar ducts end as alveolar sacs, which are
chambers that connect to two or more alveoli.
6. Gas exchange occurs between the respiratory bronchioles and the alveoli.
7. The components of the respiratory membrane are a film of water, the walls of the
alveolus and the capillary, and an interstitial space.
8. The thoracic cavity contains two lungs.
Thoracic Wall and Muscles of Respiration
1. The thoracic wall consists of vertebrae, ribs, the sternum, and muscles that allow
expansion of the thoracic cavity.
2. Contraction of the diaphragm increases thoracic volume.
3. Muscles can elevate the ribs and increase thoracic volume or depress the ribs and
decrease thoracic volume.
Lungs
1. The lungs are divided into lobes, bronchopulmonary segments, and lobules.
Blood Supply to the Lungs
1. Deoxygenated blood is transported to the lungs through the pulmonary arteries, and
oxygenated blood leaves through the pulmonary veins.
2. Oxygenated blood is mixed with a small amount of deoxygenated blood from the
bronchi.
Lymphatic Supply to the Lungs
1. The superficial and deep lymphatic vessels drain lymph from the lungs.
Pleura
The pleural membranes surround the lungs and protect against friction.
23.4 Behavior of Gases
Behavior of Gases and Ventilation
1. Ventilation is the movement of air into and out of the lungs.
2. Air moves from an area of higher pressure to an area of lower pressure.
3. Pressure is inversely related to volume (Boyle’s Law).
Measurement of Lung Function
1. Four pulmonary volumes exist: tidal volume, inspiratory reserve volume, expiratory
reserve volume, and residual volume.
2. Pulmonary capacities are the sum of two or more pulmonary volumes and include
inspiratory capacity, functional residual capacity, vital capacity, and total lung
capacity.

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 3. The forced expiratory vital capacity measures vital capacity while the individual
exhales as rapidly as possible.
4. Minute volume is the total amount of air moved in and out of the respiratory system
per minute.
5. Dead space is the part of the respiratory system where gas exchange does not take
place.
6. Alveolar ventilation is how much air per minute enters the parts of the respiratory
system where gas exchange takes place.
7. Compliance is a measure of lung expansion caused by intra-alveolar pressure.
8. Reduced compliance means that it is more difficult than normal to expand the lungs.
Behavior of Gases and Respiration
1. Partial pressure is the contribution of a gas to the total pressure of a mixture of gases
(Dalton’s law).
2. Water vapor pressure is the partial pressure produced by water.
3. The concentration of a dissolved gas in a liquid is determined by its pressure and by
its solubility coefficient (Henry’s law).
4. Atmospheric air, alveolar air, and expired air have different compositions.
23.5 Physiology of the Respiratory System
Mechanisms of Alveolar Ventilation
1. Inspiration results when barometric air pressure is greater than intra-alveolar pressure.
2. Expiration results when barometric air pressure is less than intra-alveolar pressure.
Factors Affecting Alveolar Ventilation
1. Lung recoil causes alveoli to collapse.
 Lung recoil results from elastic fibers and water surface tension.
 Surfactant reduces water surface tension.
2. Pleural pressure is the pressure in the pleural cavity.
 A negative pleural pressure can cause the alveoli to expand.
 Pneumothorax is an opening between the pleural cavity and the air that causes a
loss of pleural pressure.
3. Changes in thoracic volume cause changes in pleural pressure, resulting in changes in
alveolar volume, intra-alveolar pressure, and airflow.
Factors Affecting Diffusion Through the Respiratory Membrane
1. The respiratory membrane is thin and has a large surface area that facilitates gas
exchange.
2. The rate of diffusion of gases through the respiratory membrane depends on its
thickness, the diffusion coefficient of the gas, the surface area of the membrane, and
the partial pressure of the gases in the alveoli and the blood.
3. Oxygen moves from the alveoli (PO2 = 104 mm Hg) into the blood (PO2 = 40 mm
Hg). Blood is almost completely saturated with oxygen when it leaves the capillary.
4. The PO2 in the blood decreases (PO2 = 95 mm Hg) when it mixes with deoxygenated
blood.
5. Oxygen moves from the tissue capillaries (PO2= 95 mm Hg) into the tissues (PO2=
40 mm Hg).
6. Carbon dioxide moves from the tissues (PCO2= 45 mm Hg) into tissue capillaries
(PCO2 = 40 mm Hg).

