Dr.

Ang Boon Suen

Department of Physiology
6 Dec 2009

1
Introduction
y The fundamental goals of respiration are to
provide O2 to the tissues and to remove CO2
y To achieve this, respiration can be divided into
four major functions:
y Pulmonary
P l ventilation
til ti
y Diffusion of O2 and CO2 between the alveoli
and the blood
y Transport of O2 and CO2; and
y Regulation
g of ventilation and other facets of
respiration.

2
Components of Respiratory System
Components of
y system
respiratory y

y Respiratory tract
– Ventilation

y Alveolo-capillary
p y membrane
– Gas exchange

y Blood + Peripheral cells

– 02 utilization

3
Pulmonary ventilation
y Pulmonary ventilation is the movement of air into and
out of the lungs
y Air
Ai moves from
f an area off higher
hi h pressure to t an area
of lower pressure – pressure gradient
y The process of pulmonary ventilation requires a
pressure gradient between the outside of the body
and the alveoli
y At rest,
t the
th process off inspiration
i i ti isi an active
ti process
and expiration is a passive process
y Inspiration needs muscular contraction. The chief
muscle of inspiration is the diaphragm
y Expiration is due to elastic recoils of the lungs and
thoracic wall, and the inspiratory muscles relax.
4
 Components of Respiratory Tract
y Conducting zone:
y All the structures air
passes through before
reaching the respiratory
zone.
zone
y Mouth, nose, pharynx,
trachea, glottis, larynx,
bronchi
y Respiratory zone
y Region
R i off gas
exchange between air
and blood.
y bronchioles
y alveoli 5
Mechanics of Ventilation
y Mechanics of ventilation include forces that support
and move the chest wall & the lungs, together with
resistances that they need to overcome
y To understand the mechanisms involved in
ventilation, it is necessary to identify the forces that
are responsible for enlargement of thorax and lung
y Respiratory muscles are used to generate forces
during ventilation
y Inspiratory Muscles
y Expiratory Muscles

6
Inspiratory Muscles
Di h
Diaphragm
y The chief muscle of inspiration
y The diaphragm is a sheet of striated muscle
divides anterior body cavity into 2 parts:
thoracic cavity & abdominal cavity
y Innervated by phrenic nerve; C3 C3,4,5
45
y Dome shaped - moves down on contraction
Æ increase the length of the thoracic cavity
Æ lung increases in height

External Intercostal Muscles

y Located between the ribs
y Innervated by thoracic intercostals nerves
y Contraction Æ move the ribs upward and
outward Æ increase the diameter of the
thoracic cavity 7
Inspiratory
y Muscles
Accessory muscles of inspiration
y Become important during g exercise or respiratory
y
disstress – active breathing
y Sternocleidomastoid muscles - which lift upward on
the stern
sternum;
m
y Anterior serrati - which lift many of the ribs; and
y Scalene muscles - which lift the first two ribs.

8
Expiratory Muscles
y Involved in active breathing
y Abdominal muscles: rectus abdominis, internal
and external oblique and transverse abdominis
muscles
y Innervated
I t d by
b th
thoracic
i and
d llumbar
b spinal
i l nerves
y Contraction Æ pull the ribs downward and squeeze the
abdomen to increase abdominal p
pressure Æ move the
diaphragm upward and decrease the thoracic volume
y Internal intercostals muscles
y Contraction
C t ti Æ pulling
lli th
the ribs
ib ddownward
d
Upper Airway
y Muscles
y Upper airway muscles in the pharynx and larynx also
contract in phase with breathing and important in
determining airway resistance
y Pharyngeal muscles: stiffens the soft palate and hold the
tongue out of the way for breathing during inspiration
y Laryngeal muscles: dilate the airway during inspiration
y Dilatation of nares byy the alae nasi: decrease the
resistance to airflow
y Mouth breathing: decrease the resistance to airflow

10
INSPIRATION

11
EXPIRATION

12
Muscles of respiration

13
Pressure changes
g during
g respiration

Different types of pulmonary pressures

y Intra pulmonary (Intra-alveolar) pressure
y Intra pleural pressure
y Transpulmonary pressure
Pulmonary
y Pressures
Intra Pulmonary Pressure (Palv)
y Also called intra alveolar pressure
y is
i the
th pressure within
ithi the
th alveoli
l li off the
th lungs.
l
y Is exactly same as the atmospheric pressure
y Because the alveoli are directly connected to the
atmosphere.
y It rises and falls during breathing
y During normal/quiet breathing
y inspiration decreasing to -3mmHg
y expiration raising to +3mmHg.
y Forced/active breathing:
y Extra muscles, including abs
y +/- 20-30 mmHg intrapulmonary pressure

