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The Respiratory
System

© Jim Swan

9:15 pm, Sep 24, 2006

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1
Respiratory System Topics
1) Ventilation (breathing) – the exchange of
gases between the atmosphere and the
lungs.
2) External respiration – the exchange of
gases between the lungs and the blood.
3) Internal respiration – the exchange of gases
between the blood and the systemic tissues.
4) Cellular respiration – aerobic metabolism

We will cover the first three topics in this unit. Cellular respiration will be
briefly touched upon in the section on Nutrition and Metabolism.

2
Respiratory Phases

External
respiration
Blood

Alveolar
sacs Interstitial
Atmosphere ventilation space

Internal
respiration

The above is a diagramatic representation of the three respiratory

topics to be covered.

3
Respiratory Tract
Upper
Nasal cavity respiratory
division
Pharynx
Larynx
Trachea
1o Bronchi
Ribcage
(thoracic wall)
Pleurae
Respiratory tree
(Lower respiratory
division) Diaphragm
Marieb 5th Ed., Figure 23.1

The two basic divisions of the respiratory tract are shown above.

4
Bones of Nasal Cavity
Medial View
Frontal sinus
Sella turcica
Nasal bone
Sphenoid sinus Pependicular
plate of
ethmoid

Vomer
Septal cartilage
Palatine bone
Palatine process of
Marieb 5th Ed., Figure 7.10 b maxilla

Note the relationship of paranasal sinuses to the nasal cavity.

5
Bones of Nasal Cavity
Lateral View
Ethmoid bone:
Superior concha
Middle concha

Inferior
concha

Superior, middle and

inferior meatuses
(meati)

Marieb 5th Ed., Figure 7.10 a

The conchae force the air to pass through narrow channels, the meati.
This exposes the air to the mucosal surface.

6
Nasal Cavity, Coronal Section

Superior concha

Middle concha
Inferior concha

Sinus drainage

Anatomy Coloring Book, Kapit and Elson

The paranasal sinuses drain into the nasal cavity. Mucosa is a

continuous lining throughout the sinuses and nasal passages, and into
the nasopharynx.

7
The Upper Division Olfactory
Internal Olfactory
mucosa
mucosa
nares
Pharyngeal tonsil Nasal conchae
Respiratory
mucosa:
P.C.C.E.
Pharynx:
Pharynx:
1)1) Warms
Warmsand
andmoistens
moistensair.
air.
Opening of internal auditory 2)2) Traps
Trapsparticulates
particulates
(pharyngotympanic) canal
a.k.a. Meati
a.k.a.Eustachian
Eustachiancanal
canal
Continuation
Continuationof
ofP.C.C.E.
P.C.C.E. Palatine tonsil
Nasopharynx
Lingual tonsil
Oropharynx Non-keratinized
Non-keratinized
stratified
stratified
Laryngopharynx squamous
squamous
epithelium
epithelium
Marieb 5th Ed., Figure 22.3

The upper respiratory division (See Figure 22.3) includes the nasal
cavity and pharynx. Air enters the nasal cavity through the external
nares and passes through the narrow channels (meati) created
between the nasal conchae. This exposes the air to the mucosa which
warms and moistens the air as it passes through the entire system. The
mucosa also removes particulates, dust, pollen, etc. and moves it
toward the esophagus. In the nasal cavity the respiratory mucosa is
partly ciliated and partly non ciliated and the cilia beat downward. The
upper portion of the nasal cavity has olfactory receptors whose nerves
pass through the foramina in the cribriform plate to the olfactory bulb
of the brain. The nasal cavity narrows at the internal nares before
joining with the pharynx. The pharynx is divided into three portions: the
nasopharynx, the oropharynx and the layngopharynx which connect
to the nasal cavity, oral cavity and larynx respectively.
The nasopharynx has the pharyngeal tonsils (lymph nodes) and the
opening into the eustachian canal (a.k.a. pharyngotympanic tube or
internal auditory canal). This canal allows equalization of pressure
between the atmosphere and the middle ear. This is important when
increasing or decreasing in altitude and when atmospheric pressure
changes for any reason. Inability to equalize pressure can impair
hearing as occurs when the mucosa is inflamed due to a respiratory
infection.
The lining continues to be ciliated into the nasopharynx and then
changes to non-keratinized stratified squamous in the oropharynx and
laryngopharynx where protection from ingested food is important. 8
Upper Respiratory Division

Identify the structures labeled above

9
The Larynx (lair-inks)
This causes
causesthe
Swallowing
This causes
the
Swallowing
epiglottis to
causes
shield
epiglottis
hyoid and to shieldto
larynx
hyoid
the and larynx to
theglottis
glottis
swivel
to
toprevent
upwards. prevent
aspiration
swivel upwards.
aspiration

Trachea
Anterior view (windpipe) Sagittal section

Marieb 5th Ed., Figure 22.4

The larynx lies atop the respiratory tree and contains the voice box.
Supporting the larynx is the hyoid bone which connects to the tongue
above and to the thyroid cartilage below. When swallowing occurs, the
hyoid bone, which does not articulate with any other bones, hinges
upward and the larynx tilts backward. This causes the epiglottis to
more effectively shield the glottis and prevent aspiration of food or
liquid. The thyroid cartilage is the largest laryngeal cartilage and
projects anteriorly as the "Adam's Apple". The thyroid cartilage is open
posteriorly and the vocal folds (true vocal cords) run along its inside
antero-posteriorly. Men tend to have deeper voices and more
pronounced "Adam's Apples" due to the increased length of the thyroid
cartilage and vocal fold. Tension on the vocal cords determines the
pitch of the voice as air is pushed up between them. This tension in turn
is controlled by cartilages attached to the back of the cords called the
arytenoid cartilages. These cartilages swivel to change vocal cord
tension. Vocal cord tension is controlled by arytenoid and other
muscles [See laryngeal muscles] which contract or relax to increase
(for high pitches) or decrease (for low pitches) tightness. Lying above
the vocal folds are the vestibular folds (false vocal cords) which are
narrow ridges protecting the vocal cords from aspirated materials. The
glottis is the opening between the vocal cords and the passageway for
air into the trachea.

