RESPIRATORY SYSTEM

Prepared By: Amrutha

M.Pharm, Research Scholar
Smt.S.M Shah Pharmacy College
 Definition:

• Respiratory system is the system through which every

cells in the body receive it oxygen and excretes its carbon
dioxide.
• Lungs inhale and exhale the air through respiratory
passages.
• The process of respiration may be divided into two types.
i. External respiration
ii. Internal respiration
Function of respiration:
• Exchange of gases: They carry oxygen from lungs to the
tissues and bring back carbon dioxide from tissues to the lungs
for expiration through lungs.
• Maintenance of pH: This is carried out by balancing
excretion of carbon dioxide.
• Excretion: Volatile substances like general anaesthetics like
ether, ketone, bodies, ammonia are excreted through lungs.
• Metabolic function: It helps in maintaining the homeostasis
of metabolism in the tissue.
• Temperature regulation: Heat is lost through the expiration
air.
• Water regulation: Water vapour is excreted during
respiration from the lungs.
i. Location. The lungs occupy the entire thoracic cavity except for the
most central area, the mediastinum, which houses the heart.
ii. Apex. The narrow, superior portion of each lung, the apex, is just deep
to the clavicle.
iii. Base. The broad lung area resting on the diaphragm is the base.
iv. Division. Each lung is divided into lobes by fissures; the left lung has
two lobes, and the right lung has three.
v. Pleura. The surface of each lung is covered with a visceral serosa called
the pulmonary, or visceral pleura and the walls of the thoracic cavity are
lined by the parietal pleura.
vi. Pleural fluid. The pleural membranes produce pleural fluid, a slippery
serous secretion which allows the lungs to glide easily over the thorax
wall during breathing movements and causes the two pleural layers to
cling together
vii. Bronchioles. The smallest of the conducting passageways
are the bronchioles.
viii. Alveoli. The terminal bronchioles lead to the respiratory
zone structures, even smaller conduits that eventually
terminate in alveoli, or air sacs.
ix. Respiratory zone. The respiratory zone, which includes
the respiratory bronchioles, alveolar ducts, alveolar sacs, and
alveoli, is the only site of gas exchange.
x. Conducting zone structures. All other respiratory
passages are conducting zone structures that serve as conduits
to and from the respiratory zone.
 Mechanics and mechanism of
respiration
Entire physiology of respiration involves following steps:
1.Breathing or pulmonary ventilation
2.External respiration /Pulmonary gas exchange
3.Transport of O2 to tissue
4.Internal respiration
5.Transport of CO2 from tissue.
I. Breathing/Pulmonary ventilation:
• It is the exchange of gases between the outside air and the alveoli of
the lungs.
• Breathing supplies oxygen to the alveoli, and eliminates carbon
dioxide.
• The main muscles involved in breathing are
• the intercostal muscles and
• the diaphragm
i. Intercostal muscles: There are 11 pairs of intercostal muscles that occupy the spaces
between 12 pairs of ribs.
• They are arranged in two layers, the external and internal intercostal muscles.
• The first rib is fixed. So , when the intercostal muscles contract, they pull other ribs
towards the first rib.
• Owing to the shape and size of ribs, they move outwards when they are pulled upwards,
thereby enlarging the thoracic cavity.
ii. Diaphragm: It is a dome shaped muscular structure that separates the thoracic and
abdominal cavities.
• The intercostal muscles and diaphragm contract simultaneously, enlarging the thoracic
cavity in all directions.
• Breathing depends upon changes in pressure and volume in the thoracic cavity.
• Since air flows from an area of high pressure to an area of low pressure, changing the
pressure inside the lungs determines the direction of airflow.
Breathing involves two process: I Inspiration
ii. Expiration
Inspiration
• It takes place when the volume of thoracic cavity is increased and
the air pressure is decreased.
• Simultaneous contraction of the external intercostal muscles and
the diaphragm expands the thorax.
• As the diaphragm + external intercostals contracts (moves
downward) lung volume increases
• It involves following events:
• First of all, external intercoastal muscle contracts and internal
intercoastal muscles relaxes.
• Due to contraction of external intercoastal muscles, ribs is pulled
upward, resulting in increase in thoracic cavity size
• The thoracic cavity further enlarges due to contraction of
diaphragm, lowering the diaphragm and increases the size of
thoracic cavity.
• With increase in size of thorax, lungs expand simultaneously. As
lungs expands, the air pressure is reduced inside, so equalize the
pressure, atmospheric air rushes inside the lungs.
Expiration
• It takes place when the size of thoracic cavity
is reduced and air pressure is increased.

