ANATOMY AND PHYSIOLOGY OF RESPIRATORY

SYSTEM
Respiratory system consists of organs which provide the pathway for
supply of oxygen to the body and expulsion of carbon dioxide from the body to
the surrounding atmosphere.

ORGANS OF RESPIRATION:-
1) Nose
2) Paranasal sinuses
3) Nasopharynx
4) Larynx
5) Trachea and bronchi
6) Lungs
7) Respiratory muscles
DIVISION OF RESPIRATORY SYSTEM:
1) STRUCTURAL DIVISION:
I. upper respiratory tract:
It consists of the nose and nasal cavity, the pharynx and the
larynx.
II. Lower respiratory tract:
It consists of the trachea, and within the lungs, the bronchi,
bronchioles and alveoli.
2) FUNCTIONAL DIVISION:
1) Dead zone:
Corresponds to nose and the nasal cavity upto terminal
bronchioles
Volume of air-150ml
2) Respiratory zone :
corresponds to the lung parenchyma and includes the respiratory
bronchioles, alveolar ducts, and alveoli. 
Volume of air-5-6L

NOSE AND PARANASAL SINUSES

Functions:
1) It is a part of the respiratory passages
 2) It has the olfactory function
Parts
1) External nose
2) Nasal cavity
3) Medial wall or nasal septum
4) Lateral wall

1) EXTERNAL NOSE
Forms a pyramidal projection in the middle of the face.
External nose is made up of cartilaginous framework
supported by bones and is covered with skin.
2) Nasal cavity
It is pyramidal in shape. It extends from the nostrils(anterior nares)to the
posterior nasal apertures (choanae).
Parts
1. Vestibule
Dilated part at Anterior nasal opening
2. Olfactory region
The upper one-third of nasal cavity has the olfactory receptor cells.
3. The respiratory region
Lower two-third is lined by thick mucous membrane.
Boundaries of nose
Each half of the nasal cavity has:
1. Roof
2. Floor
3. medial wall
4. lateral wall

1) Roof
Formed by
a) cribriform plate of the ethmoid bone.
b) Nasal bone and nasal part of frontal bone(anteriorly)
c) Sphenoid bone(posteriorly)
2)Floor
Formed by palate which separate the nasal cavity from oral cavity.
3)Medial wall or nasal septum
Osseocartilaginous partition between the two halves of the nasal cavity.
 The bony part: formed by vomer and perpendicular plate of
ethmoid bone.
 The cartilaginous part: formed by septal cartilage and septal
process of inferior cartilages.
 The cuticular part: formed by fibrofatty connective tissue covered
by skin.
Blood supply
Arterial supply:By
 anterior ethmoidal artery(branch of ophthalmic artery)
 posterior ethmoidal artery
 superior labial branch of facial artery
 sphenopalatine artery
 greater palatine artery
at antero-inferior quadrant, there is a rich anastomosis between
the septal branches, the area is called the little’s area or
keisselbach’s area-common site for epistaxis.
4)Lateral wall of nose
It is irregular and owing to the presence of 3 shelf-like bony projections
called conchae or turbinate. These elevations are called superior, middle
and inferior conchae.

PARANASAL SINUSES
These are air filled extensions of the respiratory part of nasal cavity in
the skull bones.
1) FRONTAL AIR SINUS: situated in the frontal bone.
 2) ETHMOIDAL AIR SINUS: There are 3 groups- anterior, middle and
posterior
3) MAXILLARY AIR SINUS: Largest among the air sinuses.
4) SPHENOIDAL AIR SINUS:A cubical cavity within the body of sphenoid.
Functions:
 They reduce the weight of the skull
 The inhaled air is warmed and humidified
 They add resonance to the voice
 Filter the air inhaled
PHYSIOLOGY OF NOSE
1) Respiration:
2) Air-conditioning of inspired air:
Air is efficiently filtered, humidified, adjusted to proper
temperature and cleared of all the dust, bacteria and viruses by
the nose.
3) Protection of airway:
I. Enzymes and immunoglobulins: The are present
in nasal secretions. Muramidase (lysozyme) kill
bacteria and viruses. Immunoglobulins (ig A and
IgE) and interferon provide immunity against
upper respiratory tract infections.
II. Sneezing:
4) Vocal resonance
5) Nasal reflexes: sneezing
6) Olfaction
PHARYNX
12-14cm long
From the base of the skull to c6 level. lies behind nose, mouth and
larynx.
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx

1. Nasopharynx
Behind the nose, from skull base to above the level of soft palate.
Adenoids or pharyngeal tonsils are located in the posterior wall
 The auditory tube connects the middle year to the pharynx.
2. Oropharynx
Behind the oral cavity.
Below the level of soft palate upto 3rd cervical vertebrae.ie, from below the
level of uvula upto hyoid bone.
Palatine tonsils are present at the lateral wall.
Lingual tonsils are present at the base of the tongue.
3. Laryngopharynx
Also called hypopharynx
From C3 to C6 level.
From upper border of epiglottis to the lower border of cricoid cartilage.
Common passage for food and air.

Waldeyer’s ring

Functions of tonsils and adenoids

1. immunology and host defences
2. sentinels at the portal of aerodigestive tract.
3. Antibody production especially secretory IgA
 LARYNX
Also called ‘voice box’.
Serves as air passage.
Extends from root of tongue up to trachea.ie from C3 toC6.
CARTILAGES OF LARYNX
 UNPAIRED CARTILAGES
1. Thyroid cartilage
2. Cricoid cartilage
3. epiglottis
 PAIRED CARTILAGES
1. Arytenoid
2. Corniculate
3. Cuneiform
1. Thyroid cartilage
Largest
Hyaline cartilage
Forms prominence in the middle of the neck called laryngeal prominence or
Adam’s apple.
Upper border -thyroid notch
2. Cricoid cartilage
Resembles signet ring
Hyaline cartilage
3. Epiglottis
A leaf shaped elastic cartilage
It closes larynx during swallowing
4. Arytenoid
Pyramidal in shape
Locates at upper border of cricoid cartilage
o Corniculate and cuneiform cartilages are lying within the aryepiglottic
folds.
CAVITY OF LARYNX
o Two pairs of folds projects in to the cavity from the lateral walls
o Upper pair of folds are vestibular folds or the false vocal cords and
the fissure between them is called rima vestibuli
 o The lower pair of folds are the true vocal cords and the fissure
between them is the rima glottis
o Concerned with voice production.
MUSCLES OF LARYNX
1. Extrinsic muscles.
Attached to skeleton of larynx and the bone above it.
They move larynx as a a whole during respiration, deglutition etc
1) Thyrohyoid
2) Stylohyoid
3) Intrinsic omohyoid
4) Genohyoid
5) Hypoglossus muscles
2. Intrinsic muscles
1) Cricothyroid
2) Thyroarytenoid
3) Vocalis
4) Posterior cricoarytenoid
5) lateral cricoarytenoid
6) transverse arytenoid
7) oblique arytenoid
8) aryepiglotticus
9) thyroepiglotticus
NERVE SUPPLY
 Motor supply: all the intrinsic muscles of larynx except except the
cricothyroid, are supplied by the recurrent laryngeal nerves.
 Sensory supply: by internal and recurrent laryngeal nerve.
TRACHEA
Extends from lower border of cricoid cartilage (C6)as the continouation of the
larynx and ends at the level of sternal angle.(T4&T5)
Divides into right and left bronchi.
The last,thick broad tracheal ring is called carina.
TRACHEOBRONCHIAL TREE
 The trachea branches into two primary pulmonary bronchus.
 Each principal bronchus enters a lung and gives rise to many branches
called secondary bronchi.
  Right bronchus gives rise to Superior ,middle and inferior lobar bronchi
 Left bronchus gives rise to superior and inferior lobar bronchi.
 Each lobar bronchus gives rise to segmental or teritiary pulmonary
bronchi.
 The teritiery bronchi further divides in tosuccessive generations of
smaller bronchi and bronchioles.
 Trachea and the first 16 generations of tracheobronchial tree constitute
the conducting zone.
 The last 7 generations of tracheobronchial tree constitute the
respiratory zone.
LUNGS
A thoracic organ
In healthy person pink in color
In person from polluted areas,dark and mottled black in color.
Each lung is coniocal in shape.
Enveloped by double layer of membrane called pleura.
Parts of lungs:
1. Apex:
extends above the anterior and of the first rib to about 2.5cm above the
clavicle.
2. Base:
It is semilunar and is concave downwards as it rest on the dome of
diaphragm.
3. Costal surface:
It is the outer convex surface of lung covered by the costal pleura
Mediastinal surface:
4. Mediastinal surface:
Hilum -a rough triangular area that gives passages to the bronchi,
pulmonary and bronchial vessels, nerves and lymphatics.
 present at the posterior half
 LOBES OF LUNG
 Right lung
1) Upper lobe
2) Middle lobe
3) Lower lobe
 Left lung
 1) Upper lobe
2) Lower lobe
-Lingula of left lung
It is a tongue shaped projection of left lung below the cardiac notch
Arterial supply
Lung is supplied by bronchial and pulmonary arteries
Bronchial artery
This artery may arise from the thoracic aorta or one of the posterior intercostal
arteries.it supplies the bronchial tree and then anastomoses with pulmonary
artery
Pulmonary artery
One pulmonary artery enters the Hilum of the lung, carrying deoxygenated
blood right ventricle of the heart.
Bronchopulmonary segments
It is the independent functional unit of lung made up of a tertiary bronchus
with its bronchial tree up to the alveoli accompanied by an independent
branch of pulmonary artery.
Each lung has ten pulmonary segments.
Functions of lung and tracheobronchial tree
 Organ of exchange of gases.
 Surfactant secreted by pneumocytes 2 of alveoli prevents the collapse of
eye.
 Non respiratory functions of lung
 Angiotensin converting enzyme for blood pressure control.
 APUD cells or neuroendocrine cells are present in the bronchiolar tree. they
produce various vasoactive substances like VIP and substance P which may
have a role in maintaining tone of bronchioles
 Defence function
 Trapping of foreign particles by the mucus secreted by the goblet cells
 Mucus contains IgA antibodies that provides local immunity.
  Alveolar macrophages
 Preventing reflexes helps to clear air passage from the inhales foreign
particles.
SURFACTANTS
It is a complex of phospholipids, proteins, carbohydrates and several ions.
It is a surface lowering agent
tension lowering agent that prevents alveolar collapse.
It forms a layer at the fluid air interface in the alveoli
Pleura and pleural cavity
Pleura
A serous membrane lined by a single layer of squamous cells. It has outer
layer called parietal pleura and inner layer called visceral pleura. the space
between this is called pleural cavity with a thin film of fluid to prevent
friction.
The intra pleural pressure is 2mmhg during expiration and 6mmhg during
inspiration. This prevents collapse of lung parenchyma and also aids in the
venous return of body