10
Respiratory Tree
(Dissected Specimen)
Thyroid
cartilage
Cricoid
cartilage
Thyroid
gland

Primary
bronchi

11
Larynx, anterior view

Thyroid cartilage

Cricothyroid muscle
Cricoid
cartilage

12
Larynx, posterior view
Epiglottis
Greater horn of
hyoid bone

Aryepiglottic
fold and Superior horn of
muscle thyroid cartilage
Piriform recess
Arytenoid muscles

Cricoarytenoid muscle Cricoid cartilage

Membraneous part
of trachea

Notice the “tulip shape” of the epiglottis and aryepiglottic folds. These
structures curl backwards when swallowing to prevent aspiration.

13
Larynx, sagittal section
Epiglottis

Sup. Cornu of
thyroid
cartilage
Thyroid cartilage
Vestibular fold
ventricle Arytenoid muscle
Vocal fold
Vocalis muscle
Cricoid cartilage
Cricoid cartilage

Trachea

The vocal folds (true vocal chords) are protected by the overhanging
vestibular folds.

14
Glottis, superior view

epiglottis

Vestibular fold
Vocal fold
Aryepiglottic fold

Interarytenoid
notch

The glottis is the opening between the vocal folds, into the respiratory
tree.

15
The Vocal Cords

Listen to the function of the vocal folds in action.

16
Larynx, coronal section
Root of tongue
Epiglottis

Thyroid
cartilage

Vestibular fold
Thyroarytenoid
muscle Thyrohyoid muscle
ventricle
Vocal fold Vocal ligament
Lat. Cricoarytenoid muscle Vocalis muscle
Cricothyroid muscle glottis
Cricoid cartilage (cut)

Thyroid gland Trachea

17
Laryngeal Cartilages, anterior view
Epiglottis
Lesser cornu
Hyoid bone Greater cornu

Body

Thyroepiglottic ligament Thyroid

cartilage

Cornus elasticus
Cricothyroid ligament Cornus elasticus
Cricoid cartilage

18
Laryngeal Cartilages, posterior view
Lesser cornu of hyoid bone

Greater cornu of hyoid bone

Epiglottis
Thyrohyoid ligament

Sup. Cornu of
thyroid cartilage
Thyroepiglottic lig.
Corniculate cartilage
Thyroid cartilage
Arytenoid cartilage
Cricoarytenoid joint
Post. Cricoarytenoid
Cricoid cartilage Cricothyroid joint
lig.

Trachea

19
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Laryngeal Cartilages, lateral view

Lat. Thyrohyoid lig.
Greater cornu of hyoid bone

Epiglottis

Thyroid cartilage
Corniculate cartilage
Arytenoid cartilage
Cricoarytenoid joint

Cricothyroid joint
Cricoid cartilage

Trachea

20
C.S. Trachea & Esophagus

P.C.C.E

Flexible membraneous portion

Mucociliary
Mucociliaryescalator
escalator
––upward
upwardmovement
movement
and
andremoval
removalof of
mucus
mucusfrom
from
respiratory
respiratorytree.
tree.

Marieb 5th Ed., Figure 22.5

The trachea, See or windpipe, is the beginning of the respiratory tree. It

has cartilages shaped like Cs (or Us) with the open portion posterior.
The trachea is lined with pseudostratified ciliated columnar epithelium
(p.c.c.e.) which continues into the bronchi. The cilia of this mucosa beat
upward to carry particulates up and out into the esophagus. The
submucosa of the trachea contains seromucous glands to produce an
abundance of mucus for the mucociliary escalator, the mechanism by
which the mucus is moved up and out of the respiratory tract. The
membraneous portion of the trachea on the posterior side contains the
majority of the trachealis muscle and is flexible to accommodate the
esophagus nestled immediately behind the trachea.

21
The Respiratory Tree
Cricoid cartilage

Tracheal cartilages

2 Primary bronchi (to each lung)

5 Secondary bronchi (to each

lobe)
18 Tertiary bronchi (to
bronchopulmonary
segments)
Subsegmental bronchi – large and small,
about 20 generations.

The Conducting Zone - area which conducts air into the lungs. No gas
transport occurs here. Also called the anatomical dead space.
The trachea, branches into the primary bronchi (which lead to each
lung, then branching to the secondary bronchi leading to the lobes (2
on the left, three on the right), then the tertiary bronchi to the 18
broncho-pulmonary segments (8 on the left, 10 on the right). Each
broncho-pulmonary segment includes a branch of the pulmonary artery,
pulmonary vein, and a tertiary bronchus. These segments act as
structural and functional units in the lung to maintain blood flow and gas
transport. The cartilages change from C-rings to plate cartilages in the
bronchi while the walls get thinner. PCCE continues. Tertiary bronchi
lead to the large bronchioles. Large bronchioles have little or no
cartilage and the mucosa becomes simple ciliated columnar epithelium.
Large bronchioles lead to the terminal bronchioles which have simple
cuboidal epithelium. Goblet cells continue through the mucosa
providing continued mucus secretion.

22
Zones of the Respiratory System
Mucosa
Mucosalined
linedwith
with
smooth Smooth muscle
smoothmuscle
muscle
and
andcartilage.
cartilage.
Hyaline Conducting Respiratory
cartilage
Zone bronchiole
plates

alveoli
Simple
Simplesquamous
squamous
Cartilage ends epithelium
epitheliumfor
forgas
gas
after bronchi – exchange
exchange
none in
bronchioles Respiratory
Large bronchioles Zone
Terminal bronchioles Elastic
fibers

The difference between the respiratory and conducting zones is their

function: the conducting zone transports the air into and out of the
lungs; the respiratory zone allows gas exchange between the lungs
and the blood.

