Respiratory System: Functional anatomy

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
 Describe the functional anatomy of the respiratory system
 Identify the lung regions with highest cross-sectional area
 Describe cough and sneezing reflexes
 Describe the structure of the respiratory airways
 Explain the structure/function of the muco-ciliary apparatus
 Identify cell types in the alveoli
Revisit- Homeostasis
 Role of respiratory system in HOMEOSTASIS

Cells

Homeostasis Tissues

Exchange O2 and CO2 Internal System-

between the atmosphere environment Respiratory
and blood constant system
External and
internal
respiration
Functional anatomy
Nasal passages (nose)

Pharynx (throat)

Larynx

Trachea (windpipe)

Bronchi

Bronchioles

Alveoli
Structural and functional divisions
Structurally divisions
 Upper respiratory system (nose, pharynx, and
associated structures)
 Lower respiratory system (larynx, trachea,
bronchi, and lungs)
Functionally division
 Conducting zone
 Respiratory zone
 Important functions of upper respiratory
tract

1. Transfer gases
2. Warms the air
Clinical note:
3. Humidifies the air When a person breathes air
4. Filters the air through a tube directly
into the trachea (as through a
tracheostomy), the cooling
and especially the drying effect
in the lower lung can lead to
serious lung crusting and
infection
 Airway branching

1st 16 generations
Conducting zone
23
Times

Respiratory zone
Anatomical dead space
• Air in the conducting
zone does not
contribute in gas
exchange
• Air in the nose,
pharynx, trachea and
up to terminal
bronchioles
• Dead space air
Cross sectional area vs. relative air
velocity
Cough reflex

 Irritants
 Irritant receptors (The larynx, carina, terminal
bronchioles and alveoli)
 Myelinated, vagal afferents
 Medulla of the brain
 Automatic sequence of events is triggered by the
neuronal circuits of the medulla, causing the
following effects
Cough reflex conti.
Initially, up to 2.5 liters of air are rapidly inspired

The epiglottis closes, and the vocal cords shut tightly to entrap the air within the
lungs

The abdominal muscles contract forcefully, pushing against the diaphragm while
other expiratory muscles, such as the internal intercostals, also contract forcefully

Consequently, the pressure in the lungs rises rapidly to as much as 100 mmHg or
more

The vocal cords and the epiglottis suddenly open widely, so that air under this
high pressure in the lungs explodes outward

The rapidly moving air (75 to 100 miles/hr) usually carries with it any foreign
matter that is present in the bronchi or trachea
Sneeze reflex
 It is very much like the cough reflex
 The initiating stimulus is irritation in the nasal
passageways
 The afferent impulses pass in the fifth cranial nerve to
the medulla
 A series of reactions similar to those for the cough
reflex takes place
 But the uvula is depressed
 So large amounts of air pass rapidly through the nose
 Thus helping to clear the nasal passages of foreign
matter
 Wall structure of conducting airways

◼ The wall of conducting airways consists of three

major components
1. A mucosa composed of an epithelial and a
connective tissue lamina
2. A smooth muscle sleeve
3. An enveloping connective tissue tube partly
provided with cartilage
Cellular transition from conducting airway to the
alveolus
Mucociliary clearance system
 It protects the lower respiratory system
by trapping and removing inhaled Toxicants in tobacco smoke paralyze
pathogenic viruses and bacteria, in the cilia and eventually destroy them
addition to nontoxic and toxic
particulates from the lungs
 There are 3 major components of the
mucociliary clearance system
 Two fluid layers referred to as the sol
(periciliary fluid) and gel (mucus layer)
phases and the cilia, which are positioned
on the surface of the airway epithelial
cells
 Cilia beat at approximately 1000
strokes/min, with a power forward stroke
and a slow return or recovery stroke
 Cilia in the nasopharynx beat in the
direction that propels the mucus into the
pharynx
 Whereas cilia in the trachea propel
mucus upward toward the pharynx
Control of bronchial diameter
 The cells of the alveolar region

◼ This thin barrier is built of

three minimal tissue layers:
◼ An endothelium lining the
capillaries
◼ An epithelium lining the
airspaces
◼ An interstitial layer to
house the connective tissue
fibers
Cell population human pulmonary
parenchyma
Alveolar epithelium
Immunofluorescent double labeling of alveolar epithelial cells. Type I cells are stained for Lycopersicon esculentum lectin (red), type II cells are stained for
SP-D (green). Compare with Table 2-3. (Micrograph used with permission of H. Fehrenbach.)

