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External respiration

Internal respiration

Structure of the respiratory system

Airways
Trachea is a fibromuscular tube supported ventrolaterally by c-shaped cartilage and completed dorsally by smooth muscle Small airway (no cartilage) collapse when compressed

Alveolar surface -Type I alveolar epithelial cells (a single thin layer of squamous epithelial cell) -Type II alveolar epithelial cells (cuboidal epithelial cell) -Third cell type: alveolar macrophage Alveolus ~ 250 m pores of Kohn (interalveolar communication) Alveolar-capillary membrane Respiratory membrane Blood-gas interface

10%

90%

Blood-gas barrier 0.2-0.5 m thick 50-100 m2 for gas exchange

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1. Parasympathetic nerve fiber : Vagal efferent fiber smooth m. airway & bronchial mucous glands 2. Sympathetic nerve fiber (-adrenergic receptor) Bronchodilation 3. Non-adrenergic non-cholinergic system (NANC) - eNANC [substance P/neurokinin A, CGRP] Bronchoconstriction - iNANC [ATP, [ATP NO NO, NPY NPY, VIP] Bronchodilation
CGRP = calcitonin gene-related peptide NPY = neuropeptide Y

acetylcholine
atropine + methacholine muscarinic receptors smooth m. bronchus Bronchoconstriction : Vagal afferent fiber stretch receptors, irritant receptors

Pulmonary circulation
1. Bronchial circulation (systemic circulation)
Bl. bronchial a. Lung bronchial vein nutrient,O2 pul.vein (shunt)

Functions of the respiratory system Gas exchange

Other functions I. AcidAcid-base balance H2CO3 10,000 mEq/d nonvolatile acids 10 mEq/d
CA

2. Pulmonary circulation
oxygenated bl. Bl. RV deoxygenated bl. pul.artery lung pul.vein pul. capillary LA

CO2+H2O

H2CO3

H++HCO3-

pH = pKa+log [HCO3-]/0.03PCO2 6.1+log(24/0.03*40) 6.1+log20 6.1+1.3 = 7.4 Henderson-Hasselbalch equation

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Respiratory acidosis : PaCO2 pHa

Metabolic acidosis : HCO3- pHa COPD

depression of RS center, center

Respiratory alkalosis : PaCO2 p pHa

loss of HCO3- (diarrhea), lactic acidosis, ketoacidosis, renal dysfunction

Metabolic alkalosis : HCO3- pHa H

hypoxaemia (PaO2 < 60 mmHg), anxiety, hyperventilation syndrome

loss of H+ (vomitting), ingestion or intravenous of excess HCO3-

II.Pulmonary defense mechanism Filtration of inspired air : preventing entry to distal lower respiratory tract
- Nasal hairs ( (remove particles p > 10-15 m) ) - Particles > 10 m turbinate bronchi (if air enter trachea) - Particles 2-10 m sedimentation in small airway (airflow rates are low) and trapped in the mucus the lines the upper airways, trachea, bronchi, and bronchioles - Particles 0.1-0.5 m 80% of them are exhaled suspended as aerosols, and impact in nasal septum and impact at carina or within

Removal of filtered material I.Reflexes in the airway : mechanical and chemical stimulation of receptors in nose, trachea, larynx or bronchus - Bronchoconstriction - Cough & sneeze II. Mucociliary escalater

P i ili Periciliary fluid fl id layer l

Cystic fibrosis

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: Small airway (cilia beat 0.5-1 mm/min) : Trachea, bronchi (cilia beat 5-20 mm/min) Mucus reaches pharynx Swallow Expectorate Blow from nose

III. Alveolar macrophages - Phagocytosis (eg. bacteria) - Nondigestible g material ( (eg. g silica) )

Mucociliary clearance is inhibited by Cigarette smoke Cold C ld air i Sulphur oxides Nitrogen oxides

Migrate to the mucociliary escalator & eventual removal through the airway P ti l Particle-containing t i i macrophages h may also l migrate into interstitial space enter lymphatic system

III. Metabolic function of the lung

-Many vasoactive substances are inactivated, altered, or removed from the blood as they pass through the lungs.

AI

ACE

AII

V. Air conditioning :Mucosa of nose, nasal turbinate, oropharynx, and nasopharynx have rich blood sypply and a large surface area VI. Phonation :Speech, singing, and other sounds are produced by the action of CNS controllers on the muscle of respiration, causing air flow through the vocal cords and the mouth

(AGE = angiotensin converting enzyme)

IV. Reservoir for the left ventricle *

*
Balloon occlusion

VII. Olfaction :Olfactory receptors (posterior nasal cavity) :Sniff to detect hazardous gases or dangerous material in inspired air
Pul. blood volume 500 ml.

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C = Compliance

A = Alveolar

References:
1. Levitzky MG. Pulmonary Physiology. 6th ed. New York: McGraw Hill 2003. McGraw-Hill, 2003 2. Schwartzstein RM, Parker MJ. Respiratory physiology: A clinical approach. Philadelphia: Lippincott Williams & Wilkins, 2006. 3. West JB. Respiratory Physiology: the essentials. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2005. 4. West JB. Pulmonary Physiology and Pathophysiology: An Integrated, Case-Based Approach. 2th ed. Philadelphia: Lippincott Williams & Wilkins, 2007. 5. ,

F = Fractional concentration I = Inspired in dry y gas g P = Pressure or partial AW = Airway pressure Q = Volume of blood a = arterial

= Volume of blood per Q unit time R = Resistance

V = Volume of gas

c = capillary c = end-capillary v = venous

= Volume of gas per unit v = mixed venous V time

FIO2, PAO2 PaO2 VA

2554.