Department of Functional Sciences

Physiology

Physiology of respiration

Lecture 1
Functional organization of the
respiratory system

2017
 Summary

1. Functional organization of respiration

2. Physiology of the airways

3. Physiology of the pulmonary tissue

4. Non-respiratory functions of lungs

 Objectives

1. To know classification and functional structure of respiratory

airways
2. To describe mucus-cilliary transport and factors that are
influencing this transport
3. To describe the structure and functions of respiratory unit
4. To know the composition and roles of alveolar surfactant
5. To define superficial tension on the alveolar surface and the role
of superficial tension changes within the pulmonary mechanics
6. To describe the non-respiratory functions of the lungs
 1. Functional organization of respiration

Respiration = function through which O2 and CO2 are exchanged

between the organism and the atmosphere, providing gas
homeostasis at tissue level
Classification:
External respiration (pulmonary respiration)
Internal respiration (cellular respiration)
Pulmonary respiration = function through which the air is mobilized
from the atmosphere into the lungs and from the lungs into the
atmosphere + gas exchanges between the alveolar air and blood
from the pulmonary capillaries
 1. Functional organization of respiration

Respiration comprises 5 processes:

1. Pulmonary ventilation (exchange
between athmosphere and lungs)
Exchange I
2. Diffusion of respiratory gases (O2 and
CO2) through the respiratory
membrane (exchange between
alveolar air and blood) Exchange II
3. Transport of gases in the blood
4. Diffusion of gases at tissue level
(exchange between blood and
tissues) Exchange III
5. Cellular respiration

http://classes.midlandstech.com/carterp/Courses/bio211/chap22/chap22.htm
 1. Functional organization of respiration

Components of the respiratory system:

1.The airways Exchange I
(atmosphere lung)
2.The lungs
Exchange II (alveolar
3.Pulmonary circulation air blood)

4.Systemic circulation
Exchange III
5.The tissues (cells) (blood tissue)

6.Cellular respiration
 2. Physiology of the airways

The components of the respiratory system:

1. Respiratory airways air conduction system
2. Pulmonary tissue respiratory gas exchange system
3. Thorax-lung system mechanical pump system

Airways are divided based on size and functional characteristics:

1. Superior airways
2. Central inferior airways
3. Peripheral inferior airways
 2. Physiology of the airways

The main roles of the airways:

1. To ensure the bidirectional passage of the air, in/out of the lungs
2. Conditioning of inhaled air: cleaning, humidification (water vapor
saturation), and warming (to 370C)
3. Special functions: smelling, speaking
4. Reflex areas: sneezing, coughing
5. Immune defense
 2. Physiology of the airways

1. Superior airways:
Naso-pharynx to glottis
2. Central inferior airways:
Larynx, trachea, bronchial tree
down to bronchioles with a
diameter = 2 mm (the last ones
to have cartilage)
3. Peripheral inferior airways (no
cartilage, smooth muscle) (fmn):
Bronchioles with < 2 mm
down to terminal bronchioles
( = 0.2 mm)
 2.1. Superior respiratory airways

Nasal cavities:
Inferior and middle conchae
respiratory function
Superior conchae and superior
part of nasal septum
olfactory function
Roles of nasal cavities:
1. Cleaning the air of particles > 10m
2. Warming and hymidifying the air ensured by the good
vascularization of the nasal mucosa + acinous glands with serous
and mucous cells
3. Upper area: olfaction olfactory receptors (Obs: afferent pathway
= CN I, center = limbic system)
4. Inferior area: reflexogenic area sneezing (Obs: afferent pathway
= CN V, center = medulla); highly vascularized
 2.1. Superior respiratory airways

