Respiratory Physiology

Dr.Swanny, MSc. Integrative Teaching Bloc 12

General learning objectives

After studying this section, you will be able to: 1. Understand and describe the basic process that responsible for respiratory tract to be functioning well. 2. Understand the pathogenesis of respiratory insufficiency. 3. Use and apply the basic physiology knowledge to recognize and diagnose and treat the respiratory disorders.

An Illustrative case

Mr. A, a 65-year old man, is diagnosed having EMPHYSEMA by his doctor. He is a heavy smoker for nearly 45 years.

Explanation of the case

Emphysema. Literally means excess air in the lungs. Is a name given to disease in which AIR EXCHANGE is impaired by narrowing of the airways. Is an example of respiratory insufficiency Structure and Function disturbances.

Structure impaired
Can be detected in: Radiograph Lung tomography Post mortem

POST MORTEM of Smoker lung

Respiration
Ventilation: Movement of air into and out of lungs External respiration: Gas exchange between air in lungs and blood Transport of oxygen and carbon dioxide in the blood Internal respiration: Gas exchange between the blood and tissues

Respiratory System Functions

Gas exchange: Oxygen enters blood and carbon dioxide leaves Regulation of blood pH: Altered by changing blood carbon dioxide levels Voice production: Movement of air past vocal folds makes sound and speech Olfaction: Smell occurs when airborne molecules drawn into nasal cavity Protection: Against microorganisms by preventing entry and removing them

Respiratory System Divisions

Upper tract
Nose, pharynx and associated structures

Lower tract
Larynx, trachea, bronchi, lungs

Nasal Cavity and Pharynx

Nose and Pharynx

Nose
External nose Nasal cavity
Functions
Passageway for air Cleans the air Humidifies, warms air Smell Along with paranasal sinuses are resonating chambers for speech

Pharynx
Common opening for digestive and respiratory systems Three regions
Nasopharynx Oropharynx Laryngopharynx

Larynx

Functions
Maintain an open passageway for air movement Epiglottis and vestibular folds prevent swallowed material from moving into larynx Vocal folds are primary source of sound production

Vocal Folds

Trachea
Windpipe Divides to form
Primary bronchi Carina: Cough reflex

Tracheobronchial Tree
Conducting zone
Trachea to terminal bronchioles which is ciliated for removal of debris Passageway for air movement Cartilage holds tube system open and smooth muscle controls tube diameter

Respiratory zone
Respiratory bronchioles to alveoli Site for gas exchange

Tracheobronchial Tree

Bronchioles and Alveoli

Alveolus and Respiratory Membrane

Structure of Respiratory System

The structure can be imagined as: Covering the surface of a racquetball court (about 75 m2) with thin plastic wrap, and stuffing it into a 3- liter soft drink bottle.

Structure and function relationship

The structure serves a good relationship with the function. The tremendous large surface area for gas exchange is needed to supply the trillions of cells in the body with adequate amounts of oxygen.

Lungs

Two lungs: Principal organs of respiration

Right lung: Three lobes Left lung: Two lobes

Divisions
Lobes, bronchopulmonary segments, lobules

Processes in respiratory system

1. VENTILATION 2. DIFFUSION 3. TRANSPORT

Ventilation
Movement of air into and out of lungs Air moves from area of higher pressure to area of lower pressure Pressure is inversely related to volume

VENTILATION
During ventilation AIRFLOW because of Pressure Gradients. FLOW = P / R 1. Air flow in response to a pressure gradient. 2. Flow decreases as resistance increases

Inspiration
During inspiration, the thoracic volume increases when skeletal muscles of the rib cage and diaphragm contract pressure inside lung become lower than the pressure of atmosphere pressure gradient air flow into lung.

Thoracic Walls Muscles of Respiration

Thoracic Volume

Alveolar Pressure Changes

Changing Alveolar Volume

Lung recoil
Causes alveoli to collapse resulting from
Elastic recoil and surface tension
Surfactant: Reduces tendency of lungs to collapse

Pleural pressure
Negative pressure can cause alveoli to expand Pneumothorax is an opening between pleural cavity and air that causes a loss of pleural pressure

Alveolar Pressure
This is the pressure, measured in cm H20, within the alveoli, the smallest gas exchange units of the lung. Alveolar pressure is given with respect to atmospheric pressure, which is always set to zero. Thus, when alveolar pressure exceeds atmospheric pressure, it is positive; when alveolar pressure is below atmospheric pressure it is negative.

Normal Breathing Cycle

Compliance
Measure of the ease with which lungs and thorax expand
The greater the compliance, the easier it is for a change in pressure to cause expansion A lower-than-normal compliance means the lungs and thorax are harder to expand
Conditions that decrease compliance
Pulmonary fibrosis Pulmonary edema Respiratory distress syndrome

SURFACTANT
Surfactant decreases the surface tension created by the thin fluid layer between alveolar cells and the air. Surfactant decrease WORK of BREATHING.

Airway resistance
Parameters that contribute to resistance is: 1. The length of the system ( L ). 2. The viscosity of substance flowing through the system () 3. The radius in the system ( r )

R = L / r4

Airway resistance decreases as lung volume increases.

