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Chapter 20
Respiratory
System
Alveolar Duct
Respiration
1. Movement of air into and out of the lungs
(Ventilation or Breathing)
2. Exchange of O
2
and CO
2
between the
lungs and the blood
3. Transport of these gases
4. Exchange of O
2
and CO
2
between the
blood and the tissues

Functions of the Respiratory System
1. Gas exchange
2. Regulation of blood pH
3. Voice production
4. Olfaction
5. Protection
Anatomy of the Respiratory System
The respiratory system consist of the
upper and lower respiratory tract

Upper respiratory tract: external nose, nasal
cavity, pharynx, and associated structures

Lower respiratory tract: larynx, trachea, the
bronchi, and lungs
Fig. 20.1
Nose
Consist of the external nose and the nasal cavity
External nose
only visible structure
Nasal cavity
Nares or Nostrils external openings
Choanae openings to pharynx
Vestibule anterior portion of nasal cavity
Hard palate separates the nasal cavity from the oral cavity
Nasal septum divides nose into right and left parts
Conchae boney ridges in the nasal cavity
Meatus Passageway beneath each conchae
Nose
Provides an airway for respiration
Moistens and warms the entering air
Filters inspired air and cleans it of foreign
matter
Serves as a resonating chamber for speech
Houses the olfactory receptors
The Pharynx
Connects the nasal cavity and mouth to the
larynx and esophagus inferiorly
Common passageway for air, food, and drink
Commonly called the throat
There are 3 regions:
Nasopharynx: air only
posterior to the choanae and superior to the soft palate
soft palate separates the nasopharynx from the oropharynx
Oropharynx: air and food
soft palate to the epiglottis
Laryngopharynx: primarily food and drink
epiglottis to the esophagus

Fig. 20.2
Larynx (Voice Box)
Anterior part of the throat, from the base of the
tongue to the trachea
The three functions of the larynx are:
1. To provide an airway
2. To act as a switching mechanism to route air and
food into the proper channels
Epiglottis: elastic cartilage that covers the laryngeal inlet
during swallowing
Closure of the vestibular and vocal folds
3. To function in voice production
Fig. 20.3
Vocal Cords
Two pairs of ligaments
False vocal cords (vestibular folds)
Superior mucosal folds
Have no part in sound production
True vocal cords (vocal folds)
Inferior mucosal folds composed of elastic fibers
The medial opening between them is the glottis
They vibrate to produce sound as air rushes up from
the lungs
Laryngitis: Inflammation of the vocal folds