Pharynx:
12 mm, 2 major roles:
1. Reflexogenic area with major role
in proper passage of food and air
it ensures:
Passage of air from/to
trachea
Passage of food towards the
esophagus, due to the
swallowing reflex: afference =
CN X, efference = CN IX, center =
medulla)
2. Role in bacterial defense the mucoasa is rich in lymphatic tissue =
Waldeyer ring, which inclues the lingual, palatine, and pharyngeal
tonsils and is continued by the bronchial associated lymphatic tissue
= BALT
 2.1. Superior respiratory airways

Glottis:
Located between the inferior vocal folds
and internal part of arytenoid cartilages
major role in phonation
The intrinsic muscles of the larynx
(innervated by CN X) are involved in all
diameter changes of the glottis:
Partly open during respiratory rest
and during normal expiration
Fully open during forced inspiration
It narrows during speaking
Voluntary closure of the glottis during
the forced expiration of the Valsalva
maneuver
 2.2. Inferior respiratory airways (IRA)
2.2.1. Components

a) Central IRA: larynx, trachea, bronchial tree

down to bronchioles with = 2 mm (last ones
to have cartilage)
b) Peripheral IRA (no cartilage, but smooth
muscle): from the bronchiole with < 2 mm
down to terminal bronchioles ( 0.2 mm)
 2.2. Inferior respiratory airways
2.2.2. Bronchial tree
Bronchial tree the result of dichotomic
dividing of bronchi Generations
Generation 3 continues with bronchioles,
which have decreasing (the bronchiole
with 2 mm is the last one to have
cartilage)
Depending on the function:
a) Air conduction zone (16 generaii) part
of the Central IRA:
Components: lobar, segmental, inter-
segmental bronchi, and bronchioles,
down to the terminal bronchioles (
0.2 mm ) http://books.google.ro/books?id=M6vviWpZ0LsC&pg=PA400&lpg=PA4
00&dq=tracheobronchial+tree+division&source=bl&ots=IploUf7HcX&sig
=YewUPxzrrtNN9hyMN9NxpQXpJ8E&hl=ro&sa=X&ei=4Q-

Role: air conduction into/out of the lungs oUrCEF9GShQfLmYHwBw&redir_esc=y#v=onepage&q=tracheobronch

ial%20tree%20division&f=false

NO gas exchanges at this level

anatomical dead space ( 150 ml)
 2.2. Inferior respiratory airways
2.2.2. Bronchial tree
b) Respiratory zone = gas exchange
territory (the last 7 generations):
Components: respiratory bronchioles
(3 generations) continued by
alveolar ducts (3 generations)
alveolar sacs (last generation = 23)
NOT part of the air conduction zone
Role: ensures gas exchanges
(volume of air after a quiet
inspiration 3 liters)

http://books.google.ro/books?id=M6vviWpZ0LsC&pg=PA400&lpg=PA400&dq=tracheobronchial+tree+division&source=bl&ots=IploUf7HcX&sig=YewUPxzrrtNN9hyMN9NxpQXpJ8E&hl=ro&sa=
X&ei=4Q-oUrCEF9GShQfLmYHwBw&redir_esc=y#v=onepage&q=tracheobronchial%20tree%20division&f=false
2.2.2. Bronchial tree
 2.2.3. Structure of the tracheal-bronchial wall

1. U-shaped cartilage, with a fibrous-

muscular membrane in the
posterior part
The cartilage progressively
decreases along the bronchial tree
it becomes fragmented in the
small bronchi is absent in
bronchioles with < 2 mm
Role: it prevents airway collapse
2. Smooth muscle fibers: close off the
cartilage posteriorly
More numerous in the small
(distal) airways, as the cartilage
dissapears risk of
bronchoconstriction at this level
 2.2.3. Structure of the tracheal-bronchial wall