23
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Respiratory Tree
Respiratory Tract Video Clip

24
Conducting Zone Hierarchy
Nasal mucosa P.C.C.E. (partly ciliated) cilia beat down
Pharynx:
nasopharynx P.C.C.E. (partly ciliated) cilia beat down
oropharynx
Non-keratinized stratified squamous
laryngopharynx
Larynx
Trachea P.C.C.E. (partly ciliated) cilia beat up

Bronchi (1o,2o,3o, sub)

Large bronchioles Simple ciliated columnar

Terminal bronchioles Simple cuboidal

25
Tracheal Lining
Transmission Electron Micrograph (TEM)
cilia

Goblet cell with

mucinogen granules
(G)
Ciliated Epithelial Cell
(E)

26
Bronchial Lining Surface View
Scanning Electron Micrograph (SEM)

Cilia of the
pseudostratified ciliated
columnar epithelium. Note
how the cilia lean
uniformly in the same
direction, appearing just as
they were when fixed at a
specific moment in their
wave-like movement.
Goblet cells.

27
A Bronchus

Hyaline
cartilage plate

Pseudostratifi
ed ciliated
columnar
epithelium
Smooth
muscle

See the [Virtual Microscope] for histology slides.

28
A Large Bronchiole
vein

Smooth
muscle

Ciliated
columnar
epithelium
Lumen of
bronchiole

Notice the difference between the wall of bronchiole (cut, at bottom) and
the vein above.

29
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Alveoli

Alveoli are thin-walled chambers surrounded by capillaries for gas

transport. Elastic fibers, part of the stroma of the lungs, provide support
and elasticity (recoil) for the lungs.

30
Respiratory Zone

Conducting zone: mucosa

lined, allows no gas
exchange with blood.

Respiratory zone: thin walled simple

squamous epithelium, allows gas
exchange with blood.

The Respiratory Zone - this area has thin simple squamous epithelial
walls (the respiratory bronchioles start out as simple cuboidal and soon
become simple squamous), no mucosa, and permits gas transport into
and out of the blood. Respiratory bronchioles begin this zone, leading to
alveolar ducts and then alveolar sacs. These sacs are a connected
system of thin-walled chambers called alveoli. The alveoli increase the
surface area for contact with blood vessels. The structure of the lungs is
composed of these spongy-appearing alveolar sacs, together with
bronchial passageways and blood vessels. See the following for highly
magnified views of alveoli and associated cells and tissues: Look for the
numerous capillaries in these closeups. They are indicated by the red
blood cells inside them.

31
Branch into Respiratory Bronchiole

In this unlikely lung section you can see the passageways from a
terminal bronchiole to the alveoli.

32
The Respiratory Membrane
Premature
Prematureinfants often
infantsthe
often lack
lack
Surfactant
Surfactant
surfactant lowers
lowers
and need the
tosurface
surface
be
surfactant
tension of and need to be
tension
given ofwater
givenpositivewater
positive
to
tokeep
keepand
pressure
pressure and
moisture
moisture
synthetic from
from collapsing
collapsing
surfactant the
the
synthetic
alveolar surfactant––IRDS
sacs. IRDS
alveolar
(Infant sacs.
Respiratory Distress
(Infant Respiratory Distress
Syndrome)
Syndrome)or orhyaline
hyaline
membrane
membranedisease.
disease.

Marieb 5th Ed., Figure 22.9c

Alveolar capillaries are more numerous and densely arranged than in

most any other organ. They form an area of contact with the alveolar
walls of (depending on which source you read) from 50 to 400 sq.
meters. Upon this area, at rest, approximately a liter and a half of blood
is distributed. (This amount increases with exercise).
The structure of the respiratory membrane permits gas transport while
preventing much water from entering the alveoli from the capillaries.
Since interstitial fluid in the lungs would be disastrous to respiratory
function, any fluid which does enter is removed by the lymph system. All
the moisture in the alveolar sacs is the result of evaporation from the
mucosal lining of the respiratory passages above. In addition to the
Type I alveolar cells (the simple squamous cells of the alveolar wall)
there are Type II alveolar cells present which secrete surfactant.
Surfactant acts to break the surface tension (cohesiveness) of water
which would cause collapse of the alveoli during expiration. This
happens in premature infants whose respiratory systems have not
matured, a condition called Infant Respiratory Distress Syndrome
(IRDS) or Hyaline Membrane Disease . Macrophages are also present
which phagocytize bacteria that make it into the alveoli.

33
Respiratory Zone Circulation

Branch of
Pulmonary
Branch of Vein
Pulmonary
Artery

34
Alveolar Capillaries

A dense network of capillaries surrounds each alveolus to produce the

respiratory membrane consisting of the capillary wall (endothelium),
the alveolar wall (simple squamous epithelium), and the basement
membranes of each. These basement membranes are composed of a
basal lamina with collagen fibers and a small amount of elastic tissue.
The elastic tissue gives the lungs their elasticity or recoil.

35
Alveolar Sacs and Alveoli

Alveolar
sac

capillaries
Alveolar Sac Simple
squamous
epithelium

36
Alveoli

capillary

Type I
cell

Type II
cell

A high magnification view of the alveoli.

37
Normal Lung, Sec.
Normal Lung Section
Notice the hilar lymph nodes
which are small and have enough
pigment (from dusts in the air
breathed in, scavenged by
pulmonary macrophages,
transferred to lymphatics, and
collected in lymph nodes) to
make them appear greyish-black.

Lymph nodes

Area of congestion

The majority of lung tissue, the “spongy” part, is composted of the

alveoli and associated capillaries. The remainder consists of the larger
blood vessels and respiratory passageways. In the lung specimen seen
above some fluid has accumulated in the lower lobe.