It involves following events:

• The internal intercoastal muscle contracts and
external intercoastal muscles relaxes.
• Due to contraction of internal intercoastal
muscle, ribs are pulled inward, resulting in
decrease in size of thoracic cavity
• Furthermore the diaphragm is pushed upward
due to its relaxation
• With the decrease in size of thoracic cavity,
lungs is compressed .
• As lungs is compressed, pressure increases, so
the air is forced outwards.
 II. External respiration
/Pulmonary gas exchange:
• It is the diffusion of oxygen between alveoli and the
blood in pulmonary capillaries and diffusion of CO2 in
opposite direction.
• The medulla oblongata in the brain sends impulses to
the central nervous system. The central nervous system
relays it to the diaphragm, which pulls away from the
lungs, allowing the lungs to expand.
• The alveolar wall is one-cell thick and is surrounded by
many tiny capillaries through which beta haemoglobin
containing carbon dioxide enters the lungs. This carbon
dioxide is exchanged with oxygen in the lungs by
diffusion. The oxygenated haemoglobin is called alpha
haemoglobin.
• Internal respiration
• Internal respiration or systemic gas exchange is the
process by which the gases in the air that have
already been drawn into the lungs by external
respiration are exchanged with gases in the blood or
tissues to remove carbon dioxide from the blood and
replace it with oxygen.
• Thus, it is the exchange of gases by diffusion
between blood capillaries and cells of the tissues
• Internal respiration is the gas exchange down the
concentration gradient.
• The oxygen-containing alpha-haemoglobin cells
diffuse through the veins and capillaries of organs,
muscle cells and skin cells.
• The body cells then take in oxygen molecules and
the alpha cells turn into beta cells, which again
return back to the lungs to continue the cycle
 Regulation of respiration
• Control of respiration is normally involuntary. Voluntary control is
exerted during activities such as speaking and singing but is
overridden if blood CO2 rises(hypercapnia).
• Respiratory center is in the brain stem.
• Hence specific areas of brain stimulate the contraction of the
diaphragm and intercostal muscles.
• It causes rhythmic breathing pattern of inspiration and expiration.
• Respiration is regulated by:
i. Respiratory centre
ii. Chemoreceptors
The respiratory centres include the following:
• Medullary Inspiratory centre
• Pons
Medullary Inspiratory centre
• Ventral respiratory group/Expiratory centre- regulate exhalation. The
stimulation of this centre causes contraction of expiratory muscles and
expiration.
• Dorsal respiratory group/ Inspiratory centre- regulates inspiration.
Stimulation of this centre causes contraction of inspiratory muscles and
prolonged inspiration
Pons
i. Pneumotaxic centre- it sends inhibitory impulses to the inspiratory centre.
• It controls both the rate and pattern of breathing.
• The pneumotaxic centre can send neural signals to reduce the duration of
inspiration, thereby affecting the rate of respiration.
• The actions of this centre prevent the lungs from over-inflating.
• It also regulates the amount of air that the body takes in, in a single breath.
• If this centre is absent, it increases the depth of breathing and decreases the
respiratory rate. It performs the opposite function of the Apneustic centre
ii. Apneustic centre- It sends stimulatory impulses to the inspiratory area to
accelerate the depth of inspiration.
It is also responsible to decrease the duration of inspiration.
 Chemoreceptors
These are receptors that respond to changes in the partial pressure of
oxygen and carbon dioxide in the blood and cerebrospinal fluid.
They are located
i. Centrally
ii. Peripherally
Central Chemoreceptors
They are located on the surface of medulla oblongata and are bathed in CSF.
When arterial PCO2 rises( hypercapnia) even slightly, the central
chemoreceptors respond by stimulating the respiratory centre- increasing
ventilation of the lungs and reducing arterial PCO2
Peripheral Chemoreceptors
These are situated in the arch of aorta and in the carotid bodies.
They are more sensitive to small rise in arterial PCO 2 than to small
decrease in arterial PO2 levels.
Nerve impulses generated are conveyed by glossopharyngeal and
vagus nerves to the medulla and stimulate the respiratory centre.
The rate and depth of breathing are then increased.
An increase in blood acidity(decreased pH or raised [H +]) stimulates
peripheral chemoreceptors, resulting in increased ventilation ,
increased CO2 excretion and increased blood pH.
• Other factors that influence respiration:
i. Speech, singing
ii. Emotional displays eg: crying, laughing, fear
iii. Drugs , eg: sedatives , alcohols
iv. Sleep
v. Temperature: In fever, respiration is increased due to increased
metabolic rate , while in hypothermia it is depressed.
 Lung volume and capacity
• lung volume is the measure of the volume of gas/air moves in and out
during normal respiration and forceful respiration.
• Four lung volumes are:
i. Tidal volume.
ii. Inspiratory reserve volume.
iii. Expiratory reserve volume.
iv. Residual volume.

