Last edited: 9/11/2021
1. THICKNESS & SURFACE AREA OF RESPIRATORY MEMBRANE
External Respiration: Thickness & Surface Area of Respiratory Membrane
OUTLINE
I) RESPIRATORY MEMBRANE
II) THICKNESS OF RESPIRATORY MEMBRANE
III) SURFACE AREA
IV) PULMONARY CAPILLARIES BLOOD FLOW
V) REVIEW QUESTIONS
VI) REFERENCES
I) RESPIRATORY MEMBRANE
Respiratory membrane is made up
(i) Alveolar cells lining the alveoli
o Type I (97%)
 Simple squamous
 Very thin and flat
 Involve in gas exchange process
o Type II
 Simple cuboidal
 Involve in surfactant production
• Important for surface tension
(ii) Basement membrane/ basal lamina
o Underneath epithelial cells (subepithelial)
o It is the thin connective tissue lining in between
endothelial lining the pulmonary capillaries and alveoli
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It is surrounded by the pulmonary capillaries with
endothelial cells lining
On average it is about 0.5 – 1 micrometer in thickness
but may reach up to 2 micrometers
o Thickness affects the gas exchange process
o If it is too thick → there is a big barrier difference and
separation → gasses have to travel further to reach
the alveoli from the blood and vice versa
Gases move down the partial pressure gradient
through the respiratory membrane
o Example: Carbon dioxide
 Move across the endothelial cells which are the
inner lining of the capillaries → through the basal
lamina and alveolar cells → into the alveolar
space of the lungs
THICKNESS & SURFACE AREA OF RESPIRATORY MEMBRANE
Medical Editor: Dr. Sofia Suhada M. Uzir
II) THICKNESS OF RESPIRATORY MEMBRANE
External respiration is influenced by the thickness of
respiratory membrane
Thickness of respiratory membrane is inversely
proportional to the gas exchange
(A) THICK RESPIRATORY MEMBRANE
> 3 micrometers
Thick respiratory membrane increases the distance for
the gasses to move across it
o Alter the gas exchange process → abnormal gas
exchange
 Decrease the gas exchange
 Affects the ventilation/perfusion effect
o
Figure 1. Thickened respiratory membrane
Situations which cause the increase in thickness of
respiratory membrane include:
(1) Left sided heart failure/ congestive heart failure
May happen in cardiomyopathy
(i) Mechanism
The heart hypertrophies → causes dilatation and
weakness → left ventricles cannot pump blood to
circulation
This causes buildup of blood in the left ventricle which
may back up into pulmonary circulation
The fluid ooze out in into the alveolar spaces → causing
water accumulation → edema of lung
This increases the thickness of respiratory membrane
o Increase the travel distance of CO2 and oxygen
→ abnormal gas exchange → inadequate
ventilation/perfusion process
(ii) Signs
Dyspnea (shortness of breath)
Hypoxemia/ hypoxemic hypoxia
o Due to the abnormal gas exchange → not a lot of
oxygen will be able to cross the respiratory
membrane → partial pressure of oxygen will be low,
partial pressure of CO2 will increase → hypoxemia/
hypoxemic hypoxia
Respiratory acidosis
o Due to the buildup of CO2
RESPIRATORY PHYSIOLOGY: Note #1. 1 of 3
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(2) Pneumonia
(i) Mechanism
Bacteria such as Klebsiella cause damage to the
epithelial tissue → release of histamines and other
mediators of inflammations → localized dilation of the
blood vessels causing
o Blood to flush to the inflamed area in large amount
and start to leak out to the spaces
(ii) Signs
Dyspnea (shortness of breath)
(B) THIN RESPIRATORY MEMBRANE
<0.5 micrometers
Decrease in the distance for gas exchange
Increase the gas exchange
o Oxygen moves from the alveoli into the blood
 Partial pressure of oxygen will be high
o CO2 moves across respiratory membrane into alveoli
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 Partial pressure of CO2 will be low
• May cause respiratory alkalosis
III) SURFACE AREA
Surface area is directly proportional to the gas exchange
o Increase surface area → increase in the gas
exchange
 More oxygen and CO2 can pass through the
respiratory membrane
o Decrease surface area → decrease gas exchange
 Less oxygen and CO2 can pass through the
respiratory membrane
Remember:
Gases move down the partial pressure gradient
o Oxygen → alveoli to the blood
o CO2 → blood to the alveoli
(A) LARGE SURFACE AREA
Situations which increase the surface area of the
respiratory membrane will increase the gas exchange
o More oxygen and CO2 will pass through the
respiratory membrane
 High partial oxygen level
 Low partial pressure of CO2
Figure 2. Large sufrace area causes increase in the gas
exhange
(B) SMALL SURFACE AREA
(1) In the lungs
The alveolar ducts with its alveolar sacs contribute to the
large alveolar surface area
They contain a lot of elastic tissues
2 of 3 RESPIRATORY PHYSIOLOGY: Note #1.