38
Heart-Lungs in Situ
Heart-Lungs in Situ
Lung, visceral
pleura
attached
Parietal
pleura

rib

lung muscle
Pleural
space
Parietal Visceral
pleura pleura
Diaphragm
Parietal
pericardium

Pleural membranes are serous membranes: Parietal pleura –

attached to the thoracic wall. Visceral pleura – attached to the
lungs. Pleural cavity (space) – a fluid filled space which adheres the
two pleural membranes. Because of the serous fluid these membranes
adhere to one another, and when the parietal membrane is displaced
due to movement of diaphragm or ribcage, so is the visceral layer, and
so are the lungs.

39
Thorax-Lung Relationships
: 760 mm Hg STD

Thoracic wall

Parietal pleura

Visceral pleura

Pleural space

Diaphragm

The lungs are surrounded by a double layered pleural membrane or

sack. The inner layer is called the visceral pleura and is attached to
the surface of each lung. The outer layer is the parietal pleura and is
attached to the lining of the thorax and the mediastinum. It adheres to
the inner wall of the ribcage and to the upper surface of the diaphragm.
The space between these layers, sometimes called the pleural space or
cavity, is really only a potential space, normally just the layer of serous
fluid secreted by the membranes. The serous fluid binds the two layers
together so that if the parietal layer is expanded by movement of the
ribcage or diaphragm, so is the visceral pleura and so are the lungs.

40
When
Whenradial
radialfibers
fiberscontract
contractthe
the
Contraction of the
diaphragm
diaphragm flattens,pulling
flattens, pulling
down
downandandenlarging
enlargingthe
thethorax.
thorax.
Diaphrgam in
Lowered
Lowered pressure inthe
pressure in thelungs
lungs Inspiration
following
followingBoyle’s
Boyle’sLaw
Lawpulls
pullsair
air Radially
down
downthethepressure
pressuregradient
gradient arranged
into
intothe
thelungs.
lungs. fibers Central tendon
of diaphragm

Figure 10.10

Ventilation is composed of two parts: inspiration and expiration. Each

of these can be described as being either quiet, the process at rest, or
forced, the process when active such as when exercising. Boyle's Law
states that the volume and pressure of a gas are inversely proportional.
If the volume of the gas increases, its pressure will decrease. If the
volume decreases, its pressure will increase. The movement of air in
ventilation occurs as a result of the pressure gradient produced when
the volume of the lungs increases or decreases. The following table
describes the events which produce this pressure gradient:

41
Inspiration
: 760 mm Hg STD

Thoracic wall

Parietal pleura

Visceral pleura

Pleural space

Diaphragm Relaxed

Contracted

Quiet inspiration: The diaphragm contracts, this causes an increase

in volume of the thorax and the lungs, which causes a decrease in
pressure of the thorax and lungs, which causes air to enter the lungs,
moving down its pressure gradient. Air moves into the lungs to fill the
partial vacuum created by the increase in volume.

42
Diaphragmatic
Diaphragmatic
breathing
breathingis isdeep
deep
Expiration
controlled breathing.
controlled breathing.
Volume
Volumeis islarge,
large,rate
rate : 760 mm Hg STD
is slow.
is slow.

Thoracic wall
In
Inexpiration
expirationthe
theprocess
process
reverses: diaphragm
reverses: diaphragm
Parietal pleura relaxes,
relaxes,volumes
volumes
decrease,
decrease,andandair
airflows
flows
down its pressure
down its pressure
Visceral pleura gradient
gradienttotothe
the
atmosphere.
atmosphere.
Pleural space

Diaphragm Relaxed

Contracted

Quiet expiration: The diaphragm relaxes. The elasticity of the muscle

tissue and of the lung stroma causes recoil which returns the lungs to
their volume before inspiration. The reduced volume causes the
pressure in the lungs to increase thus causing air to leave the lungs due
to the pressure gradient.

43
Forced Inspiration

Scalenes
Scalenesandand
Sternocleidomastoid sternocleidomastoi
sternocleidomastoi
muscle ddmuscles
musclespull
pullup
up
on the ribcage.
on the ribcage.

External
intercostals
The
Theexternal
externalintercostals
intercostals
separate
separatethe
theribs
ribswhen
whenthey
they
contract, thus increasing
contract, thus increasing
the
thethoracic
thoracicvolume.
volume.

Forced inspiration: Other muscles aid in the increase in thoracic and

lung volumes.
The scalenes - pull up on the first and second ribs.
The sternocleidomastoid muscles pull up on the clavicle and
sternum.
The pectoralis minor pulls forward on the ribs.
The external intercostals are especially important because they
spread the ribs apart, thus increasing thoracic volume. (See Figure
22.12) It's these muscles whose contraction produces the "costal
breathing" during rapid respirations.

44
Forced Expiration
Costal The
Theinternal
internalintercostals
intercostalssqueeze
Costalbreathing
breathingis
is squeeze
shallow the
the ribs together,reducing
ribs together, reducingthoracic
shallowbut
butrapid.
rapid. thoracic
Hyperventilation volume.
volume.TheTheabdominals
abdominalshelp
helpto
Hyperventilationusually
usually to
utilizes push
pushthethediaphragm
diaphragmupward
upwardasasitit
utilizesboth
both
diaphragmatic relaxes.
relaxes.Training
Trainingthe
theabdominals
abdominalsis
diaphragmaticandandcostal
costal is
breathing. important for proper breathing
important for proper breathing
breathing.
during
duringexercise.
exercise.

Internal
intercostals

Forced Respiration
Abdominal muscles

Forced Expiration: The following muscles aid in reducing the volume

of the thorax and lungs:
The internal intercostals - these compress the ribs together.
The abdominus rectus and abdominal obliques: internal obliques,
external obliques- these muscles push the diaphragm up by
compressing the abdomen.

