Structure and Function of the Respiratory System

The primary function of the lung is gas exchange, which consists of movement of O2 into the body and removal of CO2. The lung also plays a role in host defense by functioning as a primary barrier between the outside world and the inside of the body. Finally, the lung is a metabolic organ that synthesizes and metabolizes numerous compounds. This chapter provides an overview of lung anatomy (i.e., upper and lower airways, muscles, innervation), growth and development of the normal and aginglung, and the fluids lining various anatomic sites, with special emphasis on unique features relative to the lung. Metabolic features of the lung are discussed in Chapter 25. LUNG ANATOMY The lungs are contained in a space with a volume of approximately 4 L, but they have a surface area for gas exchange that is thesize of a tennis court (85 m2). This large surface area is composed of myriads of independently functioning respiratory units. Unlike the heart but similar to the kidneys, the lungs demonstrate functional unity; that is, each unit is structurally identical andfunctions just like every other unit. Because the divisions of the lung and the sites of disease are designated by their anatomiclocations (right upper lobe, left lower lobe, etc.), it is essential to understand pulmonary anatomy in order to clinically relate respiratory physiology and pathophysiology. In adults, the lung weighs approximately 1 kg, with lung tissue accounting for 60% of the weight and blood the remainder. Alveolar spaces are responsible for most of the lung's volume; these spaces are divided by tissue known collectively as the interstitium. The interstitium is composed primarily of lung space for fluid and cells to accumulate. collagen fibers and is a potential space for fluid and cells to accumulate. the lower airway consists of the trachea, airways, and alveoli. The major function of the upper airways is to "condition" inspired air so that by the time it reaches the trachea, it is at body temperature and fully humidified. The nose also functions to filter, entrap, and clear particles larger than 10 m in size. Finally, the nose provides the sense of smell. Neuronal endings in the roof of the nose above the superior turbinate carry impulses through the cribriform plate to the olfactory bulb. The volume of the nose in an adult is approximately 20 mL, but its surface area is greatly increased by the nasal turbinates, which are a series of three continuous ribbons of tissue that protrude into the nasal cavity (Fig. 20-1). In humans, the volume of air entering the nares each day is on the order of 10,000 to 15,000 L. Resistance to airflow in the nose during quiet breathing accounts for approximately 50% of the total resistance of the respiratory system, which is about 8 cm H2O/L/sec. Nasal resistance increases with viral infections and with increased airflow, such as during exercise. When nasal resistance becomes too high, mouth breathing begins. The interior of the nose is lined by respiratory epithelium interspersed with surface secretory cells. These secretory cells produce important immuneglobulins, inflammatory mediators, and interferons, which are the first line in host defense. The paranasal sinuses, including the frontal sinuses, the maxillary sinus, the sphenoid sinus, and the ethmoid sinus, are lined by ciliated epithelium, and they nearly surround the nasal passages. The cilia facilitate the flow of mucus from the upper airways and clear the main nasal passages approximately every 15 minutes. The sinuses have two major functions-they lighten the skull, which makes upright posture easier, and they offer resonance to the voice. They may also protect the brain during frontal trauma. The fluid covering their surface is continually being propelled into the nose. In some sinuses (e.g., the maxillary sinus), the opening (ostium) is at the upper edge, which makes them particularly susceptible to retention of mucus. The ostia are readily obstructed in the presence of nasal edema, and retention of secretions and secondary infection (sinusitis) can result. The major structures of the larynx include the epiglottis, arytenoids, and vocal cords (Fig. 20-1). With some infections, these structures can become edematous (swollen) and contribute significantly to airflow

Upper Airways-Nose, Sinuses, Larynx

The respiratory system begins at the nose and ends in the most distal alveolus. Thus, the nasal cavity ,the posteriorpharynx, the glottis and vocal cords, the trachea, and all divisions of the tracheobronchial tree are included in the respiratory system. The upper airway consists of all structures from the nose to the vocal cords, including sinuses and the larynx, whereas