PHYSIOLOGY OF RESPIRATION
Composition of air
Oxygen 21%
Carbon dioxide 0.03%
Nitrogen 78%
Other gases 1%
EXCHANGE OF GASES
1) External respiration
Take place in the lung.
Then oxygen is absorbed from air into the blood and CO2 is excreted from
the blood into the air.
2) Internal respiration
Also called tissue respiration.
 O2 is transferred from blood into the tissues;which gives up CO2.
RESPIRATORY MOVEMENTS
 Inspiration
It is accompanied by expansion of lungs for uptake of air
 Expiration
expulsion of air from the lung due to retraction of lungs .
MUSCLES OF RESPIRATION
1. Primary or major respiratory muscles
2. Accessory respiratory muscles
Primary inspiratory muscles
a) Diaphragm which is supplied by phrenic nerve(C3-C5)
b) Intercostal muscles.
Accessory inspiratory muscles
a) Sternocleidomastoid,
b) Scaleni
c) Anterior serrati
d) Elevators of scapular
e) Pectoralis
Primary expiratory muscles
a) Internal intercostal muscle
Accessory respiratory muscles
a) Abdominal muscles
MOVEMENT OF THORACIC CAGE
 Pump handle movement
The contraction of external intercostal muscles causes elevation of 2nd to 6th
pair of ribs and upward and forward movement of sternum.
Increases anterior posterior diameter of the thoracic cage
 Bucket handle movement
Contraction of external intercostals raises the lateral part of the ribs causing
a bucket handling motion that increases the transverse diameter of thorax.
Movement of lungs
During inspiration, due to the enlargement of thoracic cage, the negative
pressure is increased in the thoracic cavity. It causes expansion of the lungs.
During expiration, the thoracic cavity decreases in size to the pre-inspiratory
position. The pressure in the thoracic cage also comes back to the pre-
inspiratory level. It compresses the lung tissues so that, the air is expelled out
of lungs.