45
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Ventilation
inspiration expiration

Restful Diaphragm contracts, Diaphragm relaxes,

volumes of thorax and lungs volumes of thorax and
increase, pressures decrease: lungs decrease, pressures
air flows inward along increase: air flows outward
pressure gradient along pressure gradient
Forced
(active) Additional muscles help to Additional muscles aid in
increase the volume of the decreasing the volume of
thorax and lungs: scalenes, the thorax or in pushing the
pectoralis minor, diaphragm upward.
sternocleidomastoid,
external intercostals.

Quiet Respiration

46
Pressure Changes During Ventilation
Intrapulmonary
Intrapulmonarypressure
pressureaverages
averages
atmosphere,
atmosphere, 760mm
760 mmHg HgSTD.
STD.
Intrapleural
Intrapleuralpressure
pressureaverages
averages –4
–4
mm Hg, 756 STD.
mm Hg, 756 STD.
Collapsing
Collapsingforce
forceof
oflungs
lungs==44mm
mmHg.
Hg.

Intrapulmonary
Pressures

Intrapleural
Pressures

During inspiration the pressure inside the lungs (the intrapulmonary

pressure) decreases to -1 to -3 mmHg compared to the atmosphere.
The variation is related to the forcefulness and depth of inspiration.
During expiration the intrapulmonary pressure increases to +1 to +3
mmHg compared to the atmosphere. The pressure oscillates around
zero or atmospheric pressure. The intrapleural pressure is always
negative compared to the atmosphere. This is necessary in order to
exert a pulling action on the lungs. The pressure varies from about -4
mmHg at the end of expiration, to -8 mmHg and the end of inspiration.

47
Balance Between Two Processes

Compliance (distensibility) – the tendency of the lungs to

expand. This is made possible by the negative pleural pressure
and surfactant which prevents the alveoli from collapsing upon
expiration. Compliance is the force responsible for inspiration.

Elasticity or recoil – this is the tendency of the lungs to

return to their size before inspiration. Elasticity is due to the
elastic stroma of the lungs and elasticity of respiratory
muscles. Elasticity is necessary for expiration.

The tendency of the lungs to expand, called compliance or

distensibility, is due to the pulling action exerted by the pleural
membranes. Expansion is also facilitated by the action of surfactant in
preventing the collapse of the alveoli. The opposite tendency is called
elasticity or recoil, and is the process by which the lungs return to their
original or resting volume. Recoil is due to the elastic stroma of the
lungs and the series elastic elements of the respiratory muscles,
particularly the diaphragm.

48
Balance of Compliance and Elasticity

Compliance => Elasticity =>

Inspiration Expiration

Inspiratory Diaphragm
muscles relaxes or
contract expiratory
muscles
contract

49
The Respiratory Volumes

Respiratory volumes Tidal Volume TV: Volume of a single breath,

usually at rest.
Inspiratory Reserve Volume IRV: Volume which can be inspired
beyond a restful inspiration.
Expiratory Reserve Volume ERV: Volume which can be expired
beyond a restful expiration.
Residual Volume RV: Volume remaining in the lungs after a maximum
expiration. This volume keeps the alveoli inflated.
Vital Capacity: The vital capacity (VC) is the maximum volume which
can be ventilated in a single breath. VC= IRV+TV+ERV. VC varies with
gender, age, and body build. Measuring VC gives a device for diagnosis
of respiratory disorder, and a benchmark for judging the effectiveness of
treatment.

50
The Minute Volume

Minute Volume = Respiratory Rate X Tidal Volume

Rates vary from 12 to 15 bpm (breaths per minute)

Tidal volume averages 500 cc.

For example:
Minute Volume = 12 bpm X 500 cc = 6000 cc/minute

Minute Volume = Rate (breaths per minute) X Tidal Volume

(ml/breath)
Rate of respiration at rest varies from about 12 to 15 bpm. Tidal volume
averages 500 ml (See Figure 22.16 or Lung Volumes Table below)
Assuming a rate of 12 breaths per minute and a tidal volume of 500, the
restful minute volume is 6000 ml. Rates can, with strenuous exercise,
increase to 30 to 40 bpm and volumes can increase to around half the
vital capacity.

51
The Alveolar Ventilation Rate
Out of each breath approximately 150 cc is in the anatomical
dead space (the conducting zone) where gas transport does not
occur. In order to calculate the volume of air actually entering
the alveoli the dead space volume must be subtracted.

AVR = rate X [tidal volume – 150 cc]

For example:
AVR = 12 X [500 - 150 cc] =
AVR = 12 X 350 cc = 4200 cc

Which would raise the AVR more, increasing the rate or

volume of respirations?

Not all of this air ventilates the alveoli, even under maximal conditions.
The conducting zone volume is about 150 ml and of each breath this
amount does not extend into the respiratory zone. The Alveolar
Ventilation Rate, AVR, is the volume per minute ventilating the alveoli
and is calculated by multiplying the rate times the (tidal volume-less the
conducting zone volume).
AVR = Rate X (Tidal Volume - 150 ml)
For a calculation using the same restful rate and volume as above this
yields 4200 ml.
Since each breath sacrifices 150 ml to the conducting zone, more
alveolar ventilation occurs when the volume is increased rather than the
rate.

52
Restrictive Disorders
Any disorder which interferes with compliance or elasticity is a
restrictive disorder. Examples are emphysema and fibrosis.

Restrictive disorders reduce the Vital Capacity by changing the

volume of air which can be inspired or expired.

Conditions which interfere with compliance or elasticity are called

restrictive disorders. Examples are emphysema, which increases
compliance and decreases elasticity, and fibrosis, which reduces both.

53
Emphysema Lung Section

In this section of lung, dilated

airspaces with emphysema are
seen. Compare to normal lung
below.

