Anatomy and Physiology of the Respiratory System

The Respiratory System has the following basic functions:

 Movement of air in and out of the lungs
 Exchange of Oxygen and Carbon Dioxide
 Helping maintain Acid-Base Balance
What’s more, this system warms inhaled air, filters air through the nasal hairs, and
distributes air through the vocal chords to allow speech

Upper Respiratory Tract

The upper respiratory tract consists of the nose, mouth, pharynx and larynx.
The nose consists of the external nose and the nasal cavity. The bridge of the nose is
bone, and most of the external nose is cartilage. During inspiration, air enters the body through
the nostrils (nares), where small hairs (vibrissae) filter out dust and large particles. Separated by
a septum, the two nasal passages are formed anteriorly by cartilaginous walls, and posteriorly by
light, spongy, bony structures known as conchae or turbinates.
Covered with a ciliated mucus layer, the conchae warm and humidify air before passing it
through the nasopharynx. These tiny projections form eddies in the flowing air, forcing it to
rebound in several different directions during its passage through the nose. This action traps finer
particles, which the cilia then propel to the pharynx to be swallowed. If the air passage around
the conchae is bypassed – for example, when a patient is on a ventilator – air must be humidified
and heated outside the body.
The conchae also divide the nasal passages into the superior, middle, and inferior
meatuses. The four paranasal sinuses, which provide speech resonance, drain through these
meatuses near the conchae.
The maxillary and frontal sinuses are large mucus-covered, air-filled cavities. The
sphenoid and ethmoid sinuses – also mucus-coated – consist of several small spaces in the bony
posterior portion of the nasal cavity.
The nasopharynx has lateral and posterior muscular walls. Air passes from the nasal
cavity into the nasopharynx through the choanae, which are always open. The pharyngeal tonsils
(adenoids) are located bilaterally near the choanae. In the lateral walls above the soft palate level
are the Eustachian tube openings. The Eustachian tubes regulate middle ear pressure during
swallowing or yawning.
The oropharynx is the posterior wall of the mouth that connects the nasopharynx with the
laryngopharynx, the lowest pharyngeal region, which stretches down to the esophagus. The
larynx, which contains the vocal cords, is a cartilogenous and muscular organ connecting the
pharynx and the trachea. Two of the trachea’s nine principal cartilages – the large, shield-shaped
thyroid cartilage (Adam’s apple) and the cricoids cartilage inferior to it – can be palpated in the
neck.
Formed by a leaf-shaped, flexible cartilage, the epiglottis hangs over the larynx. It bends
reflexively on swallowing, closing off the larynx to swallow substances. It opens to allow air to
enter and leave the trachea and lungs during inspiration and expiration. The inner laryngeal
structures include the vestibule, the glottis, the vocal folds, and the infraglottic cavity. The
vestibular folds (False Vocal Cords) are thick mucosal folds located just below the vestibule and
superior to the true vocal folds. The opening between the folds is called the Glottis. Located
posteriorly, the small paired arytenoid cartilages act as a fulcrum for vocal cord muscles.
The larynx aids coughing, an important protective mechanism. When dust, dirt, or other
irritants stimulate laryngeal sensory receptors, the abdominal and thoracic muscles contract
against the diaphragm, increasing pressure in the trachea bronchial tree. The vocal cords open
suddenly in a cough, forcing air and foreign particles out of the lungs.