Citation: Chapter 2 Functional Design of the Human Lung for Gas Exchange, Grippi MA, Elias JA, Fishman JA, Kotloff RM, Pack AI, Senior RM, Siegel MD. Fishman's Pulmonary Diseases and Disorders,
5e; 2015. Available at: https://accessmedicine.mhmedical.com/ViewLarge.aspx?figid=111827740&gbosContainerID=0&gbosid=0&groupID=0&sectionId=72260577&multimediaId=undefined Accessed:
January 24, 2023
Copyright © 2023 McGraw-Hill Education. All rights reserved
Respiratory System:
Respiratory muscles and pressures

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
▪ Describe the driving forces for air movement into and out of the lungs. Explain why
lung pressures are given in cmH2O.​
▪ Using Boyle's Law, state the relationship between pressure and volume and how it
describes ventilation.​
▪ Identify the muscles of inspiration and expiration. Explain their roles in driving
changes in air flow.​
▪ Describe pleura and pleural effusion
Gas laws
 Boyle’s law
 Dalton’s law
Boyle’s law
 Boyle’s law states that at constant temperature,
the absolute pressure and the volume of a gas are
inversely proportional
 The quantitative relationship between pressure (P)
and volume (V) of a gas is expressed by Boyle’s
law
 P∞ 1/V ; (at constant T)
 PV= Constant
Dalton’s law of Partial Pressure
 In a mixture of two or more gases, each gas
exerts a pressure according to its concentration,
independently of the other gases in the mixture
Dalton’s law of Partial Pressure
Respiratory pressures are measured in cmH2O
▪ Why?
▪ 1 mmHg = 1.36 cmH2O
▪ Pressure changes in the lung are so small that it is
hard to see a 1 or 2 mmHg change
▪ Much easier to see 1 or 2 cmH2O change
Changes in respiratory pressures are relative
pressures
▪ Pressure changes in lungs are reported as
“relative” to barometric pressure (PB)
▪ So PB is set to 0 cmH2O
▪ Negative pressures are less than PB
▪ Positive pressures are greater than PB

EXAMPLE:
✓ If PA (alveolar pressure) is measured as -3 cmH2O relative to a PB of 0
cmH2O, what is this in real terms?
✓ First convert PA into mmHg by dividing by 1.36, then subtract from
standard PB of 760 mmHg
✓ PA in mmHg = -3 /1.36 = -2.2mmHg
✓ 760 mmHg – 2.2 mmHg
✓ = 757.8 mmHg
Respiratory muscles
 The major inspiratory
muscles
1. Diaphragm
2. External intercostal
muscles
 Accessary muscle of
inspiration
1. Sternocleidomastoid
2. Scalenus
Respiratory muscles
Respiratory muscles
 Muscle of active
expiration
1. Internal intercostal
muscles
2. Abdominal muscles
Respiratory muscles
Intercostal retrations

Intercostal retractions:
Muscles between the ribs
pull inward
Actions of major respiratory muscles
 Pleural layers

Each Lung is enclosed in

Air-tight wrapping called
Pleura
◼ Fluid present- Pleural fluid
(5-20 mL)
◼ The majority of pleural fluid
is produced by the parietal
pleura
◼ The lymph system provides
drainage
Pleural layers…
 Pleural Effusion

◼ A build-up of fluid within the

pleural space is called a pleural
effusion
◼ The main causes of pleural
effusions are congestive heart
failure (transudative effusion due
to hydrostatic pressure) and
malignancies (exudative effusion
due to capillary leakage or
damage)
◼ Pleural effusion restricts lung
movement, compresses lung,
diminishes breath sounds, dullness
to percussion
Respiratory System:
Respiratory muscles and pressures. Conti.

Sareesh Narayanan Naduvil, Ph.D.