In emphysema the buildup of toxins from cigarette smoke and resulting

mucus production leads to destruction of the alveolar and capillary walls
and fibrosis of the tissue. This produces large thick-walled chambers
replacing the normal small thin-walled alveoli. It results in a larger
volume in the lungs but impaired gas transport and reduced ability to
expire the trapped air. Many emphysema sufferers have the
characteristic "barrel chest" as a result. Carbon dioxide tends to
increase in alveolar air and in the blood, in some individuals interfering
with normal respiratory stimuli and responses.
Pulmonary or cystic fibrosis (def) produces thickened mucus
secretions which block the airways and scar tissue often develops in
place of the normal elastic stroma. This is both restrictive and
obstructive in its effects.
Restrictive disorders reduce the volume which can be ventilated as
seen in a reduced vital capacity.

54
Emphysema, micrograph

Microscopically
at high
magnification,
the loss of
alveolar walls
with emphysema
is demonstrated.
Remaining
airspaces are
dilated. Compare
to normal lung.

Note the enlarged alveolar sacs compared with the normal tissue (lower
right).

55
Alpha 1 anti-trypsin

Leucocytes protect the body against invasion by releasing digestive

enzymes. Normally the antitrypsin prevents the enzyme released by
leucocytes from damaging the body’s own tissue. But when the
antitrypsin is deficient or inhibited, lung tissue is broken down.

56
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Emphysema, Gross
The chest cavity is opened at
autopsy to reveal numerous
large bullae (air bubbles)
apparent on the surface of the
lungs in a patient dying with
emphysema. Bullae are large
dilated airspaces that bulge out
from beneath the pleura.
Emphysema is characterized by
a loss of lung parenchyma by
destruction of alveoli so that
there is permanent dilation of
airspaces.

57
Obstructive Disorders
Disorders which obstruct the airflow are called obstructive
disorders: inflammation, mucus secretion, constriction.

Obstructive disorders do not in themselves reduce the Vital

Capacity. Instead they reduce the rate at which the VC is
expelled. This is measured by the FEV1. FEV stands for
Forced Expiratory Volume, the 1 is for the first second.
FEV1 = % of the Vital Capacity expired in the first second.
Normal is 75 to 80%. Below 65% is considered severe.

In contrast, obstructive disorders such as bronchitis and asthma

reduce the size of the bronchial passages thus interfering with the
airflow. In bronchitis an inflammation results from respiratory infection or
irritation from smoke or pollution.

58
The FEV1

1 Sec.
The FEV1 is the
portion of the vital
Expiration | Inspiration capacity expelled
in the first second.
VC

TV

Purely obstructive disorders do not technically reduce the volume which

can be ventilated but they reduce the rate of ventilation by increasing
the resistance to airflow. They will show a normal vital capacity but a
reduced FEV1, (Forced Expiratory Volume) the percentage of the vital
capacity which can be expelled in the first second. Normal FEV1 is 75%
or greater.

59
The FEV1
A person with
an obstructive
1 Sec. disorder has
difficulty
Expiration | Inspiration
expelling the
VC VC and the
proportion
expelled in the
first second
decreases below
75%

Note the shallow slope of the expiration. This indicates the reduced rate
of an obstructive disorder such as bronchitis or asthma.

60
Bronchial Asthma, L.P.

Bronchial
cartilage
C

L Submucosa
widened by
smooth muscle
hypertrophy,
edema, and
inflammation
(mainly
Bronchial lumen (filled with mucus) eosinophils).

Asthma is like an allergic reaction in which inflammation occurs together

with a constriction of the bronchial passages.

61
Disorders Which Are
Both Restrictive and Obstructive
Disorders such as COPD (Chronic Obstructive Pulmonary
Disease) and obstructive emphysema are both restrictive
and obstructive and reduce both the Vital Capacity and
the FEV1.
COPD is a combination of emphysema, bronchitis, and
asthma. Obstructive emphysema is dilation of the alveolar
sacs together with the collapse of alveolar ducts and air
trapping.

Many times disorders are both obstructive and restrictive. For example:
obstructive emphysema - in addition to the enlarging and thickening
of alveolar walls many of the passageways collapse producing
obstructive effects as well.
COPD Chronic Obstructive Pulmonary Disease - a combination of
emphysema, bronchitis and asthma, has components of each.

62
Dalton’s Law of Partial Pressures
The partial pressure of a gas in a mixture is equal to the
fraction of the gas multiplied by the total pressure of the
mixture.
For STP of 760 mm Hg: (Table 23.4)
O2 = 21% X 760 = pO2 159 (160)
CO2 = .04% X 760 = pCO2 .3
N2 = 79%
H2O = .46% ?

Movement of the respiratory gases is due to diffusion. Diffusion results

from a concentration gradient which is expressed for gases as the
difference in partial pressures. Dalton's Law of Partial Pressures
states that The partial pressure of a gas in a mixture is calculated
by multiplying the fraction occupied by the gas times the total
pressure of the mixture.
The mixture of gases under consideration is the air and Table 22.2
shows the partial pressures of its gases at STP (standard temperature
and pressure at sea level).
Oxygen is present at nearly 21% of ambient air. Multiplying .21 times
760 mmHg (standard pressure at sea level) yields a pO2 of about 160.
Carbon dioxide is .04% of air and its partial pressure, pCO2, is .3.

63
Alveolar air:
Inspired air: pO2 = 160, Expired air: pO2 = 120,
pO2 = 104,
pCO2 = .3 pCO2 = 27
Concentration
Concentration Figure 23.17
pCO = 40
2

gradients
gradientsbetween
between Diffusion
Diffusiondown
downgradient
gradient
the
theatmospheric
atmosphericair air between
between alveolarair
alveolar airand
and
and
andthe
thealveolar
alveolarair
air deoxygenated blood
deoxygenated blood
external
external
produce
producediffusion
diffusion raises
raisespulmonary
pulmonaryvenous
venous
respiration
respiration
into
intothe
thealveoli
alveolifor
for (oxygenated)
(oxygenated)bloodbloodtotopO
pO22
oxygen
oxygenand
andoutoutof
of nearly that in the alveoli
nearly that in the alveoli
the
thealveoli
alveolifor CO22..
forCO (it’s
(it’sactually
actually~100)
~100)
Deoxygenated blood:
pO2 = 40, pCO2 = 45
Concentration
Concentrationgradient
gradient
between
betweenblood
bloodand
and
systemic
systemictissues
tissuescauses
causes
pO22and
pO andpCO
pCO22to
toreturn
return
Systemic Tissues: pO2 < 40, to
tothat
thatin
indeoxygenated
deoxygenated
pCO2 >45 blood.
blood.
Figure 22.17

