Compliance of lungs

By
Dr. Kanwal Ijaz
Learning objectives
By the end of this lecture students will be able to:
• Define compliance.
• Explain factors effecting compliance.
• Discuss Principle of Surface Tension.
• Explain Surfactant and Its Effect on Surface Tension
• Define law of laplace
• Describe pathophysiology of hyaline membrane disease
• Briefly describe work of breathing
 Compliance
• Compliance is a measure of how volume changes as a result of a
pressure change.
 Compliance
Definition:
• The extent to which the lungs will expand for each unit increase in
transpulmonary pressure is called the lung compliance
• That is, every time the transpulmonary pressure increases 1
centimeter of water, after 10 to 20 seconds, the lung volume will
expand 200 milliliters.
• C= ∆V/∆P
• Compliance is half if only one lung is present.
Significance of Determining Compliance
• Determination of compliance is useful as it is the measure of stiffness
of lungs.
• Stiffer the lungs, less is the compliance.
 Compliance
• The compliance of the lungs and chest wall is inversely correlated
with their elastic properties or elastance
 Pressure volume relation
• For this demonstration:
• A lung is excised and placed in a jar.
• The space outside the lung is analogous to
intrapleural pressure.
• The pressure outside the lung is varied with a vacuum
pump to simulate changes in intrapleural pressures.
• As pressure outside the lung is varied, the volume of
the lung is measured with a spirometer.
• Negative outside pressure lung would inflate
• Reduction the negative outside pressure lung would
inflate
• The sequence of inflation followed by deflation
produces a pressure-volume loop.
Compliance diagram
Hysterises loop
• Why are the inspiration and expiration limbs of the lung compliance
curve different?????
• The explanation for the different curves (i.e., hysteresis) lies in surface
tension at the liquid-air interface of the air-filled lung
2. Elastic forces caused by surface tension of
the fluid
• In the case of the saline
solution–filled lungs, there is no
air-fluid interface; therefore, the
surface tension effect is not
present—only tissue elastic
forces are operative in the saline
solution–filled lung.
 Compliance
• The characteristics of the compliance
diagram are determined by the elastic
forces of the lungs.
• These can be divided into two parts:
1. Elastic forces of the lung tissue
2. Elastic forces caused by surface
tension of the fluid that lines the
inside walls of the alveoli in their
lung air spaces.
 1. Elastic forces of the lung
• The elastic forces of the lung tissue
are determined mainly by elastin
and collagen fibers interwoven
among the lung parenchyma.

• In deflated lungs, these fibers are in

an elastically contracted and kinked
state; then, when the lungs expand,
the fibers become stretched and
unkinked, thereby elongating and
exerting even more elastic force.
2. Elastic forces caused by surface tension of
the fluid
• When the lungs are filled with air, there is an interface between the
alveolar fluid and the air in the alveoli
What is surface tension???
• When water forms a surface with air, the water molecules on the
surface of the water have an especially strong attraction for one
another.
• As a result, the water surface is always attempting to contract. This is
what holds raindrops together.

• That is, there is a tight contractile membrane of water molecules

around the entire surface of the raindrop
Surface tension
How this surface tension can be
reduced????
• Surfactant
• What is a surfactant??
• A chemical that lowers surface tension.
 Surface Tension, and Collapse
of the Alveoli
• On the inner surfaces of the alveoli the
water surface is also attempting to
contract.
• This results in an attempt to force the air
out of the alveoli through the bronchi and,
in doing so, causes the alveoli to try to
collapse.
• The net effect is to cause an elastic
contractile force of the entire lungs, which
is called the surface tension elastic force
How this surface tension elastic force can
be reduced????
• Surfactant
• What is a surfactant??
• A chemical that lowers surface tension.
 Surfactant and Its Effect on Surface Tension