Tidal volume (TV): The volume of gas inhaled or exhaled during normal quiet
breathing is called the tidal volume.
500 ml
 Inspiratory Reserve Volume (IRV)
Inspiratory reserve volume is the maximum volume of air that can be inhaled during a
forceful inspiration ,Over and above the tidal volume
2000 -3300 ml
Expiratory Reserve Volume (ERV)
Expiratory Reserve Volume is defined as the amount of air that can be expelled during
forceful expiration.
1000 ml
Residual Volume (RV)

Even after forceful expiration, there is some volume of air still left inside the lung. That
is, the lung doesn’t get fully emptied even after forceful expiration.
“The amount of air that remains in the lungs after maximum exhalation is the residual
volume.”
1000 mL
 Lung capacities
• The four lung capacities are:
i. Inspiratory capacity.
ii. Vital capacity.
iii. Functional residual capacity.
iv. Total lung capacity.

i. Inspiratory capacity (IC)

• Inspiratory capacity is the volume of air that can be inspired from the end of the
tidal expiration or the volume of air that can be inspired forcibly after a normal
inspiration.
• So, it is the sum of Tidal Volume (TV) + Inspiratory Reserve Volume (IRV).
3000 ml
• Vital capacity (VC) is the maximum amount of air a person can inhale after a
maximum exhalation.
4000 mL
• Functional Residual Capacity(FRC): It is the volume of air that remains after
the tidal expiration. So, it is the combination of RV + ERV.
2500 mL
• Total Lung Capacity (TLC): It is the total volume of air that remains in the
lungs/thorax after a maximum inspiration.
• It is the sum of IRV + TV + ERV.
5500 mL
 Trasnsport of Respiratory Gases
Transport of Oxygen during Respiration
• During respiration, about 97% of oxygen is transported by Red Blood Cells in the blood
• and the remaining 3% gets dissolved in the plasma.
• Haemoglobin is a pigment present in the RBCs that gives blood its red colour.
• Oxygen binds with haemoglobin to form oxyhaemoglobin, which depends on the
partial pressures of oxygen, carbon dioxide, H+ concentration and the temperature.
• One haemoglobin molecule can carry up to 4 molecules of oxygen.
• The partial pressure of oxygen, H+ concentration and low temperature are the ideal
conditions for the formation of oxyhaemoglobin.
• These conditions are met in the alveoli.
• But in the tissues, opposite conditions exist and so oxygen is dissociated from the
oxyhaemoglobin.
• Every 100mL of blood that gets oxygenated in the lung surface can deliver 5 mL of
oxygen to the tissues on an average.
 Transport of Carbon Dioxide during Respiration
• Around 20-25% of carbon dioxide is carried by haemoglobin as carbamino-
haemoglobin.
• 7% is in a dissolved state in the plasma and the remaining is carried as bicarbonate.
• Again, the binding of carbon dioxide with haemoglobin is related to the partial
pressure of carbon dioxide, and the partial pressure of oxygen.
• As mentioned earlier, the partial pressure of carbon dioxide is high in the tissues
and this is where more binding of carbon dioxide occurs.
• In the alveoli where the partial pressure of oxygen is high, carbon dioxide gets
dissociated from carbamino-haemoglobin.
• The enzyme carbonic anhydrase present in a high concentration in RBCs, and in
small quantities in the plasma, facilitates this reaction in both the directions.
• So, the bicarbonate formed at the tissues releases carbon dioxide at the alveoli.
• Every 100 mL of deoxygenated blood can deliver 4 mL of carbon dioxide to the
alveoli.
 ARTIFICIAL RESPIRATION AND RESUSCITATION METHODS
Artificial respiration is a way to initialize or restore a person’s breath by using a
mechanical method or manual method.
It is a way to push air in the lungs when a person’s natural breathing has