As Figure 22.17 shows there is a partial pressure gradient between

inspired air and the alveolus with alveolar air having a pO2 of 104 and a
pCO2 of 40. So oxygen diffuses into the alveoli from inspired air and
carbon dioxide diffuses from the alveoli into air which will be expired.
This causes the levels of oxygen and carbon dioxide to be intermediate
in expired air when compared to inspired air and alveolar air. Some
oxygen has been lost to the alveolus, lowering its level to 120, carbon
dioxide has been gained from the alveolus raising its level to 27.
Likewise a concentration gradient causes oxygen to diffuse into the
blood from the alveoli and carbon dioxide to leave the blood. This
produces the levels seen in oxygenated blood in the body. When this
blood reaches the systemic tissues the reverse process occurs
restoring levels seen in deoxygenated blood.

64
Gas Exchange in the Alveoli
Expired air:
Inspired air: pO2 =120,
pO2 = 160, pCO2 = 27
pCO2 = .3

Some O2 Some CO2 CO2 Unloading

O2 Loading diffuses into the diffuses into Flash Video
Flash Video
alveoli from the outgoing
incoming air air
Alveolar air: pO2 = 104,
pCO2 = 40

Internal Respiration: CO2 and O2 Exchange

Flash Video

65
External Respiration

Alveolar air: pO2 = 104,

pCO2 = 40

Deoxygenated blood: Oxygenated blood:

pO2 = 40, pCO2 = 45 pO2 = 100-104,
pCO2 = 40
1

1
Internal Respiration

Oxygenated blood:
Deoxygenated blood:
pO2 = 100-104,
pO2 = 40, pCO2 = 45 pCO2 = 40

Systemic Tissues: pO2

< 40, pCO2 >45

2
Figure 23.20

Figure 23.20

This curve illustrates the % saturation of hemoglobin at different levels

of pO2 . Because the curve is flat on top, changes in pO2 in this region
do not result in significant differences in % saturation of hemoglobin.

66
Oxy-Hemoglobin Dissociation

deoxygenated
The
The pO
pO22 at
at sea
sea level
level

oxygenated
produces
produces a % sat of
a % sat

sea level

sea level
of
hemoglobin of 98%.
hemoglobin of 98%.
% Saturation of Hemoglobin

120
100
80

60
40
20
In
In deoxygenated
deoxygenated
0
blood
blood at
at sea
sea level
0 level
10 20 30 40 50 60 70 80 90 100 110
HbO22 isis 75%.
HbO 75%. Partial Pressure of Oxygen - pO2

At sea level with a pO2 in oxygenated blood of 100+ (as seen earlier)
the % saturation of hemoglobin is 98%. At 5000' the pO2 in oxygenated
blood has decreased to about 83, but the saturation of hemoglobin has
gone down only a few % to 95-97.
Deoxygenated blood is in the steeper portion of the curve. At sea level
the pO2 in deoxygenated blood is 40. This results in saturation of
hemoglobin of about 75%. This means that about 1/4 of the oxygen
carried by hemoglobin has been released to the tissues. The remaining
oxygen on hemoglobin represents a significant reservoir which can be
delivered to the tissues during hypoxic stress. At 5000' the pO2 is about
33. This results in a saturation of hemoglobin of 65%. More oxygen has
been unloaded (dissociated) from hemoglobin at altitude. The result of
lowered pO2, whether as a result of altitude or hypoxic stress is that
more oxygen is unloaded to the tissues from the oxygen reservoir.

67
At
At5000’
5000’the
the
Atmospheric
Atmospheric In
Inalveolar
alveolarair
air
Pressure
Pressureaverages
averages the pO22=87,
thepO =87,the
the
639
639mmHg.
mmHg.The The pCO
pCO22=33
=33
makes
makesthe
thepOpO22=138,
=138,
the pCO22=.25
thepCO =.25

Figure 23.17
In
Indeoxygenated
deoxygenated In
Inoxygenated
oxygenated
blood
bloodpOpO22=33,
=33, blood pO22=83,
bloodpO =83,
pCO22=38
pCO =38 the
the pCO22=34
pCO =34

Figure 22.17

As altitude increases, the total pressure and partial pressures

decrease. Here are the values for partial pressure at 5000’ altitude.

68
Oxy-Hemoglobin Dissociation
The
Thedifference
differencein inpO
pO22

deoxygenated
at altitude does
at altitude does notnot

deoxygenated
cause
causeaasignificant
significant

oxygenated

oxygenated
difference
differencein inthe
the %
%

sea level
5000’

sea level
sat of hemoglobin
sat of hemoglobin

5000’
either,
either,95-97
95-97 %.
%.
% Saturation of Hemoglobin

120
100
80

60
40
AAmore
moresignificant
significant
20
difference
differenceexists
exists
0
in
in
deoxygenated blood
deoxygenated blood0 10at
at 20 30 40 50 60 70 80 90 100 110
5000’
5000’ HbO
HbO22is
is 65%
65% Partial Pressure of Oxygen - pO2

Here you see the effects on hemoglobin saturation of the changes in

oxygen partial pressures at altitude.

69
2,3 Diphosphoglycerate
2,3 DPG (or BPG) is an intermediate in glycolysis which
builds up in erythrocytes during periods of reduced
oxygen supply. It attaches to hemoglobin, lowering its
affinity for oxygen, thus driving oxygen off the
hemoglobin molecule (it increases oxygen dissociation).
It is especially important in deoxygenated blood in the
systemic capillaries, and is the first response to altitude,
increasing the oxygen available to the tissue.