Lower Respiratory Tract

The lower respiratory tract is subdivided into the conducting airways (trachea, primary
bronchi, and secondary bronchi) and the acinus (respiratory bronchioles, alveolar ducts and
alveoli). The primary work of the respiratory system, gas exchange, takes place in the acinus.
Mucous membrane lines the lower respiratory tract and constant movement of mucous by ciliary
action cleans the tract and carries foreign matter upward for swallowing or expectoration.
The tubular trachea, or windpipe, half contained in the neck and half in the thorax,
extends about 5 inches (12cm) from the only complete tracheal ring – the cricoid cartilage – to
the carina, or tracheal bifurcation, at the level of the 5th thoracic vertebra. 16-20 C-shaped
cartilaginous rings reinforce and protect the trachea preventing its collapse
The trachea branches into two primary (mainstem) bronchi at the carina. Composed of
tissue similar to that of the trachea, the walls of the primary bronchi are lined with epithelium
containing cilia, goblet (mucus-producing) cells, and microvilli that increase surface area
absorption. The right primary bronchus, a more direct passageway from the trachea, is wider and
about 1 inch (2.54 cm) shorter than the left primary bronchus. As a result, aspirated particles
entering the trachea – or a malpositioned endotracheal tube – are more likely to go into the right
bronchus than the left. Like the trachea the bronchi are reinforced with cartilaginous rings.
The primary bronchi divide into five secondary (lobar) bronchi. Accompanied by blood
vessels, nerves, and lymphatics, these bronchi enter the lungs at the hilum. Each secondary
bronchus (right upper, middle, and lower, and left upper, and lower) passes into its own lung
lobe. These branches further divide into the tertiary, or segmental bronchi, which supply air to
the 18 bronchopulmonary segments (10 on the right, and eight on the left). From the tertiary
bronchi, branching continues and airways become narrower, cartilage decreases, and smooth
muscle increases.
Each bronchiole, in turn, branches into the lobules. The lobule includes the terminal
bronchioles, which conclude the conducting airways, and the acinus, the chief respiratory unit for
gas exchange. These passages continue to branch off, terminating in alveolar ducts, which lead to
walled alveoli surrounded by a network of anastomosing capilliaries. Two-way gas diffusion
occurs through the thin alveolar walls.
There are three types of alveolar cells. Type I alveolar cells are simple squamous cells,
the most abundant form the alveolar walls through which gas exchange occurs. Type II alveolar
cells are metabolically active, these cells aid gas exchange by producing surfactant – a lipid-type
substance that coats the alveolus, preventing total alveolar collapse, and facilitates gas exchange
by decreasing surface tension. Type III alveolar cell macrophages, are large, phagocytic cells that
ingest foreign matter (e.g. mucus, bacteria) and act as an important defense mechanism.
Alveolar cells, along with minute interstitial space, capilliary basement membrane, and
endothelial cells in the capilliary wall, collectively make up the respiratory membrance,
separating the alveolus and capilliary. The entire structure normally is less than 1 micron thick.
Any increase in membrane thickness or decrease in surfactant production reduces the rate of gas
diffusion across the membrane.
Straddling the heart, the cone-shaped, spongy lungs fill the thoracic cavity, with the right
lung shorter and broader than the left. Each lung’s concave base rests on the diaphragm, and its
apex extends slightly above the first rib, about 1 inch (2.54 cm) above the clavicles. Lying above
and behind the heart, the hilum provides an opening through which the primary bronchus,
pulmonary and bronchial blood vessels, lymphatics, and nerves pass. Except at the hilum, where
ligaments anchor them, the lungs are freely movable. Along with the diaphragm, each lung base
moves up during expiration and down during inspiration. Fissures partially divide each lung into
lobes – three lobes in the right and two in the left lung. The medial, inferior surface of the left
lung curves slightly around and under the heart and forms a tonguelike structure called the
lingual pulmonis sinistri. The diaphragm, the floor of the thoracic cavity, separates the inferior
surfaces of both lower lobes from the abdominal viscera. The lateral boundary of both lungs is
the chest wall.
Composed of a visceral layer and the parietal layer, the pleura totally enclose the lung.
The visceral pleura, a serous membrane adhering closely to the lung parenchyma, envelops each
lung and lung and separates it from the mediastinal structures – the heart and its great vessels, the
trachea, the esophagus, and the bronchi. The parietal pleura, which lines the thoracic cavity from
the hilum, covers all areas that contact the lungs. The visceral pleura meets the parietal pleura at
the hilum, forming a narrow fold called the pulmonary ligament. Both the visceral and parietal
pleurae contain connective and epithelial tissues, and a single layer of secreting epithelium. As
they rub together during respiration secretions minimize friction. The area between the two
membranes is only a potential space and can’t be seen unless air or excess fluid occupies it.
Normally pleural fluid maintains the surface tension forces.

