RESPIRATORY SYSTEM

The lungs are the site of the exchanges of oxygen and carbon dioxide between the air and the
blood. The respiratory system may be divided into the upper respiratory tract and the lower
respiratory tract.
The upper respiratory tract consists of the parts outside the chest cavity: the air passages of
the nose, nasal cavities, pharynx, larynx, and upper trachea.
The lower respiratory tract consists of the parts found within the chest cavity: the lower
trachea and the lungs themselves, which include the bronchial tubes and alveoli. Also part of the
respiratory system are the pleural membranes and the respiratory muscles that form the chest
cavity: the diaphragm and intercostal muscles.
The nasopharynx is a passageway for air only, but the remainder of the pharynx serves as both an
air and food passageway, although not for both at the same time.
The larynx is often called the voice box, a name that indicates one of its functions, which is
speaking.
The largest cartilage of the larynx is the thyroid cartilage.

The lungs are located on either side of the heart in the chest cavity and are encircled and
protected by the rib cage. The base of each lung rests on the diaphragm below. On the medial
surface of each lung is an indentation called the hilus, where the primary bronchus and the
pulmonary artery and veins enter the lung. The pleural membranes are the serous membranes of
the thoracic cavity. The parietal pleura lines the chest wall, and the visceral pleura is on the
surface of the lungs. Between the pleural membranes is serous fluid, which prevents friction and
keeps the two membranes together during breathing.
The functional units of the lungs are the air sacs called alveoli.

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 THE RESPIRATORY SYSTEM
MECHANISM OF BREATHING
Ventilation is the term for the movement of air to and from the alveoli. The two aspects of
ventilation are inhalation and exhalation. The respiratory centers are located in the medulla and
pons. But it is the medulla that generates impulses to the respiratory muscles. These muscles are
the diaphragm and the external and internal intercostal muscles. The diaphragm is a dome-
shaped muscle below the lungs; when it contracts, the diaphragm flattens and moves downward.
The intercostal muscles are found between the ribs. The external intercostal muscles pull the
ribs upward and outward, and the internal intercostal muscles pull the ribs downward and
inward.
Ventilation is the result of the respiratory muscles producing changes in the pressure within the
alveoli and bronchial tree.

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With respect to breathing, three types of pressure are important:
1. Atmospheric pressure the pressure of the air around us. At sea level, atmospheric pressure is
760 mmHg. At higher altitudes, of course, atmospheric pressure is lower.
2. Intrapleural pressure the pressure within the potential pleural space between the parietal
pleura and visceral pleura.
3. Intrapulmonic pressure the pressure within the bronchial tree and alveoli.

INHALATION
Inhalation, also called inspiration, is a precise sequence of events that may be described as
follows: Motor impulses from the medulla travel along the phrenic nerves to the diaphragm and
along the intercostal nerves to the external intercostal muscles. The diaphragm contracts, moves
downward, and expands the chest cavity from top to bottom. The external intercostal muscles
pull the ribs up and out, which expands the chest cavity from side to side and front to back. As
the chest cavity is expanded, the parietal pleura expands with it. Intrapleural pressure becomes
even more negative as a sort of suction is created between the pleural membranes. The adhesion
created by the serous fluid, however, permits the visceral pleura to be expanded too, and this
expands the lungs as well. As the lungs expand, intrapulmonic pressure falls below atmospheric
pressure, and air enters the nose and travels through the respiratory passages to the alveoli. Entry
of air continues until intrapulmonic pressure is equal to atmospheric pressure; this is a normal
inhalation. Of course, inhalation can be continued beyond normal, that is, a deep breath. This
requires a more forceful contraction of the respiratory muscles to further expand the lungs,
permitting the entry of more air.

EXHALATION
Exhalation may also be called expiration and begins when motor impulses from the medulla
decrease and the diaphragm and external intercostal muscles relax. As the chest cavity becomes
smaller, the lungs are compressed, and their elastic connective tissue, which was stretched during
inhalation, recoils. As intrapulmonic pressure rises above atmospheric pressure, air is forced out
of the lungs until the two pressures are again equal. Notice that inhalation is an active process
that requires muscle contraction, but normal exhalation is a passive process, depending to a great
extent on the normal elasticity of healthy lungs.

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PULMONARY VOLUMES
Tidal volume the amount of air involved in one normal inhalation and exhalation. The average
tidal volume is 500 Ml.
Minute respiratory volume (MRV) the amount of air inhaled and exhaled in 1 minute. MRV is
calculated by multiplying tidal volume by the number of respirations per minute (average range:
12 to 20 per minute). If tidal volume is 500 mL and the respiratory rate is 12 breaths per minute,
the MRV is 6000 mL, or 6 liters of air per minute, which is average.
Inspiratory reserve the amount of air, beyond tidal volume, that can be taken in with the
deepest possible inhalation. Normal inspiratory reserve ranges from 2000 to 3000 mL.
Expiratory reserve the amount of air, beyond tidal volume, that can be expelled with the most
forceful exhalation. Normal expiratory reserve ranges from 1000 to 1500 mL.
Vital capacity the sum of tidal volume, inspiratory reserve, and expiratory reserve. Stated
another way, vital capacity is the amount of air involved in the deepest inhalation followed by
the most forceful exhalation. Average range of vital capacity is 3500 to 5000 mL.
Residual air the amount of air that remains in the lungs after the most forceful exhalation; the
average range is 1000 to 1500 mL. Residual air is important to ensure that there is some air in the
lungs at all times, so that exchange of gases is a continuous process, even between breaths.
Some of the volumes just described can be determined with instruments called spirometers,
which measure movement of air.