The main factor responsible for increased dissociation of oxygen from

hemoglobin at altitude is 2,3, DPG, also known as BPG.

70
K pH resulting
Effect of pH on Respiration from LCO2 or
H+ increases
the association
of oxygen with
hemoglobin.

L pH resulting
from KCO2 or
H+ decreases
the association
of oxygen with
hemoglobin.

The effect of pH on the Oxyhemoglobin Dissociation Curve. The effect

of lowered pH steepen the curve resulting in greater dissociation or
unloading of oxygen from hemoglobin. Higher pH flattens the curve
resulting is reduced dissociation or unloading of oxygen from
hemoglobin. This is due to a coupling of chemical reactions in which the
reduction in pH which occurs as the blood picks up CO2 in the systemic
tissues enhances the unloading of oxygen from hemoglobin. Likewise
the increase in pH accompanying release of CO2 from the blood to
alveolar air causes hemoglobin to load up with oxygen.

71
The Bohr Effect:
An increase in CO2 in the blood results in a decrease in
hemoglobin association with oxygen. (Oxygen
dissociation increases).

1) As a result of the H+ produced by the reaction of CO2

and water.

2) Due to carbaminohemoglobin production.

Summary of the Bohr Effect: As the blood

picks up more carbon dioxide, hemoglobin
can carry less oxygen.

The Bohr Effect describes the result of increasing CO2 in causing more
oxygen unloading from hemoglobin. [See Bohr Effect, Figure 22.22] It
results from two circumstances: 1) the effect of lowering pH as
described above, and 2) the effect of carbaminohemoglobin in
stimulating oxygen unloading.

72
The Bohr Effect Occurs in the
Systemic Capillaries

From Tissues CO2 + H2O H2CO3 HCO3- + H+

To Tissues O2 + Hb HbO2

HHb

From Tissues CO2 + Hb Carbaminohemoglobin

73
In the Pulmonary Capillaries
the Process Reverses
To Lungs CO2 + H2O H2CO3 HCO3- + H+

From Lungs O2 + Hb HbO2

HHb H+

To Lungs CO2 + Hb Carbaminohemoglobin

74
Apneustic Center: Figure 22.24
(“Without air”) : Increases Control Over
the depth of breathing by
prolonging inspirations.
Respiration
The Respiratory
Pneumotaxic (“Air Center located in
movement”) Center: the medulla
increases rate by oblongata
shortening inspirations. stimulates
VRG (Ventral respiratory muscles
Respiratory Group): and produces
Expiratory center – respiratory rhythm.
active only in forced The pons responds
breathing. to afferent stimuli
and communicates
DRG (Dorsal Respiratory with the respiratory
Group): Inspiratory center.
center – active with each
breath.

Control of respiration: The respiratory center is located in the medulla

of the brainstem, with contributions from the pons. Within the medulla
are the DRG (dorsal respiratory group) and the VRG (ventral respiratory
group). The DRG sends stimuli to the muscles of inspiration: the
diaphragm, external intercostals, and other. The VRG sends stimuli to
the muscles of expiration: the internal intercostals and abdominal
muscles. Since these muscles act only in forced expiration the VRG is
only active then, while the DRG acts in both quiet and forced
respiration. These muscles are all skeletal muscles and the motor
control of respiration, whether quiet or forced, is a voluntary function.
The autonomic nervous system does not control the muscles of
respiration. The medulla controls the rhythmicity of respiration.
The pons sends stimuli to the medulla to regulate the rate and depth.
The pneumotaxic center increases the rate by shortening inspirations.
The apneustic center (its function is established but its location is not)
increases the depth and reduces the rate by prolonging inspirations.

76
Inputs to the response to
Respiratory Voluntary control over
excitement, emotions, respiration emanates
Respiratory
temperature, etc. comes from the cerebral cortex.
Center
from the hypothalamus.
These afferent fibers
Oxygen is are the only
secondary autonomic part of
stimulus respiration
and is not
respiratory Stretch
Peripheral chemoreceptors
drive in L O2, K CO2, K H+ receptors
healthy
individuals K CO , K H+ in central
2
chemoreceptors Irritant receptors

The muscles stimulate the respiratory

center directly, increasing respiration
before blood chemistry changes.

Inputs to these centers come from several locations:

1) peripheral chemoreceptors - located in the aortic sinus and carotid
sinus, respond to increased carbon dioxide and decreased pH (which
are related as discussed earlier).
Although the peripheral chemoreceptors include receptors to oxygen,
oxygen levels are secondary stimuli at best, normally not important in
triggering increased respiration. For healthy people the levels of oxygen
would never decrease to the point of stimulating respiration. However,
this can apparently happen in certain disorders such as emphysema, in
a condition known as hypoxic drive. This happens because CO2 levels
become permanently elevated and the CO2 receptors cease
responding. This is somewhat controversial, but some believe that
administering oxygen can actually suppress respiration in someone with
hypoxic drive.
2) central chemoreceptors - located in the medulla. Their primary stimuli
are decreased pH and increased carbon dioxide. pH is especially
important since carbon dioxide does not readily diffuse into brain tissue
but affects it through its impact on hydrogen ions.
3) muscle contraction - when you exercise there is a direct stimulus to
the respiratory center from active muscles and joint receptors. This
causes increased respiration before blood chemistry actually changes
enough to demand it.
4) higher brain centers - from the voluntary motor center for voluntary
control over respiration, and from the hypothalamus for control in 77
response to emotional stimuli and body temperature
Summary of Respiratory Stimuli
Stimulus Response
KpCO2, L pH, K H+, 2ndary LpO2
Hyperventilation
Hypoventilation, acidosis

L pCO2, K pH, L H+
Hypoventilation
Hyperventilation, alkalosis

Voluntary hypoventilation KpCO2, increased need to breathe

Voluntary hyperventilation LpCO2, decreased need to breathe

78