Pulmonary Circulation

The right and left pulmonary arteries take deoxygenated blood from the right side of the
heart to the lungs. These arteries divide into distal branches, called arterioles, that terminate as a
concentrated capilliary network in the alveoli and alveolar sacs. Here, gas exchange occurs. The
pulmonary veins also divide into branches. The venules collect the oxygenated blood from the
capilliaries and pass it along to larger vessels, which carry it back to the heart. The pulmonary
veins terminate at the left side of the heart, where they deliver oxygenated blood to be distributed
throughout the body.
An extensive network of lymph vessels drains the pulmonary pleura in the dense
connective tissues around the bronchi, respiratory bronchioles, pulmonary arteries, and veins.
Circulating freely, lymph flows into collecting trunks, which empty into bronchopulmonary
lymph nodes at the hilum.

Neurologic control of Breathing

A largely automatic and usually involuntary act, breathing is controlled neurologically by

certain regulators and chemoreceptors and with the aid of certain physiologic factors.
Located in the medulla oblongata and the pons, respiratory centers actually are groups of
scattered neurons that function as a unit to regulate breathing. At the primary location in the
medulla – the medullary-respiratory center – neurons associated with inspiration apparently
interact with neurons associated with expiration to regulate respiratory. These neurons react to
impulses from other areas, particularly the pons.
The apneustic center of the pons varulii constantly stimulates neurons in the inspiratory
center. The expiratory center inhibits inspiration, thereby providing time for muscle relaxation.
Impulses travel from the inspiratory center to the respiratory muscles by the way of phrenic
nerve and to the pneumotaxic center of the pons. After a slight delay, impulses move from the
pons to the expiratory center.
Thus the pons is the pacemaker that regulates the rhythm of respiration; the medulla
regulates rate and depth.
The Hering-Breuer Reflex, also regulates respiratory excurtion. Lung expansion
stimulates stretch receptors that send impulses along the vagal afferent fibers to the expiratory
center, thus inhibiting inspiration. When the lungs deflate, the stimulus stops, and inspiration
again dominates.

Chemical control of ventilation

Central chemoreceptors, located in the anterior medulla, respond to changes in pH,

Oxygen tension (PO2), Carbon Dioxide tension (PCO2), and peripheral chemoreceptors. These
anterior neurons are particularly sensitive to pH changes in cerebrospinal fluid: a decrease
quickly stimulates alveolar ventilation. The most active chemical stimulus is CO2 tension of
arterial blood: a small increase in inspired CO2 or hydrogen ion concentration decreases the pH,
causing quick medulla stimulation, which results in hyperventilation. The peripheral
chemoreceptors (the aortic and carotid bodies) sends changes in oxygen tension and directly
stimulate the central chemoreceptors.

Mechanics of Respiration

Voluntary and intercostals muscles, working with the diaphragm, reduce normal
inspiratory and expiratory movement of the lungs and chest wall. The lungs tendency to recoil
inward, balanced by the chest walls tendency to spring outward, creates a subatmospheric
pressure in the closed pleural cavity. This pressure, which is about – 5 mmHg below atmospheric
pressure, makes lung ventilation (gas volume movement) possible.
 At rest, the inspiratory muscles relax; atmospheric pressure is maintained in the
tracheobronchial tree while the lungs are at rest. Thus, no air movement occurs.
During inspiration, the central nervous system transmits impulses to the diaphragm via
the phrenic nerve, stimulating contraction. The diaphragm descends as its contracts, enlarging
the thorax vertically; external intercostals muscles also contract (especially during deep or forced
inspiration), raising the ribs and sternum, and enlarging the thorax horizontally. Thoracic
expansion lowers intrapleural pressure; pleural cohesion causes the lungs to expand with the
thorax; lung expansion lowers the intrapulmonic or bronchoalveolar pressure below atmospheric
pressure. The intrapulmonic-atmospheric pressure gradient pulls air into the lungs until the two
pressures equalize.
During expiration, CNS impulses to the diaphragm cease; the diaphragm slowly relaxes
and moves up in the thorax, and the lungs recoil to their resting size and position. This recoil also
reduces the thorax to its resting size. Compression of the lungs and thorax causes intrapulmonic
pressure to rise above atmospheric pressure. The intrapulmonic-atmospheric pressure gradient
forces air out of the lungs until the two pressures equalize.

