Respiratory Physiology Introduction to Respiratory Physiology...

Introduction to Respiratory Physiology

The primary function of the respiratory system is
to supply oxygen (O2) to and remove carbon
Lecture Outline
dioxide (CO2) from the tissues of the body. To
perform this cardinal function, three interrelated 1. Basic Structure and Function.
processes must occur:pulmonary ventilation
 overview of the respiratory system
pulmonary perfusion, and pulmonary gas exchange.
 basic functional anatomy

Your Respiratory Physiology Lectures have been 2. Abbreviations and Symbols.

organized in a manner to separately consider each
3. Basic Gas Laws.
of these processes in a logical order, and then
link them together. Each new lecture will present 4. Definitions.
unique information and then build upon the
5. Normal Physiological Variables, at rest.
knowledge of previous lectures. As much as
possible, clinical examples and/or applications
will be presented to help you appreciate
important physiological concepts, and
demonstrate how they apply to abnormal states.
Objectives
These lecture notes are not to be used in  Describe the basic structure and function of
isolation. Lecture attendance is required along
with use of the reference texts below. the respiratory system.

 Construct correctly the symbols commonly

Most information presented in the handouts and
during the lecture can be obtained from the well used to describe measurements in respiratory
written texts of JB West. physiology.

Respiratory Physiology - the essentials.  Recognize the units used in the measurement
6th Edition, 1999, by John B. West . of respiratory variables
Excellent. Easy to read. Concise. Will easily
meet the requirements of this course.  Understand the importance of partial

pressures in calculating inspired gas

Pulmonary Pathophysiology - the essentials. 5th
Edition, 1998, by John B. West. concentrations.
A companion to 'Respiratory Physiology - the
essentials'. Gives a clinical point of view and
deals with the diseased lungs. Ideal for more
senior medical students.

Dr. David McCormack

Respiratory Physiology Introduction to Respiratory Physiology...2

1. Basic Structure and Function of the Respiratory System

A. Overview of the respiratory system
Each section below, marked in italics, will be discussed in the lectures.

Figure 1.
Overview of the respiratory system.

higher brain
center
ventilatory control
of breathing
brain stem
respiratory
chemoreceptors
neurons

spinal cord

muscles

mechanics
mechanoreceptors of breathing
lung and
chest wall

A LVEOLAR inspired air

S PACES
ventilation
diffusion
mixed venous
blood gases CAPILLARY
perfusion

gas transport
TISSUES arterial blood gases

Dr. David McCormack

Respiratory Physiology Introduction to Respiratory Physiology...3

B. Basic functional anatomy of the respiratory tract

The tracheobronchial tree

trachea generation 0
main, lobar and segmental bronchi generations 1-4
small bronchi generations 5-11
bronchioles generations 12-16
respiratory bronchioles generations 17-19
alveolar ducts generations 20-22
alveolar sacs generations 23
alveoli 200-600 million in number
diameter ~ 250 microns

definitions:
conducting zone = generations 0 to 16 (‘wasted ventilation’)
respiratory zone = generations 17 to alveoli
acinus or lobule= portion of lung distal to a terminal bronchial
(‘the terminal respiratory unit’)

The pulmonary vasculature

the pulmonary circulation

 pulmonary arteries
 pulmonary arterioles
 pulmonary capillaries (280 billion in number, diameter ~10 microns)
 pulmonary venules and veins

the bronchial circulation

 the blood supply of the airways, from the trachea to the terminal bronchioles, is via the bronchial
arteries, a systemic source (~ 1% of the total cardiac output)

The blood-gas diffusion barrier

(less than 0.5 micron thickness, 50 to 100 m2 of surface area) (~1000 pulmonary capillaries/alveolus)
 alveolar epithelial cells, type 1 and 2
 interstitium
 capillary endothelial cells

Dr. David McCormack

Respiratory Physiology Introduction to Respiratory Physiology...4

2. Abbreviations and Symbols

Abbreviations, consisting of a series of symbols, .

are used in respiratory physiology and medicine to V E = expired volume per min (BTPS)
identify the type of measurement made, e.g., .
Q t = total cardiac output
PaO2 = the partial pressure of oxygen in arterial
.
blood. V CO2 = carbon dioxide production per min
(STPD)
A. The first symbol is usually a capital letter
relating to the variable being measured. * Note the conditions of the measurement.
STPD = standard temperature, pressure, dry
pressure P BTPS = body temperature, pressure, saturated
volume (gas) V
volume (blood) Q More about this later!
concentration C
fractional conc. F
saturation S

B. The second symbol represents the site of the

measurement. Gas phase measurements are
Question 1
capital letters while blood phase
measurements are lowercase letters.
Construct the abbreviations for the following:
alveolar gas A
inspired gas I • tidal volume = ____.
expired gas E
tidal gas T • alveolar ventilation in L/min = ____.
dead space D
barometric B • barometric pressure = ____.
arterial blood a
mixed venous blood • O2 consumption in L/min = ____.
v-
capillary blood c
end-capillary blood c’

C. If the variable is a timed measurement, for

example, ventilation in litres per minute, then
a dot is placed over the symbol.