Surfactant:
• Secreted by type II alveolar
epithelial cells (10 per cent
of the surface area of the
alveoli)
• These cells are granular,
containing lipid inclusions
that are secreted in the
surfactant into the alveoli.
 Composition of Surfactant:
• Phospholipids =
dipalmitoylphosphatidylcholine
• Proteins= apoproteins
• Ions = calcium ions
• Normal fluids lining the alveoli without
surfactant=50 dynes/cm;
• normal fluids lining the alveoli and with
normal amounts of surfactant included,
between 5 and 30 dynes/cm
 Pressure in Occluded Alveoli Caused by
Surface Tension
• If the air passages leading from the
alveoli of the lungs are blocked, the
surface tension in the alveoli tends to
collapse the alveoli.
• This creates positive pressure in the
alveoli, attempting to push the air
out.
• The amount of pressure generated in
this way in an alveolus can be
calculated from the following
formula:
 Pressure in Occluded Alveoli Caused by
Surface Tension
In average- sized alveolus:
• With surfactant=4 cm H₂O pressure (3 mm Hg)
• Without surfactant= 18 cm H ₂O
 Effect of radius on surface tension
• Surface tension is inversely related
to radius of the alveolus.
• Smaller the radius, greater the
alveolar pressure created by surface
tension.
• Smaller the radius of alveolus, more
pressure is required to open it
(laplace law)
 Respiratory distress syndrome of the newborn
• Infants have alveoli with radii less
than 25% that of an adult person.
• Surfactant is formed around 6-7
months of gestation
• Premature infants have little or no
surfactant in the alveoli when they
are born  their lungs have an
extreme tendency to collapse
respiratory distress syndrome of
newborn (hyaline membrane disease)
 Effect of the Thoracic Cage
on Lung Expansibility
• Thoracic wall also has elastic and
viscous characteristics.
• To inflate this total pulmonary system,
almost twice as much pressure is
needed as to inflate the same lungs
after removal from the chest cage.
• The compliance of the combined lung-
thorax system is almost exactly one half
that of the lungsalone—110 milliliters
of volume per centimeter of water
pressure for the combined system
Diseases in which compliance is decreased
• Pulmonary congestion
• Interstitial pulmonary fibrosis
(progressive disease of unknown
cause in which there is stiffening
and scarring of the lung)
• Pulmonary fibrosis following
tuberculosis
• Hyaline membrane disease
(respiratory distress syndrome of
new born)
• Thickening of pluera,
 Factors from thorax and chest wall that
decrease compliance of lung
• Deformities of thorax like
kyphosis and scoloiosis.
• Paralysis of respiratory muscles
• Abnormal thorax
(pneumothorax,hydrothorax,
hemothorax , and pyothorax).
Diseases in which compliance is increased
Diseases
• Emphysema
• Status asthemeticus
• Old age
 Work" of Breathing
• During quiet:
• Inspiration all respiratory muscle contraction;
• Expiration  passive (elastic recoil of the lungs and chest
cage).
• Thus, under resting conditions, the respiratory muscles
normally perform "work" to cause inspiration but not to
cause expiration.
 Work" of Breathing
• The work of inspiration can be divided into
three fractions that required to:
1. Expand the lungs against the lung and chest
elastic forces, called compliance work or
elastic work
2. Overcome the viscosity of the lung and chest
wall structures, called tissue resistance work
(increased in fibrosis of the lung)
3. Overcome airway resistance to movement of
air into the lungs, called airway resistance
work. (increased in chronic obstructive
pulmonary diseases (asthma, chronic
bronchitis).
Energy Required for Respiration
• During normal quiet respiration,
only 3 to 5 percent of the total
energy expended by the body is
required for pulmonary
ventilation.
Take home message
• Compliance: The extent to which the lungs will expand for each unit increase
in transpulmonary pressure is called the lung compliance.
• Compliance depends upon: Elastic forces of the lung tissue & Elastic forces
caused by surface tension.
• Surface tension is reduced by sufactants which is secreted by type II alveolar
cells.
• Smaller the radius of alveolus, more pressure is required to open it (laplace
law)
• Work of inspiration is divided in following three fractions , elastic force, tissue
resistance work, air resistance work
• https://www.youtube.com/watch?v=lM2-PkvstGY