Pulmonary Volumes and Capacity

Spirometry is the process of measuring volumes of air that move into and out of the
Respiratory System. Basically breathing is a rhythmic exchange of quantities of air. The
quantities can be broken down into specific lung volumes and capacities using a spirometer.
 Tidal Volume – the amount of air that enters or leaves the lungs during normal
breathing (inspiration and expiration). It amounts to about 500 milliliters (mL).
 Inspiratory Reserve Volume – the amount of air inhaled, by forced maximum
inspiration, above and beyond tidal volume. It amounts to about 3000 milliliters
(mL).
 Expiratory Reserve Volume – the amount of air forcibly exhaled beyond the tidal
volume. It amounts up to 1100 milliliters (mL).
 Residual Volume – the amount of air still remaining in the respiratory passages and
lungs after a maximum expiration. It amounts to about 1200 milliliters (mL).

If you added various lung volumes together in different combinations, you’d come up
with several lung capacities.
 Functional vital capacity – the sum of tidal, inspiratory and expiratory reserve
volumes. It represents the total exchangeable air volume in the lung. It amounts to
about 4600 milliliters (mL).
 Functional Residual Capacity – the sum of the expiratory reserve volume and residual
volume. This represents the amount of air remaining in the lungs after normal
expiration. It amounts to about 2300 milliliters (mL).
 Inspiratory Capacity – the sum of tidal volume plus inspiratory reserve volume. It is
the amount of air that can be inhaled after normal expiration. It amounts to about
3500 milliliters (mL).
 Total Lung Capacity – the sum of vital capacity and residual volume. This represents
the sum of all air in the lungs after the fullest possible inspiration. It amounts to about
5800 milliliters (mL).

Gas Exchange

Diffusion, also called external respiration, is the exchange of gases between the alveoli
and the capillaries. In this process oxygen diffuses across the alveolar epithelium, the epithelial
basement membrane, and the capilliary endothelial membrane. It then dissolves in the plasma
through the red blood cell membrane. Carbon Dioxide diffuses in the opposite direction. Oxygen
moves from the alveolus into the venous end of the capilliary because Oxygen Pressure (PO 2) is
greater in the alveolus; Carbon Dioxide diffuses from the venous end of the capilliary, where
Carbon Dioxide Pressure (PCO2) is greater, to the alveolus. Each gas acts independent of the
other because of its distinctive partial pressure. A number of factors affect the rate of gas
exchange, including drug use, geographic altitude, and the extent of the person’s functional lung
surface area.
Hemoglobin, which is normally about 98% oxygen-saturated, transports oxygen to the
tissues for gas exchange between body cells and red blood cells. This exchange is called internal
respiration. Because increased temperature and decreased pH trigger oxygen’s release from
hemoglobin, only tissues needing oxygen receive it.

References:

1. Seeley, Stephens, & Tate 2007, Respiratory System, pp 416-445.

2. DiGiulio, Jackson, & Keogh 2007, Respiratory System, pp 85-86
3. Nurse’s Reference Library Series 1982, Respiratory System, pp 278-285
4. Clinical SkillBuilders 1991, Respiratory Anatomy and Physiology, pp 1-21