Vous êtes sur la page 1sur 42

Pharmacy/Biomedical

RESPIRATORY
SYSTEM
Dr Saadiah Mohd Hidir

2008/2009
Biomedical / pharmacy
TOPICS
•Functions of resp. system
•Events during inspiration & expiration
•Pulmonary surfactant
•Lung compliance
•Airway resistance
•Lung volumes & capacities
•Pulmonary & alveolar ventilation
•Partial pressure of gases
•Hyperventilation & hypoventilation
•Pulmonary circulation
•O2 diffusing capacity
•Ventilation-perfusion ratio
•A-a PO2 difference
Reference books: Human Physiology; Respiratory Physiology
2 MAJOR FUNCTIONS OF OTHER FUNCTIONS OF
RESPIRATORY SYSTEM : RESPIRATORY SYSTEM :

1. Provides mechanisms for 1. Defends mechanism against


exchange of O2 & CO2 inhaled foreign matter
between atmosphere & • Bronchial secretions contains
tissues. Igs
2. Plays important role in the
regulation of pH of • Alveolar macrophages
extracellular fluid 2. Metabolic functions eg.:
• Adjusting rate of
removal of acid- • Synthesis surfactant
forming CO2by
• Angiotensin II
changes in alveolar
ventilation 3. Lyse small clots
4. Productions of sounds by
movement of air thro’ vocal cords
1. Respiratory airways:
• Upper airways (nasal cavity/mouth, pharynx,
larynx) and tracheobronchial tree which is a
series of branching airways (trachea, 2
primary bronchi, smaller bronchi → each
divide into secondary bronchi which then
branch into smaller & smaller bronchi →
bronchioles
2. Inhaled air is filtered, warmed & humidified as it
passes thro’ upper airways
1. Bronchioles 
• Terminal bronchioles →
• Respiratory bronchioles →
• Alveolar ducts which have
alveoli
2. Lungs ~ 300 millions alveoli
1. Alveoli surrounded by many capillaries
q(From the pulmonary artery that
brings deoxygenated blood from the
right ventricle)

2. Exchange of gases in the lungs by


simple diffusion thro’ thin alveolar-
capillary membrane
q(large surface area for diffusion )
•3 important
pressures
involved in
breathing :
qIntrapleural
pressure (Pip) /
pleural pressure
(Ppl)
1. Pleural cavity - v. thin
space between the
visceral & parietal
pleurae - contains a
thin layer of fluid
(lubricates pleural
surfaces as they slide
past each other
during respiratory
movements)
2. Pressure in pleural
cavity - intrapleural
pressure (Pip)

3. Visceral pleura (thin membrane) is firmly attached to outer surface of


each lung & parietal pleura lines the inside of the thoracic walls)
Pleural
cavity

•Normal quiet breathing:

Pip is always -ve (< atmospheric pressure (Patm) or subatmospheric

(If P = 0 mm Hg (same as Patm). If P is +ve (> Patm)


•At eqm, the inward elastic
recoil of the lungs tending
to collapse the lungs
exactly balances the
outward elastic recoil
tending to pull thoracic
cage outward →
q-ve Pip

-ve Pip
Apex of lungs

Base of lungs

•Upright position:
Pip more negative at the apex of lung

•Mean Pipat the end of normal expiration ~ - 4 mm Hg


(- 4 mm Hg less than Patm)
•Pip +ve (> Patm) eg. :
qDuring forced
expiration
qCoughing
3 IMPORTANT PRESSURES
INVOLVED IN BREATHING

1 Intrapleural pressure
(Pip) / pleural pressure
(Ppl)
(ii) Alveolar pressure (PA) /
intra-alveolar pressure /
intrapulmonary
pressure
q pressure in alveoli
15
3 IMPORTANT PRESSURES
INVOLVED IN BREATHING

1 Intrapleural pressure
(Pip) / pleural pressure
(Ppl)
(ii) Alveolar pressure (PA) /
intra-alveolar pressure /
intrapulmonary pressure
q Pressure in alveoli
(iii) Transpulmonary
pressure (PTP) = PA
minus Pip
q Force acting to
expand the alveoli)
•Normally, no air in
pleural cavity
•If air enters pleural cavity
e.g. due to stab wound or
broken rib, hole in lung

qPip = Patm (0 mm
Hg)
q→ PTP = 0 mm Hg
q→ lung on that side
collapses (atelectasis)
& thoracic wall spring
outward
qCondition is called
PNEUMOTHORAX
PRESSURES AT THE END OF QUIET EXPIRATION