Senior Lecturer in Physiology
School of Medicine
AUC UK-Track MD Program
University of Central Lancashire (UCLan)
Vernon building, Room- Ve068
Sizer Street, Preston, Lancashire, UK PR1 2HE
E-mail: snaduvil@uclan.ac.uk, sareeshnn@yahoo.co.in
Learning outcomes
At the end of this session the student shall be able to;
▪ Compare barometric, atmospheric, and relative pressures (negative and positive).​
▪ Explain the difference between Primary and Transmural Pressures​
▪ Identify the pressure that opens and maintains airways​
▪ Explain how elastic recoil and surface tension generate negative intrapleural
pressures when the lung is at rest. Predict the changes in intrapleural pressures
during normal inspiration, maximum inspiration, and maximum expiration.​
▪ Describe the presentation and effects of a pleural effusion and pneumothorax on
respiratory function, including changes in volumes and capacities.
▪ Predict the direction that the lung and chest wall will move if air is introduced into
the pleural cavity (pneumothorax). ​
▪ Diagram how pleural pressure, alveolar pressure, airflow, and lung volume change
during a normal quiet breathing cycle, identifying the onset of inspiration, cessation
of inspiration, and cessation of expiration.
▪ Describe how differences in pressure between the atmosphere and alveoli cause air
to move in and out of the lungs.
▪ Describe how respiratory muscle strength is clinically assessed.​
Pressure considerations
 Intrapleural pressure

◼ Also known as intrathoracic

pressure
◼ Pressure within the pleural sac
◼ Less than atmospheric pressure
◼ 756mm Hg at rest
◼ -4mm Hg
◼ Does not equilibrate with
atmospheric or intra-alveolar
pressure
 Intrapleural pressure is subatmospheric

◼ Chest wall and lungs moves in

opposite directions

◼ Water generates surface

tension on the pleural
membranes and ‘holds’ system
together

◼ The outward recoil of the chest

and inward recoil of the lung
creates a negative intrapleural
pressure (Ppl)
 Revisit- Primary pressures

◼ PB = Barometric pressure=Pmouth
◼ Ppl = Pleural pressure
◼ PA = Alveolar pressure

◼ During exhalation, PA = PeL + Ppl where, Pel = elastic

recoil pressure
 Transpulmonary pressure PL = PA - Ppl

Transmural pressure
Transmural pressure
gradient across lung
gradient across thoracic
wall
wall

760 756 760 756 760

Transmural pressures
▪PL = Transpulmonary pressure (across lung)= PA – Ppl
▪Pta = Transairway pressure (across airways)= Paw– Ppl
▪PW = Transthoracic pressure (across chest wall)= Ppl – PB
▪Prs= Transrespiratory system = PA- PB

Transmural Pressures are always inside – outside pressure

Intrapulmonary and intrapleural pressure
changes during various phases of respiration
▪ PL is positive- Airways & alveoli are expanded

▪ PL is negative- Airways & alveoli are compressed

Pneumothorax
 Primary spontaneous pneumothorax

Grossman, S.C. & Porth, C.M. (2014) Porth’s Pathophysiology: concepts of altered health states (9th Ed)
Philadelphia. Lippincott, Williams and Wilkins
 Risk factors for primary spontaneous
pneumothorax

◼ Being tall and thin – due to the pressure difference between the
top and bottom of the lungs, thought to contribute to the
development of blebs/blisters

◼ Smoking – causes small airway inflammation

◼ Lung diseases that involve air trapping and destruction of lung

tissue e.g. COPD, cystic fibrosis, tuberculosis

◼ More often occurs in men, peak age in early 20s

Pneumothorax
Pneumothorax
Percussion note
Breath sounds
 Assessment of inspiratory muscle strength

◼ Müller’s manoeuvre
◼ The individual breathes out as far as possible (to RV),
and then breathes in as hard as possible against a
blocked airway
◼ Measure maximum inspiratory pressure (MIP) developed
against a block of the trachea at RV
◼ PA and Ppl decreased by –80 mmHg
◼ Dilation of thoracic contents
◼ Promotes venous return
◼ Intra-abdominal pressure increases as the diaphragm
pushes down on visceral contents
 Assessment of expiratory muscle strength

◼ Valsalva Manoeuvre
◼ The individual breathes in as far as possible and then
blows out as hard as possible against an obstructed
airway
◼ Measure maximum expiratory pressure (MEP) at TLC
◼ PA and Ppl increased by +100 mmHg
◼ Compression of thoracic contents
◼ Impedes venous return, decreases cardiac output,
decreases cerebral blood flow leading to syncope
◼ Used during lifting, defecation, childbirth, suppressing
sneeze or cough