Pressure of lungs
Intra pleural pressure
Throughout the respiratory cycle intra pleural pressure remains lower than
intra alveolar pressure. This keeps lungs inflated.
It is always negative
Intra alveolar pressure
Also called intra pulmonary pressure
Normally it is equal to intra atmospheric pressure. 760mmhg
It is negative during inspiration and positive during expiration
It is measured by plethysmograph
Transpulmonary pressure
Difference between the intra-alveolar and intra -pleural pressure
LUNG VOLUMES AND LUNG CAPACITIES
The lung volumes are of four types:
1. Tidal volume
2. Inspiratory reserve volume
3. Expiratory reserve volume
4. Residual volume.
TIDAL VOLUME(TV)
Tidal volume is the volume of air breathed in and out of
lungs in a single normal quiet respiration. Tidal volume
signifies the normal depth of breathing.
 Normal Value:500 mL (0.5 litre).
INSPIRATORY RESERVE VOLUME (IRV)
Inspiratory reserve volume is an additional volume of
air that can be inspired forcefully after the end of
normal inspiration.
Normal Value:3300 mL(3.3 litres).
EXPIRATORY RESERVE VOLUME (ERV)
Expiratory reserve volume is the additional volume of
air that can be expired out forcefully, after normal expiration.
Normal Value:1000 mL(1 litre).
RESIDUAL VOLUME (RV)
Residual volume is the volume of air remaining in the
lungs even after forced expiration. Normally, lungs
cannot be emptied completely even by forceful expiration.
Residual volume is significant because of two reasons:
I. it nelps to aerate the lood in between breathing
and during expiration
ii. It maintains the contour of the lungs.
Normal Value:1200 mL(1.2 litre)
LUNG CAPACITIES
lung capacities are the combination of two or more
lung volumes.
Lung capacities are of four types:
1. Inspiratory capacity
2. Vital capacity
3. Functional residual capacity
4. Total lung capacity.
1. INSPIRATORY CAPACITY(IC)
Inspiratory capacity is the maximum volume of air that
is inspired after normal expiration (end expiratory
position). It includes tidal volume and inspiratory reserve
volume.
IC=TV+IRV
＝500+3300=3800 mL
2. VITAL CAPACITY(VC)
It is the maximum volume of air that can be expelled out forcefully after a deep
(maximal) inspiration. Vital
capacity includes inspiratory reserve volume, tidal
volume and expiratory reserve volume.
VC =IRV+TV+ERV
＝ 3300+500+1000=4800 mL
3. FUNCTIONAL RESIDUAL CAPACITY(FRC)
is the volume of air remaining in the lungs after normal
expiration (after normal tidal expiration). Functional
residual capacity includes expiratory reserve volume and residual volume.
FRC=ERV+RV
＝1000+1200=2200 mL
4. TOTAL LUNG CAPACITY(TLC)
Total lung capacity is the volume of air present in the
lungs after a deep (maximal) inspiration. It includes all
the volumes.
TLC = IRV + TV + ERV+RV
＝3300+500+1000+1200=6000 ml
Ventilation
Pulmonary ventilation
A cyclic process by which fresh air enters the lungs and an equal volume of air
leaves the lungs.it is the volume of air moving in and out of lung per minute in
quite breathing
Also called respiratory minute volume
Normal value is 6L/min