3. Mucosa with many cell types cylindrical

cilliate cells, goblet cells, undifferentiated
cells, neuro-ectodermic origin cells, etc.),
with many roles:
Barrier for particles / toxic molecules
from air
Mucocilliary clearance
In trachea and bronchi: pseudo-stratified
epithelium woth cillindrical cell with
many cilia which show rapid movements
movement of the surface mucus layer
In small airways: the epithelium becomes
flatter, with fewer cilia, and it becomes
unistratified in terminal bronchioles
The mucus secred by goblet cells and
mucous glands layer onto which
Cecil Medicine, 23rd ed. (2007)
particles deposit
 2.2.3. Structure of the tracheal-bronchial wall

Role in immune function:

Antigen presenting cells (APCs)
located near epithelial cells, with
elongations that go between
epithelial cells

They come into contact with
antigens from the mucosal
surface (e.g., bacteria, viruses,
allergens) engulfment
processing presentation to
the immune effector cells (B
cells, T cells) from the regional
lymph nodes role in
activation of cellular and
humoral immunity and immune
tolerance
 2.2.3. Structure of the tracheal-bronchial wall

4. Bronchial associated lymphatic

tissue = BALT:
Structure: lymph nodes,
lymphatic aggregates, solitary
lymphocytes, dendritic cells
Role in immune defense
5. Tracheal-bronchial glands
mucus secretion
Stimulated by the vagus nerve,
irritants, inflammatory factors
6. Nerve fibers
Sensory and motor
PSNS (well represented), SNS
(poorly represented), NANC
system (non-adrenergic, non- http://users.atw.hu/blp6/BLP6/HTML/C02597
80323045827.htm
cholinergic) Berne and Levy Physiology, 6th Edition
 2.2.3. Structure of the tracheal-bronchial wall

Role of innervation: it interacts

will all the other structures
control
E.g.: the effect on smooth
muscle fibers from the airways:
Cholinergic fibers release
acetylcholine (Ach), which acts
on muscarinic receptors (M3,
M2) BC (bronchoconstriction)
Adrenergic fibers release
catecholamines, which act on
beta2-adrenergic receptors
BD (bronchodilation)
NANC nerves release NO + VIP
(co-mediator) BD
 2.2.3. Structure of the tracheal-bronchial wall

PSNS innervation = vagus nerve

(post-ganglionic fibers)
Mediator: acetylcholine (ACh)
Ach effects depend on the type
of muscarinic receptor:
On smooth muscle fibers: M3
(main) and M2 rec BC
On nerve endings (pre-
synaptic): M2 rec (auto-
receptors) inhibition of Ach
release BC
On bronchial epithelial cells:
M1 rec release of BD
factors
On bronchial glands: mucus
secretion
Nature Reviews Drug Discovery 6, 721-733, 2007
2.2.3. Structure of the tracheal-bronchial wall

http://users.atw.hu/blp6/BLP6/HTML/C0259780323045827.htm
Berne and Levy Physiology, 6th Edition
 2.2.3. Structure of the tracheal-bronchial wall

1. Ciliated epithelium
2. Mucous cells
3. Glands
4. Cartilage
5. Smooth muscle fibers
6. Club (Clara) cells
7. Capillaries
8. Basement membrane
9. Surfactant
10. Type I pneumocytes
11. Alveolar septum
12. Type II pneumocytes

Air conduction zone down to the bronchiole with = 2 mm:

The walls have cartilage, which decreases as the bronchi become
smalles risk of collapse due to BC factors
Increasing number of smooth muscle fibers
Mucous glands
Cylindrical epithelial cells with many cilia
 2.2.3. Structure of the tracheal-bronchial wall

1. Ciliated epithelium
2. Mucous cells
3. Glands
4. Cartilage
5. Smooth muscle fibers
6. Club (Clara) cells
7. Capillaries
8. Basement membrane
9. Surfactant
10. Type I pneumocytes
11. Alveolar septum
12. Type II pneumocytes

Bronchioles with <2 mm:

NO cartilage risk of collapse due to
smooth muscle fibers BC agents (Ach, PSNS)
No mucous glands
Cuboidal epithelial cells with few cilia
Structure of ciliated epithelium of trachea and bronchi
Cells of the respiratory tract
 2.2.4. Central inferior airways