EXCHANGE OF GASES
There are two sites of exchange of oxygen and carbon dioxide: the lungs and the tissues of the
body. Also known as external and internal respirations respectively.

The air we inhale (the earth’s atmosphere) is approximately 21% oxygen and 0.04% carbon
dioxide.
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Although most (78%) of the atmosphere is nitrogen, this gas is not physiologically available to
us, and we simply exhale it. This exhaled air also contains about 16% oxygen and 4.5% carbon
dioxide, so it is apparent that some oxygen is retained within the body and the carbon dioxide
produced by cells is exhaled.

Within the body, a gas will diffuse from an area of greater concentration to an area of lesser
concentration. The concentration of each gas in a particular site (alveolar air, pulmonary blood,
and so on) is expressed in a value called partial pressure (mmHg).

The air in the alveoli has a high PO2 and a low PCO2. The blood in the pulmonary capillaries,
which has just come from the body, has a low PO2 and a high PCO2. Therefore, in external
respiration, oxygen diffuses from the air in the alveoli to the blood, and carbon dioxide diffuses
from the blood to the air in the alveoli. The blood that returns to the heart now has a high PO2
and a low PCO2 and is pumped by the left ventricle into systemic circulation. The arterial blood
that reaches systemic capillaries has a high PO2 and a low PCO2. The body cells and tissue fluid
have a low PO2 and a high PCO2 because cells continuously use oxygen in cell respiration
(energy production) and produce carbon dioxide in this process. Therefore, in internal
respiration, oxygen diffuses from the blood to tissue fluid (cells), and carbon dioxide diffuses
from tissue fluid to the blood. The blood that enters systemic veins to return to the heart now has
a low PO2 and a high PCO2 and is pumped by the right ventricle to the lungs to participate in
external respiration.

TRANSPORTATION OF GASES IN BLOOD

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Another measure of blood oxygen is the percent of oxygen saturation of hemoglobin (SaO2).
The higher the PO2, the higher the SaO2, and as PO2 decreases, so does SaO2, though not as
rapidly.

Carbon dioxide transport is a little more complicated. Some carbon dioxide is dissolved in the
plasma, and some is carried by hemoglobin (carbaminohemoglobin), but these account for only
about 20% of total CO2 transport. Most carbon dioxide is carried in the plasma in the form of
bicarbonate ions (HCO3–).

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When carbon dioxide enters the blood, most diffuses into red blood cells, which contain the
enzyme carbonic anhydrase. This enzyme (which contains zinc) catalyzes the reaction of
carbon dioxide and water to form carbonic acid:
CO2 + H2O - H2CO3
The carbonic acid then dissociates:
H2CO3 - H+ + HCO3 –
The bicarbonate ions diffuse out of the red blood cells into the plasma, leaving the hydrogen ions
(H+) in the red blood cells. The many H+ ions would tend to make the red blood cells too acidic,
but hemoglobin acts as a buffer to prevent acidosis. When the blood reaches the lungs, an area of
lower PCO2, these reactions are reversed, and CO2 is re-formed and diffuses into the alveoli to
be exhaled.

RESPIRATORY ACIDOSIS AND ALKALOSIS

Respiratory acidosis occurs when the rate or efficiency of respiration decreases, permitting
carbon dioxide to accumulate in body fluids. The excess CO2 results in the formation of more
H+ ions, which decrease the pH. Holding one’s breath can bring about a mild respiratory
acidosis, which will soon stimulate the medulla to initiate breathing again. More serious causes
of respiratory acidosis are pulmonary diseases such as pneumonia and emphysema, or severe
asthma. Each of these impairs gas exchange and allows excess CO2 to remain in body fluids.

Respiratory alkalosis occurs when the rate of respiration increases, and CO2 is very rapidly
exhaled. Less CO2 decreases H+ ion formation, which increases the pH. Breathing faster for a
few minutes can bring about a mild state of respiratory alkalosis. Babies who cry for extended
periods (crying is a noisy exhalation) put themselves in this condition. In general, however,
respiratory alkalosis is not a common occurrence. Severe physical trauma and shock, or certain
states of mental or emotional anxiety, may be accompanied by hyperventilation and also result in
respiratory alkalosis. In addition, traveling to a higher altitude (less oxygen in the atmosphere)
may cause a temporary increase in breathing rate before compensation occurs (increased rate of
RBC production.