Dr. David McCormack

Respiratory Physiology Introduction to Respiratory Physiology...5

3. Basic Gas Laws

Barometric pressure (PB) The partial pressure for any gas (PG) is obtained
PB is the total pressure exerted by the kinetic by multiplying PB by the fractional concentration
energy of all the molecules in our atmospheric (FG) of that gas.
mixture. At sea level, the total weight of the
atmosphere on the earth's surface is equal to the Calculation of the partial pressure of O2 and CO2
weight of a column of mercury 760 mm in height in the gas phase.
(760 mm Hg ). PB decreases with increasing
altitude. At the summit of Mt. Everest (29,028 Question 2
feet) the PB is only 253 mm Hg.
On the top of Mount Everest, where the PB is
253 mm Hg, what is the partial pressure of
Fractional concentrations of gases
oxygen in the dry atmospheric air? Make the
Fractional concentrations of gases in the gas
same calculation at sea level.
phase are expressed as fractions of the total gas
volume, e.g., FatmO2 = 0.2093.
Answer
Irrespective of altitude, the composition of the
atmospheric air expressed as a fractional
concentration of dry air is:
Fatmnitrogen = 0.78
Fatmoxygen = 0.21 (0.2093 to be exact!)
Fatmcarbon dioxide = 0.0003
eg. gases in lung are CO2, O2, N2 and H2O

Partial pressure of a gas (PG)

The pressure exerted by each component in a gas
mixture is independent of other gases in the
mixture and the total pressure of the mixture is
equal to the sum of the separate pressures which
each gas would exert if it occupied the whole
volume alone. This is called Dalton's Law.
PCO2 + PO2 + PN2 +PH2O = PB
(where PB = barometric pressure)