Components: larynx trachea

bronchial tree down to bronchioles with
2 mm
Larynx: air conduction to/from the trachea
Trachea ( = 20 mm, length = 10-12 cm)
Structure: 15-20 U-shaped, incomplete
cartilage rings, with an elastic membrane
in the posterior part rigid tube, but can
stretch prevention of tracheal collapse
Roles:
1. air conduction to/from the bronchi
2. mucociliary clearance motion of
epithelial cells transport of particles
deposited on the mucus (including
bacteria) towards the oro-pharynx, where
they can be swallowed
 2.2.4. Central inferior airways

Bronchial tree down to the bronchiole

with 2 mm (last one to have cartilage)
Structure: U-shaped, incomplete cartilage
rings, with smooth muscle fibers in the
posterior part (few at first, but in greater
number afterwards, as the cartilage rings
decrease, in the small, distal airways
prevention of collapse during breathing
Roles:
1.Air conduction to/from the alveoli
2.Mucociliary clearance motion of
epithelial cells transport of particles
deposited on the mucus (including
bacteria) towards the oro-pharynx, where
they can be swallowed
3.Immune defense (BALT)
 2.2.5. Peripheral inferior airways

From bronchioles with <2 mm to

terminal bronchioles ( 0.2 mm )
As they divide, the bifurcation angle
decreases the small airways are
parallel large surface are laminar
air resistance to flow
No more cartilage risk of collapse
Maintained open by the peribronchial
elastic fibers
smooth muscle fibers major
influence by BC/BD factors
 2.2.5. Peripheral inferior airways

Bronchodilator (BD) factors

bronchial air flow
SNS, adrenaline, -agonists -2
adrenergic receptors
Parasympatholytics (atropine) they
block the effect of PSNS
Bronchoconstrictor (BC) factors
bronchial air flow
PSNS (vagus nerve), acetylcholine,
metacholine muscarinic receptors
-blockers block SNS effects
Leukotrienes + Prostaglandins =
proinflammatory, BC factors
Histamine = released by mast cells, acts
on H1 receptors
 2.2.5. Peripheral inferior airways

Terminal bronchioles = 3rd

generation of bronchioles
smooth muscle fibers
Final part of the airways
Respiratory bronchioles =
transition segment
between airways and
alveoli
Respiratory zone starts
where the terminal
bronchioles are continued
by the respiratory
bronchioles continued
by alveolar ducts
alveolar sacs
 2.3. Air filtration
Inhaled particles are deposited in the airways depending on:
Size
Density
Distance across which the particle can travel
Relative air humidity
Particle deposit mechanisms:
1. Precipitation
Particles >10 m are deposited in the naso-pharynx
Particles with = 2-10 m are deposited in the inferior airways,
due to inertial impact in areas with turbulent flow (proportional to
particle mass and velocity)
2. Sedimentation
Due to gravity
Main depositing process for particles with = 0.2-2 m
Starts at the 4th generation bronchi and continues down to the
lung periphery (depends on particle size and density and on airway
diameter)
 2.3. Air filtration

3. Diffusion (brownian motion)

Process of sedimentation in peripheral airways and alveoli, for
particles with < 0.2 m
No mucociliary clearance at this level particle elimination by
lymphatic drainage or phagocytosis
Depends on the diffusion coefficient of the particle
Particle evacuation from the airways:
Reflexes of the respiratory/digestive tract (swallowing, cough,
expectoration)
Slower evacuation higher risk of injury
Achilles heel: areas without cilia (terminal bronchioles
alveoli) most commonly affected area in occupational lung
disorders
 2.4. Mucociliary clearance