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 7. Carbon dioxide moves from the pulmonary capillaries (PCO2 = 45 mm Hg) into the
alveoli (PCO2= 40 mm Hg).
23.6 Oxygen and Carbon Dioxide Transport in the Blood
Hemoglobin
1. Hemoglobin is a protein synthesized and contained with the red blood cells.
2. Fetal hemoglobin has a higher affinity for oxygen than maternal hemoglobin does.
Transport of O2
Oxygen is transported by hemoglobin (98.5%) and is dissolved in plasma (1.5%).
Transport of Carbon Dioxide
1. Carbon dioxide is transported dissolved in plasma (7%), as HCO3− dissolved in
plasma and in red blood cells (70%), and bound to hemoglobin (23%).
2. In tissue capillaries, the following events occur:
 Carbon dioxide combines with water inside red blood cells to form carbonic acid,
which dissociates to form HCO3−. Decreasing HCO3−concentrations promote
carbon dioxide transport.
 Exchange of Cl- for HCO3− occurs between plasma and red blood cells; this is
called the chloride shift.
 Hydrogen ions binding to hemoglobin promote carbon dioxide transport, prevent
a pH change in red blood cells, and produce a Bohr effect.
 In the Haldane effect, the smaller the amount of oxygen bound to hemoglobin, the
greater the amount of carbon dioxide bound to it, and vice versa.
3. In pulmonary capillaries, the events occurring in the tissue capillaries are reversed.
Summary of Gas Transport
O2 is delivered to the tissues and CO2 is taken from the tissues to the lungs to be released
from the body.
Physiological Factors Affecting Gas Transport
1. The oxygen-hemoglobin dissociation curve shows that hemoglobin is almost
completely saturated when PO2 is 80 mm Hg or above. At lower partial pressures, the
hemoglobin releases oxygen.
2. Hemoglobin’s ability to hold oxygen decreases because of a shift of the oxygen-
hemoglobin dissociation curve to the right due to decreased pH (Bohr effect),
increased carbon dioxide, or increased temperature.
3. Hemoglobin’s ability to hold oxygen increases because of a shift of the oxygen-
hemoglobin dissociation curve to the left due to increased pH (Bohr effect), decreased
carbon dioxide, or decreased temperature.
4. The substance 2,3-bisphosphoglycerate increases hemoglobin’s ability to release
oxygen.
23.7 Regulation of Ventilation
Local Control
1. Increased alveolar ventilation or increased pulmonary capillary perfusion increases
gas exchange.
2. The physiological shunt is the deoxygenated blood returning from the lungs.
Neural Control
1. The medullary respiratory center consists of the dorsal and ventral respiratory groups.
 The dorsal respiratory groups stimulate the diaphragm.

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  The ventral respiratory groups stimulate the intercostal and abdominal muscles.
2. The pontine respiratory group is involved with switching between inspiration and
expiration.
3. Neurons in the medullary respiratory center establish the basic rhythm of ventilation.
4. When stimuli from receptors or other parts of the brain exceed a threshold level,
inspiration begins.
5. As respiratory muscles are stimulated, neurons that stop inspiration are stimulated.
When the stimulation of these neurons exceeds a threshold level, inspiration is
inhibited.
6. Ventilation can be voluntarily controlled and can be modified by emotions.
7. Carbon dioxide is the major regulator of ventilation. An increase in carbon dioxide or
a decrease in pH can stimulate the chemosensitive area, causing a greater rate and
depth of ventilation.
8. Oxygen levels in the blood affect ventilation when a 50% or greater decrease from
normal exists. Decreased oxygen is detected by receptors in the carotid and aortic
bodies, which then stimulate the respiratory center.
9. Stretch of the lungs during inspiration can inhibit the respiratory center and contribute
to a cessation of inspiration.
10. Collateral fibers from motor neurons and from proprioceptors stimulate the
respiratory centers.
11. Chemosensitive mechanisms and learning fine-tune the effects produced through the
motor neurons and proprioceptors.
12. Touch, thermal, and pain sensations can modify ventilation.
13. Tidal volume, respiratory rate, minute ventilation, and gas exchange between the
alveoli and blood remain unchanged or slightly lower at rest or during submaximal
exercise but increase at maximal exercise.
23.8 Effects of Aging on the Respiratory System
1. Vital capacity and maximum minute ventilation decrease with age because of weakened
respiratory muscles and decreased thoracic cage compliance.
2. Residual volume and dead space increase because of the enlarged diameter of respiratory
passageways. As a result, alveolar ventilation decreases.
3. An increase in resting tidal volume compensates for decreased alveolar ventilation, loss
of alveolar walls (surface area), and thickening of alveolar walls.
4. The ability to remove mucus from the respiratory passageways decreases with age.

Topics Related to Respiratory System Function

Respiration is more than breathing. Other functions that most students do not know about
include: gas exchange between air in lungs and the blood (external respiration), transportation of
the gases, and gas exchange between the blood and the tissues (internal respiration). Also,
mention in the introduction that cellular respiration is also used in reference to cellular
metabolism.

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Smoking is an issue of concern to students. Students can research and write an essay about the
effects of cigarette smoke on the lungs and respiratory passages. Tell them to include the effects
of second-hand smoke. Compare this with the effects of smoke inhalation experienced by fire
fighters and victims in building fires.

Discuss why the respiratory system has protective mechanisms that usually prevent foreign
matter from getting into the alveoli. Ask students to predict the consequences when these
defenses are compromised.

Use Clinical Impact 23.6: Cough and Sneeze Reflexes, to initiate a discussion of these reflexes.
Have students explain the protective value of these reflexes.