Dr. David McCormack

Respiratory Physiology
When inspired gas enters the upper portion of
the respiratory system it is rapidly warmed to
body temperature and becomes fully saturated
with water vapor. The pressure exerted by water
vapor at body temperature (37°C) is 47 mm Hg,
regardless of barometric pressure. Therefore,
moist tracheal gas has a PH2O of 47 mm Hg, and
this accounts for a part of the total PB. It must
be considered!
Question 3
On the top of Mount Everest, where the PB is
253 mm Hg, what is the partial pressure of
oxygen in the inspired tracheal air (PIO2 )?
What is the PIO2 at sea level?
Answer
Introduction to Respiratory Physiology...6
Gas in solution
Henry’s Law states that gases are carried in
physical solution in the blood in proportion to
their partial pressure (assuming temperature is
constant).
Cgas = Kgas x Pgas where:
C = content (mL of the gas/L of blood)
K = solubility of the gas in the blood
(mL of the gas/L of blood/mm Hg)
P = partial pressure of the gas (mm Hg)
Calculation of the content of O2 & CO2 in blood.
Content of gas in blood is expressed as mL of the
gas per liter of blood
(e.g., mL O2 /L of blood).
For oxygen, K = 0.03 mL O2 /L blood/mm Hg. At
a normal PaO2 of 100 mmHg, only 3 mL of O2/L
of blood is stored in physical solution. Therefore,
very little O2 is carried in the blood in the
dissolved form at normal partial pressures of O2.
More about this later (Blood Gas Transport
lecture)!
Dr. David McCormack
Respiratory Physiology
4. Definitions*
ACIDEMIA
• A pH less than normal.
ACIDOSIS
• A clinical term indicating a disturbance that can
lead to acidemia. It is usually indicated by a
reduced blood bicarbonate level when metabolic
(non-respiratory) in origin and by hypercarbia
when respiratory in origin. The term should
always be qualified as metabolic (non-
respiratory) or respiratory.
ACINUS
• The portion of lung parenchyma distal to the
terminal bronchiole and consisting of
respiratory bronchioles, alveolar ducts, alveolar
sacs and alveoli.
ACUTE RESPIRATORY FAILURE
• Rapidly occurring hypoxemia or hypercarbia due
to a disorder of the respiratory system. The
duration of the illness and the values of arterial
oxygen tension and arterial carbon dioxide
tension used as criteria for this term should be
given. The term "acute ventilatory failure"
should only be used when the arterial carbon
dioxide tension is increased. The term
"pulmonary failure" has been used to indicate
respiratory failure due specifically to disorders
of the lungs.
AIRWAY
• A collective term for the air-conducting
passages from the larynx to and including the
respiratory bronchioles.
AIR SPACE
• The gas-containing portion of lung parenchyma,
including the acini and excluding the
interstitium and purely conductive portions of
the lung.
Introduction to Respiratory Physiology...7
ALKALEMIA
• A pH greater than normal
ALKALOSIS
• A clinical term indicating a disturbance that can
lead to alkalemia. It is usually indicated by an
increased blood bicarbonate level when
metabolic (non-respiratory in origin) and by
hypocarbia when respiratory in origin. The
term should always be qualified as metabolic
(non-respiratory) or respiratory.
APNEA
• Cessation of air flow for greater than ten
seconds.
ATELECTASIS
• Less than normal inflation of all or a portion of
lung with corresponding diminution in volume.
BTPS
• Gas volumes expressed at conditions of body
temperature (37°C), ambient pressure, and
saturated with water vapor
BRONCHUS
• A conducting airway distal to the trachea
bifurcation that contains cartilage in its wall.
BRONCHIOLE
• An airway that contains no cartilage in its wall.
C(a-v- )O2
• Arteriovenous oxygen content difference.
CENTRAL APNEA
• Apnea without respiratory effort.
CHRONIC RESPIRATORY FAILURE
• Chronic hypoxemia or hypercarbia due to a
disorder of the respiratory system
Dr. David McCormack
Respiratory Physiology
COLLAPSE
• A state in which lung tissue has undergone
complete atelectasis.
CONSOLIDATION
• The process by which air in the lung is replaced
by the products of the disease, rendering the
lung solid (as in pneumonia).
COR PULMONALE
• Right ventricular hypertrophy and/or dilatation
occurring as a result of an abnormality of lung
structure of function
DYSPNEA
• A subjective sensation of difficult or laboured
breathing
EMPHYSEMA
• A morbid condition of the lung characterized by
abnormally expanded air spaces distal to the
terminal bronchiole with or without destruction
of the air space walls.
EMBOLUS
• A clot or mass of formed material that has
been carried by the blood stream to occlude
partly or completely the lumen of a blood
vessel.
ERV (Expiratory reserve volume)
FEV1
• Forced expiratory volume (1 sec.)
The volume of air exhaled during the first
second of the forced vital capacity.
FEV1/FVC(%)
• Forced expiratory volume (1 sec.) to forced
vital capacity ratio expressed as a percentage.
Normal values ~75-80%
FRC (Functional residual capacity)
• The sum of RV and ERV. The volume of air
remaining in the lungs at the end expiratory
position.
Introduction to Respiratory Physiology...8
FVC
• Forced vital capacity;
Vital capacity performed with a maximally
forced expiratory effort.
HYPERCARBIA (Hypercapnia)
• An increased arterial carbon dioxide tension.
HYPOCARBIA (Hypocapnia)
• A reduced arterial carbon dioxide tension.
HYPOXEMIA
• A reduced partial pressure of oxygen in arterial
blood.
HYPOXIA
• A term for reduced oxygenation.
IC (Inspiratory capacity)
• The sum of IRV and VT.
INFLATION
• The state or process of being expanded or
filled with gas, used specifically with reference
to expansion of the lungs with air.
INTERSTITIUM
• A continuum of loose connective tissue
throughout the lung which surrounds the
bronchoarterial bundles; is situated between
the alveolar and capillary based membranes
within the alveolar air spaces, and is situated
between the pleura and lung parenchyma.
IRV (Inspiratory reserve volume)
• The maximal volume of air inspired from the
end inspiratory level.
OBSTRUCTIVE APNEA
• Apnea with respiratory effort.
OBSTRUCTIVE PATTERN
• Obstructive ventilatory defect (slowing of air
flow during forced ventilatory maneuvers).
Dr. David McCormack
Respiratory Physiology
OVERVENTILATION
• A general term indicating excessive ventilation.
When unqualified, it refers to alveolar over-
ventilation; excessive ventilation of the gas
exchanging areas of the lung manifested by fall
in arterial CO2 tension.
P(A-a)O2
• Alveolar-arterial oxygen pressure difference.
PaO2
• Arterial oxygen tension.
PaCO2
• Arterial carbon dioxide tension.
PARENCHYMA
• The gas exchanging portion of the lung
consisting of the alveoli and their capillaries,
estimated to comprise approximately 90% of
the total lung volume
PEF
• Peak expiratory flow being the highest forced
expiratory flow measured with a peak flow
meter.
PERFUSION
• The passage of blood into and out of the lung.
PNEUMONIA
• Infection (or non-infectious inflammation) of
the air spaces and/or interstitium of the lung.
PNEUMOTHORAX
• A state characterized by the presence of gas
within the pleural space
PULMONARY EDEMA
• The accumulation of liquid in the interstitial
compartment of the lung with or without
associated alveolar filling
Introduction to Respiratory Physiology...9
PULMONARY INSUFFICIENCY
• Altered function of the lungs that produces
clinical symptoms, usually indicating dyspnea.
Pv- O2
• Mixed venous blood oxygen tension.
RESTRICTIVE PATTERN
(Restrictive ventilatory defect)
• Reduction of vital capacity but non-explainable
by airways obstruction.
RESPIRATORY FAILURE
• A state characterized by an arterial PO2 below
60 mmHg., or an arterial PCO2 above 50 mmHg.,
at rest at sea level, resulting from impaired
respiratory function.
RV (Residual volume)
• That volume of air remaining in the lungs after
maximal exhalation.
SaO2
• Arterial oxygen saturation.
STPD
• Volume of gas expressed at conditions of
standard temperature (0°C or 273°K) and
pressur e(760 mmHg) and dry.
TLC (Total lung capacity)
• The sum of all volume compartments or the
volume of air in the lungs after maximal
inspiration.
UNDERVENTILATION
• A general term indicating reduced ventilation.
When otherwise unqualified, it refers to
alveolar underventilation; decreased effective
alveolar ventilation manifested by an increase in
arterial CO2 tension.
Dr. David McCormack
Respiratory Physiology Introduction to Respiratory Physiology...10