Physiological process of cleaning inhaled air of particles with < 3m

2 components:
1. Mucus layer external viscous layer + internal serous layer
2. Epithelial cell cilia
 2.4. Mucociliary clearance
1.Mucus layer
Produced by: goblet cells, cells of the mucous glands
Amount: 10 ml/day - 100 ml/day
The production is stimulated by: vagus nerve, airway irritation,
inflammation
Characteristics: 5 m thick, mucopolysaccharide polymer: 95%
water, 2-3% proteins, 0.5-1% lipids, 0.1-0.5% proteoglycans
 2.4. Mucociliary clearance
1. Mucus layer
2 layers:
Viscous (fibro-reticular gel, gel layer) on the mucosal surface
carpet onto which inhaled particles < 3m are deposited
Serous (periciliary fluid, sol layer) - deeper ensures cilia motion
Mucus transport is ensured by cilia motion: anterograde, starting
from the terminal bronchioles towards the larynx
 2.4. Mucociliary clearance
2. Epithelial cilia
The cilia have a rapid forward Mucus motion
Viscous mucus

movement, with a frequency of 10-20/s Serous mucus

push the mucus from the small,

inferior airways, to the superior airways
Velocity induced by cilia motion:
In the small airways: v = 0.5-1 mm/min
In the trachea: v = 5 mm/min
Mucociliary escalator
Due to cilia motion escalator
mechanism through which the mucus
layer and the deposited particles move
anterograde from bronchioles up
the bronchial tree to the pharynx,
where the mucus is eliminated by:
Swallowing
Cough with expectoration
 2.4. Mucociliary clearance

Very efficient air cleaning mechanism for particles < 3 m

90% of the particles are eliminated during the first hour
100% clearance (full clearance) requires 6-12 h
Factors that influence mucociliary clearance:
Ciliodepressor factors Ciliostimulant factors
Tobacco smoke Cholinergics
Air pollutants (SO2, Myofilin
NO2, O3), prolonged Saline solutions,
hyperoxia hypertonic or
Anticholinergics isotonic
(debatable) Humid air (water
Anesthetics aerosols)
Antidepressants Adrenergics ( and
Dry air agonists)
Extreme temperatures Mucolytics http://www.ncbi.nlm.nih.gov/pubmed/10515429

Lack of vitamin A http://www.transrespmed.com/content/2/1/6

 3. Physiology of the pulmonary tissue

Lung tissue is organized into:

pulmonary lobes, lobules, and
acini (respiratory unit)
Right lung: 3 lobes
Left lung: 2 lobes

The morphological and functional

unit of the lung is the respiratory
unit or the pulmonary acinus
 3.1. Structure and function of the respiratory unit

Respiratory unit = respiratory bronchiole +

alveolar ducts and alveoli
1. Begins from the respiratory bronchiole,
which divides dichotomously 3
generations
2. Continues with alveolar ducts, with
irregular division progressively
3. Ends with alveolar sacs, which are
continued by >3-4 alveoli
Alveolar walls are extremely thin +
surrounded by a network of
interconnected capillaries sheet of
flowing blood ensures close contact
between alveolar gases and capillary
blood
Air velocity 1% of the velocity in the
trachea
 3.2. Alveolar structure

Alveoli: 300 million/lung,

= 0.2 mm
Large respiratory surface area
Structure: epithelium with a
basement membrane, 3 cell
types:
Alveolar epithelial cells (type I
pneumocytes) thin layer
Granulose pneumocytes (type II
pneumocytes) surfactant-
secreting cells
Alveolar macrophages at the
epithelial surface, they ensure
alveolar cleaning
 3.3. Physiology of alveolar surfactant

Secreted by type II alveolar epithelial

cells (10% of the alveolar surface
area) starting from the 6th-7th month
of gestation
Surface active agent in water
(decreases surface tension of water)
Major role: to change local surface
tension during breathing
Structure: complex mixture of
phospholipids (most important for
decreasing surface tension is
dipalmitoylphosphatidylcholine),
proteins (apoproteins), and ions (such
as Ca2+)
 3.3. Physiology of alveolar surfactant