Pleural cavity

PTP
(0 – (-
4)

(= Patm) (mean Pip)


20
1. Inspiration – active
process
• Initiated by the
contractions of the
diaphragm (main
muscle of inspiration)
& the external
intercostal muscles →
thorax expands
• Skeletal muscles
Main muscle External intercostal
of inspiration muscles

Force acting to expand lung

(Boyle’s law)

until Pavl = atmpres (0 mm Hg) & airflow ceases


Main muscle External intercostal
of inspiration muscles

Force acting to expand lung

(Boyle’s
law)

Changes in Pavl, Pip, PTP& tidal volume


until Pavl = atmpres (0 mm Hg) & airflow (TV) / during a respiratory cycle
ceases
1. Normal breathing
2. Referred to as negative
-pressure breathing
(during inspiration, air
moves into the lungs
because the PA< Patm)
3. Positive-pressure
breathing eg. mouth to
mouth breathing
Accessory
muscles of
inspiration
Changes in Pavl, Pip, PTP & tidal volume
during a respiratory cycle
1. During forced
expiration,
expiration is active
• Muscles of
expiration (internal
intercostal muscles,
abdominal
muscles) contract
which ↓ thoracic
dimension
COMPLIANCE
1. change in volume per unit
change in pressure

Compliance = 

Lung compliance
(
•the
magnitude of the change
in lung volume produced
by a given change in the
transpulmonary pressure

Normal CL 0.2 L / cm
H2O 


•High CL eg. in
emphysema → easier
to expand the lungs
(loss of elastic tissues)
•



 



SOME FACTORS AFFECTING CL:

Pathological states
P
 

 ↑

 


3. Posture – CL higher in standing position

4. Lung volumes

5. Surface tension of alveoli : High alveolar surface  


•
 

•Type II alveolar cells


secrete pulmonary
surfactant - a mixture
of phospholipids &
proteins
 alveolar
surface tension
FUNCTIONS OF PULMONARY SURFACTANT
↓ alveolar surface tension
3 ↑ lung compliance (easier to expand the lungs) & 


(ii) Stabilises alveoli of different sizes


- it prevents small alveoli from collapse at the end
of expiration
FUNCTIONS OF PULMONARY SURFACTANT
↓ alveolar surface tension
3 ↑ lung compliance (easier to expand the lungs) & 


(ii) Stabilises alveoli of different sizes


- it prevents small alveoli from collapse at the end
of expiration

(iii) Helps to prevents pulmonary oedema


•Lack of pulmonary surfactant in premature infants →
respiratory distress syndrome of the newborn (RDS) / infant
respiratory distress syndrome / hyaline membrane disease
after birth
•Lack of pulmonary surfactant in premature infants → high
alveolar surface tension → CL , alveoli collapsed, difficulty
in inspiration → respiratory failure
•Administration of glucocorticoid to mother ↑ rate of
maturation of foetal lungs
•Chest wall compliance
•Total compliance
•Dynamic compliance 

•Breathing 100 % O2for prolonged period


•Atelectasis
•Pulmonary oedema ↓ Surfactant pulmonary
•Hypoxia
•Shallow breathing

•Cigarette smoking

40
•25-40% of total resistance to airflow - in upper airways – nose, pharynx,
larynx
•In the tracheobroncial tree, most resistance in medium -sized bronchi (2-
4 mm)
•Normally, resistance is low
•Main determinant of
airway (bronchi &
bronchioles) R is
radius of airways

(R      

•


↑ parasympathetic
nerve activity, smoke,
histamine, →
smooth muscles
contraction →
bronchoconstriction →


Adrenaline (through 


), ß2-agonists
relaxation of smooth
muscles of airways
(wheezing – due turbulent airflow thro’ narrowed airways- more
prominent during expiration)

•Less dense gas such


as helium can be used
to replace N2in air to
reduce airway
resistance