Dr.

Mahmoud Alkhateeb

RESP-314

Mechanics of Breathing II
Dr. Mahmoud Alkhateeb
Department of Physiology
College of Medicine, KSAU-HS, Riyadh.

Mechanics of Breathing II/ Mahmoud

Alkhateeb
 Learning Objectives

• By the end of the lecture students should be able to:

Describe the mechanisms of inspiration and expiration.
Describe the mechanical properties of the lung and chest
wall resulting in negative pleural pressures and an apical to
basal gradient of lung distension.
Explain the apical to basal gradient of ventilation.
Describe the Ventilation/perfusion (V/Q) relationship.
Define and explain compliance and elastane of the lungs.
Define the different lung volumes and capacities.
 Boyle’s Law

 the relationship between

pressure & volume of gases
 The pressure of gas decrease if
the volume of the container
increase

 Pressure is related inversely to the

volume of the container.
↑ volume = ↓ pressure
 Ohm’s law of flow (Q)

Ohm’s law: Flow  P/R = air flows

due to pressure gradient and
decreased with increased resistance.

Air flow is increased with

increasing:
1. Pressure gradient (driving
pressure, from high to low
pressure)
2. Diameter of the airway

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 Mechanics Of Breathing(Pulmonary
Ventilation)
•Air moves by difference in pressures (pressure gradient).

•Direction of airflow depends on the pressure differences between the

atmosphere pressure (Patm)and the alveoli pressure (Palv).

•The pressure inside lungs must drop to draw air into the lungs.

High pressure

AIR

Low pressure Air enters the lungs Air exits the lungs
when Palv< Patm when Palv> Patm
 Relation Between Pressure And Volume
The pressure of a fixed number of molecules is related to the volume of a
container in which they are placed Pressure and volume have inverse
relationship. (Boyle’s Law)

• Changes in chest volume lead to pressure

changes and air flow.
• During inspiration:
–the volume of the chest increases.
–both intra-pleural pressure and intra-
alveoli pressure drop
draws air through the conducting
airways to the respiratory zone.
The mechanism of inspiration ( inhalation)

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The mechanism of 'Expiration (exhalation)

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Pressure Relationship In the Thoracic Cavity
• Intrapulmonary pressure- pressure within the alveoli
• Intrapleural pressure- pressure within the pleural
cavity
• Intrapulmonary pressure and Intrapleural pressure
fluctuate with the phases of breathing

• Intrapulmonary pressure always eventually equalized

itself with atmospheric pressure

• Intrapleural pressure is always less than

intrapulmonary pressure and atmospheric pressure
Pressure Across the Lungs
•Atmospheric pressure:
–Constant at 760 mm Hg.
•Intra-pleural pressure:
–Pressure in the intra-pleural space is
always sub-atmospheric (Negative)
due to :
1.Recoil of the lungs and the chest wall
in opposite direction.
2.Lack of air in the intra-pleural space.
Intra-alveolar pressure:
–Pressure inside the alveoli
(Intrapulmonary pressure).

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 Mechanisms Of Inspiration And Expiration

Patm = Palv Pressure inside falls Pressure inside rises

No air movement Palv < Patm, Palv> Patm
so air flows in so air flows out

Contraction of inspiratory muscles (mainly the diaphragm) generation of a

more negative intrapleural pressure Intra-alveolar pressure drop
air enters.
•Relaxation of inspiratory muscles allows the elastic tissues to passively return
to pre-inspiratory state (recoil), pressure increase achieving exhalation.
 Mechanism of Inspiration

•Inspiration is normally an active process:

–Contraction and of the diaphragm (70%) and external
intercostals muscles increases the thoracic
volume.

–Intra-pleural pressure drops from –3 to –6

mm Hg.
–Lung expands (lungs volume increases).

–Intra-alveolar pressure decreases below

atmospheric (–1 to –3 mm Hg) air
rushes in to fill the expanded lungs until
intrapulmonary pressure equals
atmospheric pressure.

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Mechanism of Expiration

Expiration at rest is a passive process:

–Inspiratory muscles relax return of the ribs to rest position
diminishing the lung volume.

–Intra-pleural pressure rises and the lungs recoil.

–Lungs volume decreases rise in the intra alveolar pressure (above the
atmospheric+1 up to + 3 mm Hg) and air moves out.

•Internal intercostal and abdominal muscles are active process when:

–muscle contraction is required in forced expiration.
–airways are narrowed by mucus (chronic bronchitis) or spasm of the bronchioles
(asthma).
 Interrelationships among pressures inside & outside
 4 different pressure considerations
1. Atmospheric (barometric pressure, PB):
 =760 mmHg or 0 CmH2O).

