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1. distensibility 2. stiffness 2 things determining lung compliance 3 common causes of airway resistance 3 factors determining airway resistance 3 forces to overcome for inspiration
1. ease w/ which lungs can be stretched (inflated) 2. resistance to stretch (inflation) - CT of lung (elastin, collagen) - surface tension b/w alveoli (reduced by surfactant) - swelling of bronchial wall (edema) - obstruction (mucus, tumor) - bronchospasm (airway constriction, like w/ asthma) - lung volume - elastic recoil - airway smooth muscle tone - elastic recoil of lung & chest wall (volume dependent) - frictional resistance of airways & tissues (flow dependent) - inertia of gas, opposes acceleration (flow dependent)
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- lung volume - airflow (w/ pneumotachograph) - esophageal pressure (~pleural pressure) - alveolar pressure - P(L): across lung = P(A) - P(pl) = P(tp): transpleural P - P(w): across chest walls = P(pl) - P(bs) - P(rs): across resp. system = P(A) - P(bs) - P(ta): across airway = P(aw) - P(pl) - P(atm): atmospheric (barometric) - P(pl): intrapleural (pleural) - P(A): alveolar (intrapulmonary) - P(bs): at body surface, us. = P(atm) - P(aw): airway pressure
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4 lung capacities - 23 generations of branching total: - 1-16: conducting zone - 17-19: transitional zone - 20-23: respiratory zone
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- large bronchi is major site of R - most airway R occurs in first 8 airway generations - low total resistance - smallest airways contribute little, b/c large effective cross-sectional area - airways in parallel: 1/R(total) = 1/R + 1/R + ... - nose to glottis, 25-40% total airway R - resistance higher when breathing thru nose - physical interaction of surrounding alveoli opposes tendency for alveolus to collapse / expand (at expense of other alveoli) mechanical tethering stabilizes alveoli PV = PV - basis of respiration: mechanically changing lung volume creates pressure gradients to drive gas flow C V /V = T/T - air expands as it's warmed during inspiration
1. VC: vital cap. 2. TLC: total lung cap. 3. IC: inspiratory cap. 4. FRC: functional residual cap.
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- cap's are combos of 2 or more volumes: 1. VC = IRV + V(T) + ERV 2. TLC = IRV + V(T) + ERV + RV 3. IC = IRV + V(T) 4. FRC = V(T) + ERV
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1. IRV: inspiratory reserve volume (3L) 2. *V(T): tidal volume (0.5L) 3. ERV: expiratory reserve volume (1L) 4. RV: residual volume (1.2L)
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Compliance
- reflects distensibility (elastic properties) = C = V/P = 1/recoil (inverse) - change in lung volume made by a change in pressure across lung compliance, recoil - due to destruction of elastic tissue & alveoli TLC at lower pressure compliance, recoil - stiff lung from CT proliferation TLC at higher pressure
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Compliance in emphysema
- R to airflow and/or recoil premature airway closure occurs in smaller airways w/out cart. equal pressure point moves closer to alveolus - dyn = static at resting state, resp. rate (RR) of 15/min, V(T) of 0.5L - dyn > static: RR & V(T), in exercise - dyn < static: RR & V(T), in resistance - resp. muscles relaxed (no tension) - inward lung recoil forces = outward chest wall forves - lung volume = FRC, no air flow - P(pl) ~ -4mmHg, P(atm) = P(A) - P(atm) = P(A) (alveolar) - no air flow - P(pl) ~ -7mmHg (more neg.) - lung volume = FRC + V(T) - contraction of inspiratory muscles: - lung volume, air flow starts, P(pl) - P(A) < P(atm) - ability of stretched (inflated) lung to return to its resting volume - inverse of compliance ( = 1/C) - tendency of lung to oppose stretch - affects airway width thru direct traction & effects on intrapleural pressure - determines normal breathing: passive process of normal exhalation - to overcome elastic recoil forces of lungs & chest wall - to overcome surface tension of alveoli - 65% of work - surfactant Dyn C(L): deeper & faster breathing induces more secretion - resistance Dyn C(L): lowers filling volume during course of breathing - parasymp. stim'n (ACh) - histamine - serotonin pCO in small airways - symp. stim'n (-AR agonists) - nitric oxide, NO - pCO , pO , in small airways
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- varies w/ inhalation / exhalation (hysteresis), due to surfactant - max C (V/P) at FRC (greatest change) - min at TLC & RV: little V w/ high P
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Elastic recoil
Dalton's law & application Driving force of air flow thru tube Dynamic compliance in exercise Dynamic compliance, Dyn C(L)
P(total) = P(gas) + P(gas) + ... - for atm. air, P(B) = P(N) + P(O ) - pressure diff b/w 2 ends of tube: - airflow = Q = P/R - for lungs, P = P(atm) - P(A) - raises Dyn C(L), compared to tidal breath - stim's surfactant exocytosis, w/ mas at 5 min. after signals, until 30min after - change in volume of lung over distending pressure during course of breathing - slope of line b/w end-inspiratory & endexpiratory points - due to airway compression - occurs where airway diameter is narrowed (from neg. transmural pressure) - occurs at end of expiration - dynamic airway compression occurs in forced exhalation, not in tidal breathing - equal pressure point occurs in airways w/ cart. (higher up bronchi)
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Factors that constrict bronchial smooth muscle Factors that dilate bronchial smooth muscle
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- no airflow, at TLC (completely filled) - P(A) = P(tp) + P(pl) = 30+(-30) = 0 - P(A) = 0 b/c same as P(atm) - P(tp) pos. (inward), P(pl) neg. (outward)
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- R: alveolus fills more slowly, ventilation distributes to others b/c there is time to fill - C: less volume fills alveolus in inhalation, won't distribute to others
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- pressure in intrapleural space - indirectly attaches lungs to thoracic wall (no direct attachment) - always neg., from pulling apart of 2 layers
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- expiratory airflow is effort independent - as P dissipates, there will be equal pressure point where P(pl) = P(aw) high P(pl) will collapse airway as much as it driving gradient flow
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- when upright, P(pl) more neg. at apex than base of lung - b/c lungs push pleural fluid down toward diaphragm, making more pos. pressure
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- P(A) = P(tp)+P(pl) = 30+60 = 90 - P dissipates thru exh. due to airway resistance & cross-sectional area ( v distending P)
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Inward & outward forces determining airway diameter & their factors Laminar vs. turbulent flow: where, factors, sound LaPlace's law & surface tension
- inward: smooth muscle, elastic forces - outward: pos. transpulmonary pressure P(L), alveolar interdependence
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C(x) = K P(x) - volume of dissolved gas is proportional to its partial pressure - K = solubility constant - lack of surfactant & lung compliance causes debris to line alveolar sacs - made of damaged cells, necrosis, protein - this lining stains like hyaline cart.