Fig. 20.4
Sound Production
Sound: Vibration of the vocal folds as air moves
past them
Loudness: depends on the amplitude of the
vibration, which is determined by the force at
which the air rushes across the vocal cords
Pitch: determined by the length and tension of
the vocal cords, which changes the frequency of
the vibrations
Sound is shaped into language by action of the
tongue, lips, teeth, and other structures
The pharynx resonates, amplifies, and enhances
sound quality
Trachea
Descends from the larynx through the neck to
the fifth thoracic vertebra
Composed of dense regular connective tissue
and smooth muscle reinforced with 15-20
C-shaped rings of hyaline cartilage, which
protect the trachea and keep the airway open
The mucous membrane lining the trachea is
made up of goblet cells and pseudostratified
ciliated columnar epithelium
Goblet cells produce mucus
It ends by dividing into the two primary bronchi
Main Bronchi
The right and left bronchi are formed by the
division of the trachea
Right primary bronchus is wider, shorter and
more vertical than the left
Common site for an inhaled object to become lodged
By the time that incoming air reaches the
bronchi, it is warmed, cleansed and saturated
with water vapor
Lungs
Principal organs of respiration
Base rest on diaphragm and the apex
extends superiorly to ~2.5 cm above the
clavicle
Right lung has 3 lobes, while the left has
only 2 lobes
The Tracheobronchial Tree
Once inside the lungs each main bronchus
Subdivides into lobar (secondary) bronchi
Then segmental (tertiary) bronchi
Finally giving rise to the bronchioles, which
subdivide many times to give rise to the
terminal bronchioles
~16 generations of branching from the
trachea to the terminal bronchioles
The Tracheobronchial Tree
Terminal bronchioles divide into respiratory
bronchioles, which have a few attached alveoli
Alveoli small air filled chambers where gas
exchange between the air and blood takes place
Respiratory bronchioles lead to alveolar ducts,
then to terminal clusters of alveolar sacs
composed of alveoli
Approximately 300 million alveoli
Account for most of the lungs volume
Provide tremendous surface area for gas exchange
~7 generations of branching occur from the
terminal bronchioles to the alveolar ducts
Fig. 20.5
Fig. 20.6
Fig. 20.7
The Tracheobronchial Tree
As air passageways become smaller,
structural changes occur
Cartilage support structures decrease
Amount of smooth muscle increases
Epithelium types change
Terminal bronchioles are mostly smooth
muscle with no cartilage, which allows the
bronchioles to alter their diameter when a
change in air flow is needed (i.e. during
exercise)
Alveoli
Alveolar walls:
Are a single layer of type I pneumocytes
Squamous epithelial cells
Compose 90% of the alveolar surface
Permit gas exchange by simple diffusion
Type II pneumocytes
Round or cube-shaped secretory cells that
produce surfactant
Surfactant reduces surface tension, which makes it
easier for the alveoli to expand
Respiratory Membrane
Where gas exchange between air and blood
occurs
It is very thin to facilitate the diffusion of gases
Consists of:
1. Thin layer of fluid lining the alveolus
2. Alveolar epithelium
3. Basement membrane of the alveolar epithelium
4. A thin interstitial space
5. Basement membrane of the capillary endothelium
6. The capillary endothelium
Fig. 20.8
Pleura
Thin, double-layered serous membranes
Parietal pleura
Covers the thoracic wall, diaphragm, and mediastinum
Visceral pleura
Covers the external lung surface
Pleural cavity
Negative pressure space between the parietal and visceral
pleura
Pleural Fluid
Fills the pleural cavity
Made by the pleural membranes
Serves as a lubricant
Holds the pleural membranes together
Fig. 20.9
Blood Supply to Lungs
Lungs are perfused by two circulations: pulmonary and
bronchial
Pulmonary circulation
Pulmonary arteries: supply deoxygenated systemic blood to be
oxygenated
Ultimately feed into the pulmonary capillary network surrounding the
alveoli
Pulmonary veins: carry oxygenated blood from lungs back to the
heart
Bronchial circulation
Bronchial arteries: provide systemic oxygenated blood to the
lung tissue
Supply all lung tissue except the alveoli
Bronchial veins: carry the deoxygenated blood back to the heart
Inspiration: movement of air into the lungs
Muscles involved are the diaphragm and those that elevate the
ribs and sternum
As the diaphragm and other muscles of inspiration contract and
the rib cage rises and thoracic volume increases
Expiration: movement of air out of the lungs
Muscles actively involved are those that depress the ribs and
sternum (usually only with forceful expiration)
Largely a passive process
Muscles of inspiration relax, the rib cage descends due to gravity
and the thoracic cavity volume decreases
Pressure changes in the thoracic cavity change air
pressure in the lungs, which in turn causes ventilation
largest change in thoracic volume is due to the diaphragm
Ventilation
Fig.
20.10
Pressure Changes and Airflow
Physical Principles Influencing Pulmonary Ventilation
1. Air flows from areas of higher to lower pressure
If pressure is higher at one end of a tube (P
1
) than at the other
(P
2
), air will flow down its pressure gradient
2. Changes in volume result in changes in pressure
As volume increases in a closed container the pressure
decreases or as volume decreases pressure increases
This inverse relationship is known as Boyles law
3. Changes in tube diameter result in changes in resistance
Poiseuilles law: resistance (R) to airflow is proportional to the
diameter (d) of a tube raised to the fourth power (d
4
)



F =
P
1
P
2
R
F=Airflow
(mm/min)
Alveoli Airflow
Fig.
20.11
Alveoli Airflow
Fig.
20.11
Fig.
20.11
Lung Recoil
Tendency for an expanded lung to
decrease in size due to
1. Elastic fibers in the connective tissue
2. Surface tension
Two factors keep lungs from collapsing
1. Surfactant
2. Pleural Pressures
Surfactant
Surface acting agent
Mixture of lipoprotein molecules
Acts in reducing surface tension in the
alveoli
Attraction of water molecules to each other
Surfactant reduces the surface tension in
alveoli by 10-fold
Pleural Pressure
Pressure in the pleural cavity
When pleural pressure is less than alveolar
pressure alveoli expand
Subatmospheric pleural pressure is
caused by
Removal of fluid from the pleural cavity
Lung recoil

Measurement of Lung Function
Measurements can be used to
Diagnose disease
Track progress of disease
Track recovery from disease
Measurements include
Lung compliance
Pulmonary volumes and capacities
Minute ventilation
Alveolar ventilation
Lung Compliance
Measurement of the ease with which the lungs
and thorax expand
Volume increases for each unit of pressure
change in alveolar pressure
Liters (volume of air)/Centimeter of H
2
O (pressure)
In a normal person = 0.13 L/cm