Surfactant componentele are arranged in 3 layers:

Basal layer - glycoproteins
Middle layer aqueous phase (PL and MPS)
Superficial (surface) layer tensioactive properties
It does not dissolve uniformily in the fluid that lines tha alveolar
surface:
Part of the molecule dissolves, while the remainder spreads
over the surface of the water in the alveoli, ensuring that the
surface has 1/12 1/2 of the surface tension of a pure water
surface
 3.3. Physiology of alveolar surfactant

Surfactant functions:
1. Decrease of surface tension of the alveoli
decrease the work of breathing
Respiratory rest: surface tension is 20-25 dyne/cm
Expiration: surfactant molecules gather closely as
the alveolar volume decreases, forming a
continuous layer on the alveolar surface
tension decreases as the alveolar surface
decreases the surfactant prevents alveolar
collapse
Inspiration: surfactant molecules disperse on the
alveolar surface as its volume increases
surface tension increases to 40 dyne/cm the
surfactant prevents inflation prevents alveolar
over-distension
 3.3. Physiology of alveolar surfactant

2. Keeps the alveoli dry, by opposing liquid filtration from the

capillaries into the alveoli
3. Allows emulsification of inhaled particles
4. Dissolves and neutralizes air pollutants
5. Ensures alveolar cleaning of small particles towards the
bronchioles removal by the mucociliary escalator
 3.3. Physiology of alveolar surfactant

Surfactant variations and pathologic conditions :

The smaller the alveoli, the greater the alveolar
pressure
Premature newborns have little or no surfactant
tendency for pulmonary collapse during
expiration respiratory distress syndrome of
the newborn: the alveoli collapse during
expiration and the respiratory work needed to
distend them is too great, leading to risk of death
by respiratory exhaustion
In adults, due to: pulmonary edema, in smokers,
after prolonged oxygen therapy or surfactant
inactivation due to aspiration of fluids
Conclusion: the absence of surfactant is
incompatible with life!!!
 4. Non-respiratory functions of lungs

Alveolar air clearance

Phonation (speech)
Singing or playing an instrument - resonator
Maintaining homeostasis
Acid-base balance
Water and electrolyte balance
Pulmonary defense mechanisms
Metabolic functions (synthesis, catabolic)
Non-respiratory functions of pulmonary circulation:
Blood clearance
Blood reservoir
Cardio-respiratory reflex functions
 4.1. Speech

Speech involves:
The respiratory system, specific nervous centers, respiratory
control centers in the brain, articulation and resonance
structures of the mouth and nasal cavities
two mechanical functions: phonation (larynx) and articulation
(structures of the mouth)
Phonation = generation of sounds when the air passing between
the vocal folds (cords) causes their vibration
Normal breathing vocal cords are wide open
Phonation vocal cords move together vibration
Vibration (sound) pitch depends on the degree of vocal cord
stretching
Articulation and resonance involves 3 major organs: lips, nasal
sinuses, pharynx
 4.2. Maintenance of acid-base balance

Involves elimination of excess CO2

CO2 concentration from blood and cerebrospinal fluid receptors
from central nervous system adaptation of pulmonary
ventilation
CO2 is continuously generated during the cellular metabolic
processes and it induces acidification, to which ventilation opposes,
by continuously eliminating CO2
PCO2 depends on the relationship between generated CO2 and
eliminated CO2, which is directly related to the ratio of bicarbonate
that balance other acidic catabolites
The bicarbonate buffer is the most important plasma buffer, the
ratio between the two components of the bicarbonate/carbonic
acid buffer system being 20 for a pH of 7.4
 4.3. Pulmonary defense mechanisms