Alveolar ventilation
It is the amount of air utilized for gaseous exchange every minute.
Normal value is 4.2L /min
Ventilation-Perfusion Ratio
It is the ratio of the alveolar ventilation to the pulmonary blood flow.
Normal alveolar ventilation at rest is 4.24 L/minute, and pulmonary blood flow
is 5 L/minute. Therefore ,the ventilation-perfusion ratio is 4.2 L/5L or 0.84.The
ventilation-perfusion ratio is high in the apex of the lungs and less in the base
of the lungs (due to gravity).
GASEOUS EXCHANGE IN LUNGS
Gases diffuse from alveoli to blood circulation and vice Versa.
It consists of:
1. Alveolar epithelium
2. Pulmonary capillary endothelium
3. Basement membrane of both lining cells
TRANSPORT OF GASES BETWEENLUNGS AND TISSUES
Transport of gases is one of the most important functions
Oft he blood.
TRANSPORT OF OXYGEN
The partial pressure of dissolved O2 (Po2) in the pulmonary
venous blood is 40 mm Hg and that in the alveolar air is
104 mm Hg . Because of this marked pressure
gradient, O2 diffuses from the alveolar air into the
pulmonary capillary blood . However, the pO2
becomes 100 mm Hg when the blood reaches the aorta.
This is due to some mixing of blood occurring in the
besian vessels and physiological shunts.
Methods by which O2 is carried by the blood:
 About 97% of the O2 transported from the lungs to the tissues is by
chemical combination with Hb of RBCs.
 The rest 3% is carried in the dissolved state in plasma.
 About 3% of O2 is transported as dissolved form in blood.
The dissolved O2 exerts the partial pressure, which
actually determines the amount of O2 that combines
with haemoglobin. Thus, even though a small amount of O2 is transported in
dissolved form.
ROLE OF HB IN OXYGEN TRANSPORT
Each of the four iron atoms of Hb can bind loosely and reversibly with one
oxygen molecule, by oxygenation reaction (not oxidation).
At a pO2 of 100 mm Hg, Hb is fully saturated with
oxygen.
each 100 mL of arterial blood can carry 20 mL of oxygen to the tissues.
The maximum amount of O, that can be carried in the blood by Hb is called the
oxygen carrying capacity of Hb (20 mL/100mL of blood). About 5 mL of O, is
given off to the tissue.
OXYGEN-HEMOGLOBIN DISSOCIATION CURVE
 This curve represents the relationship between the PO2
and the degree of oxygen saturation of Hb
 The curve is sigmoid shaped. This particular shape of the curve is due to
the biological properties of Hb.
 When O2 combines with Hb, it assumes the relaxed or R-state,which
favours O2 binding, and additional uptake of O2 is facilitated. When all
the four heme molecules have combined with O2, it assumes the tense
or T-state. The
sigmoid shape is due to this T-interconversion.
At PO, values of 100 mm Hg or above, Hb is 100%
saturated .Even when the pO2 falls to 60 mmHg, the Hb saturation is 90%. This
provides a margin of safety when one ascends up to high altitudes, where
there is decreased alveolar PO2. Even then he will suffer only a
small decrease in the arterial O2 content.
 FACTORS AFFECTING OXYGEN DISSOCIATION CURVE
The important factors that affect the affinity of Hb for oxygen are:
PH
2,3-DPG concentration in the RBC
temperature
A rise in temperature, a fall in pH and an increase in 2,3-DPG concentration can
shift the 02-Hb dissociation curve to right,i.e. there is decreased affinity of Hb
for O2 and more of O2 is liberated or offloaded.
Bohr effect: The affinity of Hb for O2 decreases when the pH of blood falls. This
is called Bohr Effect. At the tissue level, there is increased pCO2 and decreased
po2,. This causes the Hb to liberate more 02 into the tissues (Bohr effect).
The curve is shifted to the left by a fall in temperature, a rise in pH and a fall in
2,3-DPG concentration, i.e. the affinity of Hb forO2 is more and their binding is
favoured.
TRANSPORT OF CARBON DIOXIDE
Carbon dioxide is carried in the blood in three forms:
 As physically dissolved form: This accounts for about
10% of the total CO2, in blood. CO, is 20 times more
soluble in water than O2.
 As bicarbonate: About 80% of the CO, is transported as bicarbonate CO2
diffuses into the red cells where, in the presence of carbonic anhydrase
enzyme, it rapidly reacts with water to form carbonic acid (H2CO3).
The carbonic acid dissociates into HCO3 and H+.
H+ ion formed is buffered by Hb, while HCO3 enters
the plasma. DeoxyHb is a weaker acid than the oxyHb
and, therefore, it binds to H' more than the oxyHb.
As the bicarbonate, which is formed in red cell, diffuses
out to the plasma, Cl diffuses from the plasma into the red cells to maintain
electrical neutrality. This phenomenon is called the chloride shift or Hamburger
shift. This is the cause of the increased content of Cl in venous blood.
 As carbaminohemoglobin: About 10% of CO2 is transported as
carbaminohemoglobin CO2 combines with the amino (-NH,) group of Hb to