2. Intra-alveolar pressure (intrapulmonary

pressure, PA):
 Equals PB=760 mmHg at rest.
 Varies with the phases of respiration
 Open system

3. Intrapleural pressure (intrathoracic

pressure, PIP). Always sub atmospheric
(negative):
 Varies with the phase of respiration.
 756 mmHg ⇒ = -4 mmHg ⇒ creates
-5 cmH02 at rest.
 Closed system.
 Keeps the lungs open against the
chest wall.
 If the chest wall is opened, the lungs
collapse (Pneumothorax).
 PIP= PB (atmospheric pressure)

 Transpulmonary pressure
 PTP = PA – PIP
 = 760-756= 4 mmHg
 Intrapleural Pressure (PIP) and PIP
gradient
Is affected by:
1. Gravity (pull lungs down⇒ more
negative at the apex.
2. Posture: Lying down, on one side
or in Up right position.
3. Weight of the lung

This creates PIP gradients across the

lung From top to bottom
 Pressures Changes During Breathing cycle

Intrapleural Pressure (PIP) Pulmonary Pressure

 Always sub-atmospheric  Equal to atmospheric (zero) when
or (Negative). glottis is open and no breathing .

 Always less than PA.  Negative during inspiration.

 More negative during inspiration.  Positive during expiration.

 Less negative at the end of forced
expiration.
 Factors Affecting Breathing

•Compliance:
–Distensibility (Pressure Volume Relationship).
•Elasticity (Recoil tendency of the lung):
–Tendency to return to initial size after distension.
•Airway resistance:
–Depends mainly on diameter of bronchioles.
 Lung Compliance (CL)
 Lung Compliance: Ease with which lungs can be
stretched.
 CL is a measure of the change of lung volume (ΔVL)
that occurs with a given change in transpulmonary
pressure
 CL = ΔVL / ΔPtp
 The greater the lung compliance, the easer it is to
expand the lung
 Can be considered the inverse of stiffness
 At rest, the average CL for each breath is
about 0.2 L/cm H20 (200 mL).
 The lower the compliance, the more work is needed
to produce a given degree of inflation
 Decreases with higher PIP pressures
 Compliance: ability to stretch (Emphysema)

 High compliance
 Stretches easily
 Emphysema (Fibrosis)

 Low compliance
 Requires more force
 Restrictive lung diseases
 Fibrotic lung diseases and inadequate surfactant
production
 Elastance: returning to its resting volume
when stretching force is released

• Elastic Recoil refers to how quickly the lungs rebound( come

back to normal after they have been stretched.

 Pulmonary Elastic behaviour depends on two factors:

• Connective tissue in the lung (air-filled lung) I/3 of total :
 Collagen: decreases inflation.
 Elastin: Increases elastic recoil.
 Alveolar Surface tension (2/3): increases elastic recoil
 Compliance Vs Elastance
• Compliance is a measure of distensibility
• Elastance is a measure of elastic recoil
• These both oppose each other!
– Compliance decreases as Elastance increases:
» Pulmonary fibrosis (restrictive lung disease)
» Pulmonary hypertension/congestion
» Decreased surfactant – increased surface tension
(prematurity, artificial ventilation)
– Compliance increases as Elastance decreases
» Normal ageing (alteration in elastic tissue)
» Asthma (unknown reason)
» Emphysema* (obstructive lung disease)
 Surfactant
• Surfactant is a surface active agent to reduce surface
tension.
• More concentrated in smaller alveoli
• Secreted by Type II alveolar epithelial cells
• Mixture containing proteins and phospholipids
• Newborn respiratory distress syndrome
– Premature babies
– Inadequate surfactant concentrations
In the lung:
Surface tension is created by the thin fluid layer
between alveolar cells and the air.
 Causes of Pulmonary Surfactant Deficiency

General causes: Specific causes:

1. Acidosis 1. Acute respiratory distress
2. Hypoxia syndrome (ARDS)
3. Hyperoxia 2. Infant respiratory distress
4. Atelectasis syndrome (IRDS)
5. Pulmonary vascular 3. Pulmonary edema
congestion 4. Pulmonary embolism.
5. Pneumonia
6. Excessive pulmonary lavage
or hydration
7. Drowning
Pulmonary Resistance
• Types of Pulmonary Resistance:
1. Elastic Resistance:
• The elastic forces caused by:
– Elastic tissue of the lung and the thoracic wall.
– Surface tension of the fluid lining inside wall of the
alveoli.
2. Non - Elastic Resistance:
– Airway resistance (friction between gas molecules
and the walls of the airways); it is inversely
proportional to Air flow and is mainly influenced by
the diameter of the bronchioles. (Ohm’s law)
 Control of bronchial diameter
 Relaxation of the bronchial smooth muscle  increases diameter and
airflow and reduces resistance

Factors that modulate airway Caliber (Resistance).