The lungs are continuously in contact with pathogens, pollutants, and

inhaled particles defense mechanisms:
1. Air conditioning
The air is warmed, saturated in water vapors, partially filtered
2. Olfaction
Contributes to detection of potentially toxic substances from the
atmospheric air
3. Filtration and elimination of inhaled particles
Nose hairs filtration of large particles
Turbulent precipitation removal or particles with >10 m
Small airways sedimentation of particles with = 0.2-5 m
Alveoli sedimentation of particles with < 0.1 m
Particle removal mechanisms: reflex mechanisms (cough, sneeze)
and mucociliary clearance
Removal mechanism at the pulmonary acinus: alveolar
macrophages engulf inhaled particles
 4.3. Pulmonary defense mechanisms

4. Bronchial associated lymphatic tissue - BALT

Structure: lymph nodes, lymphatic
aggregates, solitary lymphocytes, dendritic
cells diffuse network in the submucosa
Roles:
1. Filtration of fluids and particles
2. Non-ciliated lympho-epithelium, involved in
facilitation of drainage of pathological
collection and immune processing of non-self
particles
3. Dendritic cells (APCs) located between the
epithelial cells: they come into contact with
antigens from the mucosal surface
engulfment processing presentation to
immune effector cells (B cells, T cells)
Berne and Levy, Physiology, 6th ed
4.3. Pulmonary defense mechanisms

Antigen presentation and immune response at the BALT

Kiyono 2004, Nature Reviews Immunology

 4.3. Pulmonary defense mechanisms
5. Alveolar defense functions:
Surfactant
Immunoglobulins: IgAs, IgG
Cells of the innate immune system (alveolar macrophages and
neutrophils)

SP-A = surfactant
protein A, SP-D =
surfactant protein D
J. R. Wright, Nature
Reviews Immunology
(2005)
 4.4. Pulmonary metabolic functions

Metabolism of vasoactive substances

PGE1, PGE2, PGF2 - are completely eliminated from blood during
the first passage
30% of noradrenaline is inactivated
Synthesis and release of molecules with local effect
Alveolar surfactant
Histamine, prostaglandins, leukotrienes, PAF (platelet activator
factor), serotonin are released from pulmonary mast cells as a
reaction to allergens they can induce bronchoconstriction,
inflammation and cardio-pulmonary reflexes
Synthesis and release of mediators of pulmonary origin into blood
Bradikinin, histamine, serotonin, heparin, prostaglandins
Intra-pulmonary activation of hormone-like substances
Angiotensin activation by the angiotensine converting enzyme
 4.5. Non-respiratory functions of pulmonary
circulation
Blood reservoir - 500-600 ml of blood in adults
Filtering role
It protects the systemic circulation from particles that can go
into the blood and induce arterial obstructions with severe
effects at the cardiac and cerebral levels (thromboembolism,
gas embolism, etc.)
Maintenance of fluid-coagulant balance
Plasminogen tissue activator and heparin are synthesized in
pulmonary circulation important effect on blood clotting
Drug absorption
Some drugs can easily cross the respiratory membrane and
rapidly diffuse into the systemic circulation
a very useful administration route in case of gaseous
substances: halothane or nitric oxide
partial elimination of volatile substances from blood: alcohol or
metabolic compounds (ammonium, ketone bodies, etc.)
 MCQ

1. *Central inferior airways include:

A. Pharynx
B. Nasal cavities
C. Bronchi with >2 mm
D. Bronchi with <2 mm
E. Respiratory bronchioles
 MCQ

2. Mucociliary transport:
A. Takes place from the terminal bronchioles towards the larynx
B. Is due to the motion of epithelial cell cilia
C. Tobacco smoke has a depressor effect on transport
D. Is inhibited by -adrenergics
E. Tobacco smoke has a stimulating effect on transport
 MCQ

3. Alveolar surfactant:
A. Prevents alveolar collapse during expiration
B. Increases work during breathing
C. Keeps the alveoli dry
D. Directly favors alveolar opening during inspiration
E. Directly favors alveolar closing during expiration