form
carbaminoHb.
HALDANE EFFECT
Deoxygenated Hb combines with more CO2 compared to
oxygenated Hb at any PO2. This is called Haldane effect. Binding of O2 to Hb
thus reduces its affinity for CO2.
Significance of Haldane Effect
Haldane's effect is essential for release of carbon dioxide from blood into the
alveoli of lungs and uptake of oxygen by the blood.
CARBON DIOXIDE DISSOCIATION CURVE
The relationship is linear over a wide range of pco2.when Hb oxygenated ,the
dissociation curve shifts to the right, ie CO2 is removed.
REGULATION OF RESPIRATION
Respiration is an automatic process that occurs without
any conscious effort while we are asleep or
awake
rhythmical excitation of respirator muscles occurs
result of multiple neuronal interactions involving all
levels of the nervous system.
Various neural and hormonal stimuli as well as
Chemical changes in blood (ie, changes in blood pO2 ,pco2 and pH) can
influence the central control of respiration
Hence, regulation of respiration can be broadly classified
As:
"Neural regulation" and “Chemical regulation'"
NERVOUS CONTROL OF RESPIRATION
Nervous regulation of respiration includes:
1. Voluntary control
2. Automatic control
VOLUNTARY CONTROL
Respiration is a spontaneous (reflex) process. But to some extent, it can be
controlled voluntarily because most of the muscles concerned with respiration
are voluntary muscles. The centre for voluntary control is the motor cortex,
which sends impulses through the corticospinaltract to the respiratory motor
neurons.
AUTOMATIC CONTROL
The automatic centers for control of respiration are
located in the pons and medulla. The respiratory centers
are located bilaterally.
Medullary Centers
 1. Dorsal respiratory group of neurons(DRG)
2. Ventral respiratory group(VRG).
 DRG is located in and near the nucleus of tractus solitarius (NTS). DRG is made
up of I (inspiratory)
neurons. They are active during inspiration. They also
receive impulses from lungs, chemoreceptors, and
baroreceptors through vagus. (Flowchart 9.4).
 VRG is located in the ventrolateral part of medulla
It extends through nucleus ambiguus.VRG is made up of E'(expiratory) neurons
mainly. 'E' neurons inhibit 'I’
neurons in expiration.
pontine Centers
Although the rhythmic discharge of medullary respiratory neurons is
spontaneous, it is modified by neurons in the pons. In the upper part of pons
there is a pair of respiratory centers called pneumotaxic center. Pneumotaxic
center has inhibitory effect on 'T' neurons. When this area is stimulated, I
neurons are inhibited. Respiration becomes shallow and rapid.
Vagal Influences on Respiration
Stretch of the lungs during inspiration stimulates stretch
receptors in lung which generates vagal fibers. These
impulses inhibit 'I' neurons and produce expiration.
Hering-Breuer Reflex
Stretch receptors are present in the smooth muscles of
bronchial wall. They are stimulated when the lung inflates above the tidal
volume.
Afferent impulses from these stretch receptors reach the nucleus of tractus
solitarius of medulla, via the vagus
nerve.
These impulses inhibit inspiratory neuron discharge and
limit the tidal volume, thereby increasing the respiratory rate.This
phenomenon is called Hering-Breuer reflex.
CHEMICAL CONTROL OF RESPIRATION
Chemical control of respiration is exerted through the
central and peripheral chemoreceptors .The
chemoreceptors respond to changes in the pH, PO2 and
PCO2of blood.
Arise in PCO2, a rise in H+ concentration or a decrease
in PO, can stimulate respiration.
Central Chemoreceptors
They are located in the medulla, near the origin of IX and
X cranial nerves.
Peripheral Chemoreceptors
They are the carotid and aortic bodies. Carotid bodies
are located at the bifurcation of the common carotid
arteries. The aortic bodies are located in the arch of aorta.
RESPIRATORY SOUNDS
SL.NO NAME LOCATION QUALITY OF SOUND
WHERE SOUND DURATION
HEARED
NORMALLY

1 Tracheal Over the Very loud Equal in

trachea both
inspiration
and
expiration
2 Bronchial Over the Loud, high Expiratory
manubrim pitched sound is
more
3 Broncho- Anteriorly intermediat Ins[iratory
vescicular between e and
1st and 2nd expiratory
intercostal are equal
space
Posteriorly
in between
the
scapula.
 4 vesicular Over most Soft, low Inspiratory
of both pitched sound is
lungs more

CONCLUSION
The respiratory system is important in gas exchange and works through
inspiration and expiration. having a basic knowledge of the anatomy and
physiology of respiratory system will enable us to perform assessments
effectively.
BIBLIOGRAPHY
1. PR Ashalatha, G Deepa Textbook of anatomy and physiology for nurses,4th
edition ,jaypee publications, page number:302-329
2. K Sembulingam, Prema sembulingam, Essentials of medical physiology,5 th
edition,jaypee publications, page number:645-721
3.