1. The bronchial smooth muscles are innervated by Neural control:
Parasympathetic stimulation  bronchoconstriction
 Sympathetic stimulation  bronchodilation

2. Histamine (Constricts )
3. Prostaglandin E: Constricts.
4. Prostaglandin F: Dilates
5.Air flow & lung volume
Inspiration : (dilates)
Expiration : (Constricts).
6. Environmental pollution : Smoke, dust , irritants: causes
bronchoconstriction.
 Work of Breathing

 Work of breathing increases:

 With decreased pulmonary compliance (stiffness of the
lung like fibrosis)
 With increased airway resistance
 With increased elasticity
 With need for increased ventilation (e.g. Exercise)
 Ventilation Perfusion Ratio (V/Q)
 Ventilation : Renews alveolar air so as to maintain
High PO2
Low PCO2
 Perfusion: The movement of blood into the lung through pulmonary
capillaries
 Ventilation/ Perfusion Ratio:
It is the ratio of alveolar ventilation and the amount of blood that perfuse
the alveoli
V/Q= alveloar ventlation ÷Pulmonary blood flow
Alveolar ventlation=4200ml/min
Pulmonary blood flow =5000ml/min.
So
VA/Q = 0.8
 Effect of Pressures On Ventilation
 Apical to basal graient of ventaltion(in
upright position)
 Intra-pleural pressures is more
negative at the apical part of the lung

 Alveoli at the upper portion of the lung

are more distended containing
more residual air (less ventilated).

 During ventilation more air flow to

the lung bases than the apices (High
ventilated).

 Compliance is more at the bases of

the lungs.

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 Distribution Of Ventilation And Perfusion

 The consequence of V/Q matching at alveolar

level is important to gas exchange
BF

 The alveoli in the upper lung portions receive VA

moderate ventilation and little blood flow⇒
V/Q ratio ˃ 1 (ventilation > perfusion).

 In lower regions of the lung, the alveolar

ventilation is moderately increased and the
blood flow is greatly increased. ⇒
V/Q ratio ˂1 (perfusion > ventilation).

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 Pulmonary Flow

In an upright person:

–Gravity pulls blood downward.

 Medium =15mmHg
–As the vessels are highly compliant, gravity
causes the blood volume and flow to be
greater at the bottom of the lung (the base)
than at the top (the apex).
 Apex =2mmHg
•Gravity causes the lungs to be:  Base =25mmHg
–Underperfused at the apex.
–Overperfused at the base.

When a person is lying down, blood flow is distributed relatively evenly from the
base to the apex

The effects of gravity on pulmonary blood flow result in an uneven distribution

of blood in the lungs with upright position
Blood Flow Distribution in the lungs
Zone 1
• Alveolar pressure greater than pulmonary arterial
pressure);
•Zone 1 is small or non-existent in healthy people
• Pulmonary capillaries collapse and there is no blood
flow
•Increase means increased alveolar dead space
(ventilated but not perfused) e.ga patient is placed on a
mechanical ventilator; hemorrhage, hypotension and
astronauts.

Zone 2:
Blood flow is not by the arterial–venous pressure
difference but by the difference between arterial
pressure and alveolar pressure.

Zone 3:
blood flow is determined by the usual arterial–venous
pressure difference(venous pressure exceeds alveolar
pressure).
 Gravity, Alveolar Pressure and Blood
Flow
• •Driving pressure (gradient) for perfusion
is different in the lung
• 3 zones:
• –Zone 3: Continuous flow driven by the
pressure in the pulmonary arteriole -
pulmonary venous pressure.

• –Zone 2: Intermittent driven by the pressure

in the pulmonary arteriole –alveolar pressure.

• –Zone 1:No flow; absent because there is

inadequate pressure to overcome alveolar
pressure.
Ventilation And Perfusion
Lung Volumes During Normal Breathing Cycle
(Spirograph Pattern Graph)

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 References:
• 1. Medical Physiology, 2nd or 3rd Edition
• Authors: Walter Boron Emile Boulpaep
• 2. Medical Physiology, 11th edition,
• Athours: Guyton and Hall

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