Pulmonary Volumes
Tidal volume
Volume of air inspired or expired during a normal inspiration or expiration

Inspiratory reserve volume

Amount of air inspired forcefully after inspiration of normal tidal volume

Expiratory reserve volume

Amount of air forcefully expired after expiration of normal tidal volume

Residual volume
Volume of air remaining in respiratory passages and lungs after the most forceful expiration

Pulmonary Capacities
Inspiratory capacity
Tidal volume plus inspiratory reserve volume

Functional residual capacity

Expiratory reserve volume plus the residual volume

Vital capacity
Sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume

Total lung capacity

Sum of inspiratory and expiratory reserve volumes plus the tidal volume and residual volume

Spirometer and Lung Volumes/Capacities

Minute and Alveolar Ventilation

Minute ventilation: Total amount of air moved into and out of respiratory system per minute Respiratory rate or frequency: Number of breaths taken per minute Anatomic dead space: Part of respiratory system where gas exchange does not take place Alveolar ventilation: How much air per minute enters the parts of the respiratory system in which gas exchange takes place

Ventilation perfusion relationship

Ventilation-perfusion coupling:

WORK of BREATHING

DIFFUSION
FICK law of diffusion: V = A/T x D ( P1 P2 ). D=Sol / MW V= rate of diffusion A=area T=thickness D=diffusion constant Sol=solubility MW= molecular weight

Physical Principles of Gas Exchange

Partial pressure
The pressure exerted by each type of gas in a mixture Daltons law Water vapor pressure

Diffusion of gases through liquids

Concentration of a gas in a liquid is determined by its partial pressure and its solubility coefficient Henrys law

Physical Principles of Gas Exchange

Diffusion of gases through the respiratory membrane
Depends on membranes thickness, the diffusion coefficient of gas, surface areas of membrane, partial pressure of gases in alveoli and blood

Relationship between ventilation and pulmonary capillary flow

Increased ventilation or increased pulmonary capillary blood flow increases gas exchange Physiologic shunt is deoxygenated blood returning from lungs

Oxygen and Carbon Dioxide Diffusion Gradients

Oxygen
Moves from alveoli into blood. Blood is almost completely saturated with oxygen when it leaves the capillary P02 in blood decreases because of mixing with deoxygenated blood Oxygen moves from tissue capillaries into the tissues

Carbon dioxide
Moves from tissues into tissue capillaries Moves from pulmonary capillaries into the alveoli

Changes in Partial Pressures

TRANSPORT OF GAS
Gas transport to blood is important for survival of life. The Law of MASS ACTION plays an important role in this process. Changes in O2 or CO2 concentration disturbs the equilibrium of reactions, shifting the balance between substrate and products.

Hemoglobin and Oxygen Transport

Oxygen is transported by hemoglobin (98.5%) and is dissolved in plasma (1.5%) Oxygen-hemoglobin dissociation curve shows that hemoglobin is almost completely saturated when P02 is 80 mm Hg or above. At lower partial pressures, the hemoglobin releases oxygen. A shift of the curve to the left because of an increase in pH, a decrease in carbon dioxide, or a decrease in temperature results in an increase in the ability of hemoglobin to hold oxygen

Hemoglobin and Oxygen Transport

A shift of the curve to the right because of a decrease in pH, an increase in carbon dioxide, or an increase in temperature results in a decrease in the ability of hemoglobin to hold oxygen The substance 2.3-bisphosphoglycerate increases the ability of hemoglobin to release oxygen Fetal hemoglobin has a higher affinity for oxygen than does maternal

Oxygen-Hemoglobin Dissociation Curve at Rest

Bohr effect:

Temperature effects:

Shifting the Curve

Transport of Carbon Dioxide

Carbon dioxide is transported as bicarbonate ions (70%) in combination with blood proteins (23%) and in solution with plasma (7%) Hemoglobin that has released oxygen binds more readily to carbon dioxide than hemoglobin that has oxygen bound to it (Haldane effect) In tissue capillaries, carbon dioxide combines with water inside RBCs to form carbonic acid which dissociates to form bicarbonate ions and hydrogen ions

Transport of Carbon Dioxide

In lung capillaries, bicarbonate ions and hydrogen ions move into RBCs and chloride ions move out. Bicarbonate ions combine with hydrogen ions to form carbonic acid. The carbonic acid is converted to carbon dioxide and water. The carbon dioxide diffuses out of the RBCs. Increased plasma carbon dioxide lowers blood pH. The respiratory system regulates blood pH by regulating plasma carbon dioxide levels

CO2 Transport and

Cl

Movement

Respiratory Areas in Brainstem

Medullary respiratory center
Dorsal groups stimulate the diaphragm Ventral groups stimulate the intercostal and abdominal muscles

Pontine (pneumotaxic) respiratory group

Involved with switching between inspiration and expiration

Respiratory Structures in Brainstem

Rhythmic Ventilation
Starting inspiration
Medullary respiratory center neurons are continuously active Center receives stimulation from receptors and simulation from parts of brain concerned with voluntary respiratory movements and emotion Combined input from all sources causes action potentials to stimulate respiratory muscles

Increasing inspiration
More and more neurons are activated

Stopping inspiration
Neurons stimulating also responsible for stopping inspiration and receive input from pontine group and stretch receptors in lungs. Inhibitory neurons activated and relaxation of respiratory muscles results in expiration.

Modification of Ventilation
Cerebral and limbic system
Respiration can be voluntarily controlled and modified by emotions

Chemical control
Carbon dioxide is major regulator
Increase or decrease in pH can stimulate chemo- sensitive area, causing a greater rate and depth of respiration

Oxygen levels in blood affect respiration when a 50% or greater decrease from normal levels exists

Modifying Respiration

Regulation of Blood pH and Gases

Herring-Breuer Reflex
Limits the degree of inspiration and prevents overinflation of the lungs
Infants
Reflex plays a role in regulating basic rhythm of breathing and preventing overinflation of lungs

Adults
Reflex important only when tidal volume large as in exercise

Effects of Aging
Vital capacity and maximum minute ventilation decrease Residual volume and dead space increase Ability to remove mucus from respiratory passageways decreases Gas exchange across respiratory membrane is reduced

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