Use the Diseases and Disorders of the Respiratory System to focus student attention on the ways
in which alveolar ventilation can be reduced. Students should know how each condition reduces
ventilation and the consequences of the reduction.

Themes in Chapter 23
Structure and Function
Anatomy of the Respiratory System

Compare the differences in wall structure among the parts of the respiratory system to the
specific functions performed by each part. Emphasize the protective features of the
pharyngeal epithelium, the ciliated, mucus producing epithelium of the trachea which helps
remove foreign particles, the smooth muscle of the terminal bronchioles which help regulate
airflow, and the simple squamous epithelium of the alveoli which allows gas exchange.

Maintenance of the functional separation between the digestive and respiratory tracts at the
pharynx involves reflexes and complex muscular coordination. Explain how the events of
swallowing manipulate the structures of the pharynx to functionally direct food to the
esophagus and keep it out of the trachea.

Review pulmonary circulation. Emphasize the independence of the air and blood supply to
each lobe and lobule of the lungs. This explains how surgical removal of parts of the lungs is
possible without disrupting the function of neighboring units.

Understanding of the arrangement of the pleural membranes is essential to an understanding of

pulmonary ventilation. Cover the roles of the pleural fluid as both lubricant and sealant
between the parietal and visceral pleura. The analogy of two sheets of plastic wrap stuck
together by a thin film of water can be used as a visual image.

Use Fig. 23.8, Alveolus and the Respiratory Membrane, to show the layers the gases must
cross.

Use Fig. 23.9, Effect of the Respiratory Muscles on Thoracic Volume, to facilitate the
discussion on ventilation. Clinical Impact 23.3: Effect of Spinal Cord Injury on Ventilation,

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 further covers the role of abdominal muscles in breathing.

Stress the value of pulmonary volumes and capacities in diagnosis of pulmonary disease.
Point out that restrictive types of pulmonary disease are characterized by a decreased vital
capacity, whereas obstructive respiratory diseases reduce airflow through the lungs, but do not
generally change the vital capacity. Use Fig. 23.13, Lung Volumes and Lung Capacities, to
explain lung volumes and capacities. An understanding of the relationship between pressure
and volume is essential in the understanding of ventilation. Use Process Figure 23.14, Intra-
alveolar Pressure Changes During Inspiration and Expiration, to facilitate this discussion.

Homeostasis
Behavior of Gases

Cover these topics well: partial pressure, diffusion of gases through liquids, diffusion of gases
through the respiratory membrane, and the relationship between ventilation and pulmonary
capillary blood flow.

Oxygen and Carbon Dioxide Transport in the Blood

Students must understand the partial pressures of oxygen and carbon dioxide in the alveoli,
lung capillaries, tissue capillaries, and tissues to understand gas exchange. Use Process Fig.
23.16, Gas Exchange, to explain these different values. Cover all gradients and be sure they
understand the heart’s relationship to the lungs in this figure.

Cover hemoglobin and oxygen transport in the blood and transport of carbon dioxide.
Students will get confused about the oxygen-hemoglobin dissociation curve and the chloride
shift if it is not simplified for them.

Control of Respiration
Students usually have significant difficulties understanding the complete reflexes involved in
ventilation. Cover respiratory areas in the brainstem and generation of rhythmic ventilation to
help students understand. Use Fig. 23.23, Major Regulatory Mechanisms of Ventilation, to
help students understand reflex pathways.

Students don’t know that carbon dioxide is the major regulator of respiration. Students must
understand the chemical equation that combines carbon dioxide and water to understand how
pH can change with changes in ventilation. Understanding this equation will also help them
understand the chloride shift, buffering, and production of HCl in the stomach. Use
Homeostasis Figure 23.22, Regulation of Blood pH, to help students understand the effect of
pH on ventilation. Clinical Impact 23.5: Importance of Reduced Po2 covers the importance of
reduced oxygen.

Respiratory Adaptations to Exercise

Tidal volume, respiratory rate, minute ventilation, and gas exchange between the alveoli and
blood remain unchanged or slightly lower at rest or during low levels of exercise, but increase
at maximal levels of exercise.

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 Changes Through Time
Effects of Aging on the Respiratory System
Use the Representative Diseases and Disorders of the Respiratory System to begin this
discussion. Also, the Systems Pathology: Asthma, will interest students. Systems Interactions
relates this problem to the other systems.

Learning Outcomes Correlation with Predict Question Types

Question Type Question # Bloom's level Learning Outcome
Learn to Predict Application 23.3d,e
Predict 1 Comprehension 23.3a
Predict 2 Comprehension 23.3a
Predict 3 Evaluation 23.2a
Predict 4 Evaluation 23.4c,e
Predict 5 Application 23.4b,23.5d
Predict 6 Evaluation 23.6b,d
Predict 7 Evaluation 23.6a
Predict 8 Comprehension 23.7c
Predict 9 Comprehension 23.6d
Predict 10 Comprehension 23.7c
Predict 11 Comprehension 23.7e
Predict 12 Evaluation 23.7c

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