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- small airways, alveoli vs. trachea, bronchi - at airflow, radius, vs. airflow, radius - silent vs. detected by stethoscope P = 2T/r (pressure depends on surrounding surface tension & radius) more pressure needed to keep smaller bubble inflated w/ same surface tension - R(aw) w/ lung volumes - reciprocal of conductance: R = 1/C - patients w/ R(aw) have FRC
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- determine work of breathing - determined by interaction b/w lung & chest wall -> don't self-inflate, so force supplied by respiratory muscles
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- absence of surfactant in premature infants lung compliance, work of breathing atelectasis (progressive lung collapse) hypoxia, acidosis, gas exchange
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1. normal: RV w/ age 2. COPD: chronic obstructive pulmonary disease: RV 3. restrictive disease: TLC, from fibrotic tissue 4. obesity: fat lung vol., abdom. pressure
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Movement of gas from atmosphere to tissue Normal (tidal) breathing Pneumothorax & treatment
- atmosphere lungs (bulk flow) blood (diffusion) heart & vasculature (bulk flow) tissues & mitochondria (diffusion) - breath lasts 5 sec, for 12 breaths/min - inhal.:exhal. = 1:2 to 1:3 - lung collapse, from injury to chest wall, pleura, or lung - treat: add pos. pressure to airway, OR remove air from pleural space for neg. P(pl) - surface tension to collapsing pressure around alveoli (P = 2T/r) lung compliance (recoil) work of breathing = surface active agent, from type II pneumocytes lining alveolar walls - DPPC (dipalmitoyl phosphatidylcholine) - hydrophobic part interacts w/ alveolar membrane (lipid bilayer) - hydrophilic part interacts w/ aqueous fluid lining membrane 1. airway R: in tubes of whole airway 2. pulmonary (lung) R: airway + lung parenchyma, combined 3. chest wall R: friction of walls (treat w/ OMT) - depends on radius & length (& viscosity): R = 8 L / ( r) = P / flow - when turbulent (Re = 2rv/ > 2000) - non-elastic, frictional work - to overcome resistance to air flow (28%) - to overcome viscous resistance (lobe friction, 7%)
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- people breathe at resp. rate that minimizes total work of breathing (arrow) - work of breathing done mostly by muscles
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Pulmonary surfactant: effects Pulmonary surfactant: origin Pulmonary surfactant: structure & interactions Resistance to airflow in resp. system (3 types)
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1/C(rs) = 1/C(l) + 1/C(w), in parallel - combo of individual lung & chest wall C's - greater functional range when the 2 parts work as a unit
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- contraction/ relaxation of submucosal smooth muscle changes diameter of bronchi - independent of lung volume or P(pl) - contraction constriction resistance - old tool, measures lung volumes - can find IRV, V(T), & ERV - can not find residual volume - tendency depends on lung volume: expand from outward elastic recoil, for lung volume from RV to 60% VC collapse, for lung from 60% VC to TLC
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Static property of lungs Static vs. dynamic properties of resp. system Which will airflow resistance: O , NO:O , or He:O (80:20) ? Work of breathing & 2 components
- tendency to collapse, for any lung volume - due to inward elastic recoil - static: no airflow, involves pressure & volume - dynamic: lungs in motion, airflow in airways, involves airflow & resistance He:O (80:20): / = 0.31 (lowest) - / of O = 1.00; / of NO:O = 1.49 - Reynold's number dependent on /, so / turbulence resistance - W = PV - elastic component - resistive component
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- A. normal B. w/ elastic work: restictive pulm. disease (pulmonary fibrosis) smaller tidal volume at higher resp. rate C. w/ resistive work: obstructive disease (COPD, asthma, bronchitis) larger volumes w/ lower resp. rate