(2) Mechanism of the decrease in the surface area of
respiratory membrane
In inflammatory situations such as smoking, neutrophils
produce enzymes called elastase
o Elastase breaks the elastic tissue of alveolar
membrane → causes damage to the alveolar sacs
which lead to the transformation of alveoli into one
large alveolar chamber → this decreases the
surface area Figure 3
Figure 3. Reduction of the surface area
(3) Effects of small surface area
Gas exchange decrease
o Less oxygen and CO2 can pass through the
respiratory membrane
(C) ELASTASE EZYME
Elastases normally degrade the elastic fibers within the
alveoli
They are normally inhibited by the alpha 1 antitrypsin
molecule which is produced by the lungs and abundant in
the body
(1) Alpha 1 antitrypsin
It is a protease
It inhibits elastase → inhibit break down of elastic tissues
o Maintain normal elasticity of lungs
o Maintain appropriate amount of surface area
(2) Elastase build up
Happens especially in emphysema, a type of chronic
pulmonary disorder (COPD)
o Common in smokers
Risk factors which may lead to elastase build up include:
(i) Cancer
o Inhibition of alpha 1 antitrypsin gene → cannot
produce alpha 1 antitrypsin → elastase buildup
o May be caused by smoking or genetical
predisposition
(ii) Smoking
o Inflammation causes the activation of neutrophils
release → release elastase
Elastases will build up due to the lack of degradation
process/increase in production → breaking down the
alveolar membrane
This causes the alveoli to be left only with one large
chamber → surface area of alveoli decreases
significantly
o Smaller surface area → decrease in gas exchange
 Decrease in CO2 moving out of the blood into the
alveoli
 Decrease in the O2 moving from the lungs into the
blood
THICKNESS & SURFACE AREA OF RESPIRATORY MEMBRANE
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IV) PULMONARY CAPILLARIES BLOOD FLOW
Blood flow through the pulmonary capillaries:
o Generally, it takes about 0.75 secs for the blood to
flow through the pulmonary capillaries
o General partial pressure of oxygen is about 40
mmHg
o It takes approximately about 0.25 secs for the blood
flowing through the pulmonary capillaries to increase
from 40 mmHg to 100 mmHg (maximum amount of
hemoglobin oxygenation)
Correlation of the thickness of respiratory membrane to
the blood flow through the pulmonary capillaries:
o Thick respiratory membrane as seen in
pneumonia/left sided heart failure
 Never reach 100 mmHg (the maximum amount of
oxygen saturation of the hemoglobin)
 Never reach the maximum partial oxygen
saturation to take to the tissues
 May cause hypoxia
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Figure 4. Graph showing the blood flow through the pulmonary
capillaries
THICKNESS & SURFACE AREA OF RESPIRATORY MEMBRANE
V) REVIEW QUESTIONS
1) Regarding the respiratory membrane, which is true?
a) Is made up of stratified columnar epithelial cells
b) There are two types of alveolar cells lining the
alveoli
c) The basement membrane is subendothelial
d) Has no role in gas exchange
2) The normal thickness of respiratory membrane is
a) Around 1-2 micrometers
b) Around 0.1-1 micrometers
c) Around 0.5 -1 micrometers
d) May reach up to 3 micrometers
3) Thick respiratory membrane may cause
a) Increase in the gas exchange
b) Increase in perfusion rate
c) Alteration of gas exchange process
d) Inhibition to gas exchange process
4) Regarding dyspnea, which is true?
a) May be caused by left sided heart failure
b) Is not affected by the thickness of respiratory
membrane
c) It is the increase number of breaths taken in a minute
d) May cause respiratory alkalosis
5) In pneumonia, which is false?
a) Can be caused by Klebsiella
b) It causes the releases of histamines
c) The respiratory membrane becomes thinner
d) The respiratory membrane becomes thicker
6) The surface area
a) Is inversely proportional to the gas exhange
b) Increase in surface area decrease the amount of
carbon dioxide exhaled
c) Decrease in the surface area decrease the amount
of oxygen inhaled
d) Doesn’t affect the gas exchange
7) Large surface area
a) Increase the amount of oxygen inhaled
b) Decrease the amount of oxygen inhaled
c) Increase the amount of oxygen exhaled
d) Decrease the amount of oxygen exhaled
8) Elastase
a) Breaks down proteins
b) Breaks down elastic fibers
c) Breaks down smooth muscle
d) Breaks down alpha 1 antitrypsin
9) Deficiency of alpha 1 antitrypsin may cause
a) Increase in the degradation of elastase
b) Increase in the amount of elastic tissue
c) Decrease in the amount of elastase
d) None of the above
10) Smoking may lead to all of the following except
a) Cancer
b) Elastase production
c) COPD
d) Increase in degradation of anti 1 antitrypsin protease
CHECK YOUR ANSWERS
VI) REFERENCES
● Sabatine MS. Pocket Medicine: the Massachusetts General
Hospital Handbook of Internal Medicine. Philadelphia: Wolters
Kluwer; 2020.
● Le T. First Aid for the USMLE Step 1 2020. 30th anniversary
edition: McGraw Hill; 2020.
● Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL,
Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth
Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical; 2018
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
Pearson; 2020.
● Boron WF, Boulpaep EL. Medical Physiology.; 2017.
● Guyton and Hall Textbook of Medical Physiology. Philadelphia,
PA: Elsevier; 2021.
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