VA .
VD
• Alveolar gas volume.
. • Ventilation per minute of the physiologic dead
VA space (wasted ventilation).
• Alveolar ventilation per minute.
VDan
VC (Vital capacity) • Volume of the anatomic dead space.
• The maximal volume of air exhaled from the .
point of maximum inspiration. VE
. • Expired volume per minute.
V CO2 .
• Carbon dioxide production per minute. VI
• Inspired volume per minute.
VD .
V O2
• The physiologic dead space volume.
• Oxygen consumption per minute.

VT (Tidal volume)
• That volume of air inhaled or exhaled with each
breath during quiet breathing.

5. Normal Physiological Variables, at rest.

Table 1
Common cardiopulmonary variables for a young, normal adult male, 70 kg body weight.

Variable Units Normal Value, At Rest

Constants
Hemoglobin g /L 150
O2 capacity of hemoglobin mL O2/g Hb 1.34
Atmospheric pressure mmHg 760
(sea level)
Water vapor pressure (37°C) mmHg 47
STPD °K, mmHg, mmHg 273, 760, 0
BTPS °K, mmHg, mmHg 310, 760, 47

Continued on the next page.

Dr. David McCormack

Respiratory Physiology Introduction to Respiratory Physiology...11

Variable Units Normal Value, At Rest

Cardiopulmonary
Cardiac output L blood /min 5
Heart rate per min 60
PaO2 mmHg 100
SaO2 % 97
CaO2 mL O2/L blood 200
Oxygen delivery to the tissues (DO2) mL O2/min 1000
(CaO2 x cardiac output)
PvO2 mmHg 40
SvO2 % 75
CvO2 mL O2/L blood 150
Oxygen returned back to the heart mL O2/min 750
(CvO2 x cardiac output)
Oxygen consumption (VO2) ml/min STPD 1000 - 750 = 250
Carbon dioxide production (VCO2) ml/min STPD 200
Respiratory exchange ratio (VCO2/VO2) none 0.80

Lung Volumes, BTPS

Residual Volume L, BTPS 1.5
Functional residual capacity L, BTPS 3.0
Vital capacity L, BTPS 4.5
Total lung capacity L, BTPS 6.0

Ventilation, BTPS
Tidal volume mL, BTPS 500
Respiratory Rate per min 12
Minute ventilation L, BTPS/min 6.0
Anatomic dead space mL, BTPS 150
Physiologic dead space/tidal volume ratio none 0.30
Alveolar ventilation L, BTPS/min 4.2

Lung Mechanics
Pleural pressure, mean at FRC cm H2O -5
Chest wall compliance, at FRC L/cm H2O 0.2
Lung compliance, at FRC L/cm H2O 0.2
Airway resistance cm H2O/L/sec 2.0
Work of breathing, at rest mW (0.001 watts) 50
Work of breathing, at maximal exercise mW (0.001 watts) 5000

Dr. David McCormack