15
 Pulmonary Pressures
Intrapleural Pressures (Pplr)
y is the pressure within the pleural cavity
y space between the lungs and the walls of
the thoracic cavity
y The pressure is ALWAYS negative for the
following reasons
y Surface tension of the fluid inside the alveoli
always makes the alveoli try to collapse.
y Elastic fibers spread in all directions through the
lung tissues and tend to contract the lungs
y These factors creating a negative pressure, -2
mmHg at the end of expiration to -6 6 mmHg at
the end of inspiration
y Factors affecting intra-pleural pressure
y Physiological factors - deep inspiration,
inspiration gravity
y Pathological factors - injury to thoracic wall

16
 Pulmonary
y Pressures
Transpulmonary pressure (Tpp)
y The pressure difference between
intrapulmonary
i t l pressure andd
intrapleural pressure.
Tpp
pp = Palv – Pplr
p
y Tpp is the distending pressure which
helps to prevent airway collapse
Transthoracic pressure (Ttp)
y The pressure difference between
intrapulmonary pressure and
atmospheric pressure

17
 Pressure changes
g during
g respiration
y Intrapulmonay pressure
y Reduces from 0 to -1mmHg during
inspiration and comes back to 0 at
the end of inspiration
y Increases to +1mmHg and comes
back to 0 at the end of expiration
y Intraplueural pressure
y At the start of q
qiuet breathing,
g, it
is -2mmHg. At the end of
inspiration it becomes -6mmHg

18
Respiration
During normal inspiration following events occurs

Diaphragm & external intercostal muscle contracts

↓
Increase in vertical & anteroposterior diameter
(thoracic cavity )
↓
D
Decrease iin pleural
l l pressure
↓
Decrease in intrapulmonary
p yppressure
↓
Expansion of lungs - Air flows into the lungs
↓
Inspiration
19
Respiration
During normal expiration following events occurs
Relaxation of external intercostal muscles & diaphragm
↓
Return of diaphragm, ribs, & sternum to resting position
↓
Restores thoracic cavity to preinspiratory volume
↓
Increases pressure in lungs
↓
Elastic recoil of the lungs
↓
Air is exhaled
↓
Expiration
20
Elastic properties of the lung
g
y Elastic behaviour of lung is due to the presence of
((i)) elastin fibers
(ii) collagen fibers
(iii) surfactant

y Elastic forces of the lung tissue (1/3) and the

elastic forces created by surface tension (2/3)
are the two main mechanisms involved in the
tendency of the lung to recoil
Collapsing
g tendency
y of lungs
g
y Lungs are under constant threat of collapsing even
under normal condition because of following
reasons:
y The elastic property of lung tissues, which induces the
recoiling tendency of lungs
y Surface tension over the surface of the alveoli of lungs
(it is the tension exerted over the alveolar membrane,
by fluid secreted by the alveolar epithelium)
y The factors preventing the collapsing tendency of
lungs:
g
y Intrapleural pressure as it is negative
y Surfactant, which reduces surface tension

22
Compliance
y Is defined as the change in volume per unit change in the
pressure,
Compliance
C li = ΔV/ΔP
y Distensibility or stretchiness of lungs when under tension
y A lung stretches easily (high compliance)
compliance), does not
necessary mean that it will return to its resting volume when
the stretching force is release (elastance).
y The greater the amount of elastic tissue, the greater the
elastance (elastic recoil force), but the lower the compliance
y Factors that affect Compliance:
y Elastic fibers in the alveoli
y Pulmonary surfactant in the alveolar fluid

23
Pressure-Volume Curve
y relating lung volume changes to changes in transpulmonary
pressure,
y the inspiratory compliance curve and the expiratory compliance curve
y is
i called
ll d the
th compliance
li diagram
di off the
th lungs
l
y The characteristics of the compliance diagram are
determined by the elastic forces of the lungs:
y elastic forces of the lung tissue itself and
y elastic forces caused by surface tension of the fluid

Figure: Compliance Diagram of the Lungs

24
Pressure-Volume Curve
Compliance diagrams of saline filled and air
saline-filled filled
air-filled.
y The compliance diagram of the lungs demonstrate three
important features
y The
Th pressure–volume
l relationship
l ti hi is
i nonlinear
li
y changes with volume, the air curves show hysteresis, i.e., a difference
between inflation and deflation,
y the curves are different for inflation with air and saline
y The curves also show the work required to expand air-filled and
saline-filled lungs
y It requires less work/pressure to expand
saline-filled lung compared to air-filled lungs
y the surface tension effect is not present,
only tissue elastic forces are operative in
the saline solution–filled lung
.
Pressure-Volume Curve (cont’)
y The transpleural pressures required to expand air-filled lungs
are about three times as great as those required to expand
g
saline solution–filled lungs
y This shows that the tissue elastic forces tending to cause
collapse of the air-filled lung represent only about one third of
the total lung
g elasticity,
y, whereas the fluid-air surface tension
forces in the alveoli represent about two thirds

Comparison
p of the compliance
p diagrams
g of
saline-filled and air-filled lungs

26
Alveolar Surface Tension
y Thin layer of fluid in alveoli causes inwardly directed
force alveolar surface tension
y Causes alveoli to remain as small as possible

27
 Surfactant
S f
y Surface ti material
acting t i l or agentt that
th t is
i responsible
ibl ffor
lowering the surface tension of a fluid is called surfactant.
y The surfactant ppresent in the alveoli of lungsg pprevents the
collapsing tendency of lungs.
y It is secreted by type II alveolar epithelial cells (surfactant
secreting alveolar cells or pneumocytes)
pneumocytes).
y Composition of surfactant:
y Phospholipids & other lipids (90-95%),
y Proteins (alb,
(alb globulin,
globulin surfactant proteins)
y Carbohydrate, and ions.