H
2
O
Higher than normal compliance = less resistance to
lung and thorax expansion
Emphysema
Lower than normal compliance = more resistance to
lung and thorax expansion
Pulmonary fibrosis, infant respiratory distress syndrome,
pulmonary edema, asthma, bronchitis, and lung cancer
Pulmonary Function Tests
Spirometry is the process of measuring volumes
of air that move into and out of the respiratory
system
Spirometer a device used to measure these
pulmonary volumes
The following factors can cause variations in
Pulmonary Volumes and Capacities
Sex
Age
Body Size
Physical Condition
Pulmonary Volumes
Tidal volume (TV)
volume of air inspired or expired with each breath (approximately
500 ml at rest)
Inspiratory reserve volume (IRV)
amount of air that can be inspired forcefully after inspiration of
the tidal volume (approximately 3000 ml at rest)
Expiratory reserve volume (ERV)
amount of air that can be forcefully expired after expiration of the
tidal volume (approximately 1100 ml at rest)
Residual volume (RV)
volume of air still remaining in the respiratory passages and
lungs after the most forceful expiration (approximately 1200 ml)
Pulmonary Capacities
Sum of two or more pulmonary volumes
Inspiratory capacity (IC = IRV + TV)
Amount of air that a person can inspire maximally after a normal
expiration (approximately 3500mL at rest )
Functional residual capacity (FRC = ERV + RV)
Amount of air remaining in the lungs after a normal expiration
(approximately 2300mL at rest )
Vital capacity (VC = IRV + TV + ERV)
Maximum volume of air that a person can expel from the
respiratory tract after a maximum inspiration (approximately
4600mL at rest )
Total lung capacity (TLC = IRV + ERV + TV + RV)
Sum of all lung volumes (approximately 5800 ml at rest)
Fig.
20.12
Pulmonary Function Tests
Forced expiratory vital capacity
individual inspires maximally and then exhales
maximally as rapidly as possible
volume of air expired at the end of the test is the
persons forced expiratory vital capacity
Forced expiratory volume in 1 second (FEV
1
)
amount of air expired during the first second of the
test
decreased FEV
1
can be caused by airway
obstruction, asthma, emphysema, tumors, pulmonary
fibrosis, silicosis, kyphosis, and scoliosis
Minute Ventilation
Minute Ventilation
equals tidal volume (~500mls) times respiratory rate (~12
breaths/min.)
Average ~ 6 L/min
Only measures movement of air into and out of the lungs, not
amount of air available for gas exchange
Dead space
Areas of the respiratory system where gas exchange does
not take place
Includes the nasal cavity, pharynx, larynx, trachea, bronchi,
bronchioles, and terminal bronchioles (~150 mLs)
Nonfunctional alveoli can also contribute, but are rare in
healthy individuals
Alveolar Ventilation
Alveolar ventilation (V
A
)
volume of air available for gas exchange
Slow, deep breathing increases AVR and rapid,
shallow breathing decreases AVR
V
A
=

X
(V
T
V
D
)
(mLs/min)
(frequency,
breaths/min)
(Tidal Volume Dead Space)
(mLs/respiration)
Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA).
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
).
4. In the chloride shift, as HCO
3
-
diffuse
out of the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) into them.
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Tissues
1. In the tissues, CO
2
diffuses into the
plasma and into RBC. Some of the
CO
2
remains in the plasma
2. In RBC, CO
2
reacts with H
2
O to form
carbonic acid (H
2
CO
3
) in a reaction
catalyzed by the enzyme carbonic
anhydrase (CA)
3. H
2
CO
3
dissociates to form
bicarbonate ions (HCO
3
-
) and
hydrogen ions (H
+
)
4. In the chloride shift, as HCO
3
-

diffuses out of the RBC, electrical
neutrality is maintained by the
diffusion of chloride ions (Cl
-
) into
them
5. Oxygen (O
2
) is released from
hemoglobin (Hb). O
2
diffuses out of
RBCs and plasma into the tissues
6. H
+
combine with Hb, which promotes
the release of O
2
from Hb (Bohr
effect)
7. CO
2
combines with Hb. Hb that has
released O
2
readily combines with
CO
2
(Haldane effect)

Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)
Gas Exchange in the Lungs
1. In the lungs, CO
2
diffuses from the
RBCs and plasma into the alveoli
2. Carbonic anhydrase (CA) catalyzes
the formation of CO
2
and H
2
O from
carbonic acid (H
2
CO
3
)
3. Bicarbonate ions (HCO
3
-
) and H
+
combine to replace H
2
CO
3

4. In the chloride shift, as HCO
3
-
diffuse
into the RBC, electrical neutrality is
maintained by the diffusion of
chloride ions (Cl
-
) out of them
5. Oxygen diffuses into the plasma and
into RBCs. Some of the O
2
remains
in the plasma. O
2
binds to Hb
6. H
+
are released from Hb, which
promotes the uptake of O
2
by Hb
(Bohr effect)
7. CO
2
is released from Hb. Hb that is
bound to O
2
readily releases CO
2

(Haldane effect)