28
Surfactant
Functions:
y The surfactant reduces the surface tension in the
alveoli of lungs and thereby prevents the collapsing
tendency of lungs.
y The surfactant is responsible for stabilization of the
alveoli, which have the tendency to deflate.
y It plays an important role in the inflation of lungs
during birth.
y The deficiency of surfactant causes respiratory
distress syndrome or hyaline membrane disease (in
infants) and adult respiratory distress syndrome (in
adults).

29
Function of surfactant
y promote alveolar stability

Alveoli are not bubbles, they are interdependent network

of air resembling a sponge; tendency of one alveolus to
collapse is opposed by elastic forces in adjacent alveoli
resisting further expansion
30
 Function of surfactant
y Reduce surface tension at low lung
volumes (prevent atelectasis/lung
collapse)
Surface tension tends to shrink the
surface area and tends to decrease
alveolar volume
The law of LaPlace relates the surface
tension (T) and pressure (P) in a gas-
filled, liquid-lined sphere with radius r;
P = 2T/r
Pressures inside the alveoli are inverselyy
proportional to their radius
Therefore, smaller alveoli would collapse
and empty p y into larger
g alveoli if the
surface tension were equal in both
alveoli
31
Function of surfactant
y Reduce pulmonary capillary infiltration (keep
y)
alveoli dry)
Surfactant reduces the transudation of liquid into the
alveolus by increasing the interstitial pressure to -4
mmHg (without surfactant
surfactant, pressure is -23
23 mmHg)

32
Airway
y Resistance
Airway resistance, Raw= ΔP/V
Where, ΔP = pressure difference, (ΔP= Pmouth-Palveoli ) and
V = volume of airflow

Poiseuille-Hagen
g formula,, air flow
V= ΔPπr4/8ηl
Where, r =radius of tube, η = viscosity, and l = length of the
tube

Therefore,
Raw =8ηl/πr4
y Radius of the tube has critical importance

33
Factors affecting airway resistance

y Lung volume
y Tone of the bronchial smooth muscle
y Airwayy generation
g
y Type of flow
Lung volume
• Increase lung volume (inspiration)
g
– Negative p
pleural ppressure ((NPP))
– Elastic pull of the lung tissue

visceral pleura
NPP

Elastic pull

Resistance
expiration > inspiration
Tone of the bronchial smooth muscle
y r (airway diameter) is the primary determinant
p
y Smooth muscle tone responds y stimuli
to many
Stimulus Bronchial Bronchial
constriction relaxation
Neural cholinergic β2 adrenergic

Neurohumoral acetylcholine norepinephrine

Chemical histamine,
histamine prostaglandin E2
leukotriene
Physical
y smoke,, dust

36
Airway generation
y Trachea and bigger airways upto
7th generation - 80% of Raw
y The
Th highest
hi h t regional
i l resistance
i t is
i
at generation 4, medium sized
bronchi of short length and
f
frequent branching,
b hi h
have an
extreme turbulence
y Small airways represent silent
zone
y In disease conditions, the smaller
bronchioles often determine air
flow resistance because of their
smaller size (easily obstruct) and
y have ggreater % of smooth muscle
in the walls (easily constrict)
37
 Type of flow
Resistance of turbulent flow is
effectively greater than of
laminar flow
Medium sized bronchi of short
length and frequent branching,
have an extreme turbulence Laminar (streamlined flow)

Turbulent flow in Central

Airways
Measures of airway
y resistance
y Airflow - plethysmography
y Force expiratory volume during the first second
(FEV1)
y Peak
P k expiratory
i t flflow rate
t (PEFR)
Work of Breathing
g
y The work of breathing is best displayed on a
pressure-volume curve. The total work of breathing
of the cycle is the area contained in the loop.
y Work done by respiratory muscles
y In normal breathing, most energy is used to expand
lungs
y During heavy breathing
breathing, most energy is used to
overcome airway resistance

40
Work of Breathing
Work of inspiration can be divided into three fractions

y Compliance or elastic work (60-65%)

y required expanding the lungs against the lung and chest
elastic forces
y Frictional work (28-35%)
y required overcoming airway resistance during the
movement of air into the lungs
y Tissue resistance work (2-7%)
y required overcoming the viscosity of the lung and chest
wall structures

41