stopped or altered.
The breathing techniques help to keep a person alive and restart breathing.
There is alternate inflation and deflation of lungs and thus it stimulates the
respiratory centre which maintains respiration reflex through its nerves.
In artificial respiration , expiration is actively aided, where as inspiration is
passive. The reverse happens in normal respiration.
Methods of giving artificial respiration:
i. Manual Methods
ii. Instrumental methods
i. Manual Methods
a) Schafer’s method
b) Sylvester’s method
c) Eve’s rocking method
d) Holger-Nielson’s method
e) Mouth to mouth method
ii. Instrumental methods/ mechanical methods
 Schafer’s method
• Schaffer’s method is an outdated method of artificial respiration.
• In this method, the patient is made to sleep facing down, i.e., in prone
position.
• The patient is then asked to bend hands at the elbow and place it next to
the lower area of the chest. The head is kept in an outward position so
that the patient can breathe through mouth and nose.
• The therapist kneels down near the patient and slowly presses on the
loins of the patient by putting his body weight. As a result, pressure is
created in the abdomen which pushes up the diaphragm and air is
thrown out from the lungs. The process in which air is drawn from the
lungs is also known as exhalation or expiration.
• After this, the therapist releases pressure and gets back to his initial
position.
• This also releases the pressure on the abdomen, the diaphragm goes
down and air is inhaled.
• This process is termed as inhalation or inspiration.
• The steps are repeated for 12 times in a minute or as per the usual
respiration rate. In Schaffer’s method exhalation is for three seconds
and inhalation continues for two seconds (approximately).
Advantages
• Schaffer’s method is non-tiring procedure, which can be repeated easily and
the patient can take this therapy as long as possible.
• As the patient is laid on abdomen, mucus or saliva cannot block his airways.
• Schaffer’s method allows treatment of back and thorax in case of injuries.
• Due to prone position, obstructing material (mucus or saliva) present in the
airway directly comes out. This clears the air passage and allows the patient to
inhale and exhale properly.
Disadvantages
• This method cannot be used for the patients having abdominal injury.
• Passive inhalation – In this method, the process of inhalation occurs passively
whereas exhalation occurs actively. But both of the processes are not
physiological.
 Sylvester’s method
 In this method, the patient is laid on a surface facing upwards.
 The therapist stands near the head of the patient in order to hold the wrist.
 The first step is to pull the arms in upward direction, or towards the head. As a result, the
process of inhalation takes place.
 After that, the therapist puts a heavy pressure on the patient’s chest by folding hands over
the chest.
 This action compresses the chest wall and results in the process of exhalation.
 In Sylvester’s method of artificial breathing, inhalation should take place for three seconds
and exhalation should take place for two seconds.
Advantages
• This method is helpful in cases of accidents or in operation theatre.
• Sylvester’s method of artificial breathing offers excellent ventilation.
• Both the processes, inspiration and expiration, are active in this method.
Disadvantages
• This method cannot be used in drowning cases as water cannot be drawn out
of lungs because of supine position.
• Sylvester’s method cannot be used for patients suffering from thorax or rib
fracture.
 Holger Nielsen Method
• This method is also called the arm liftback pressure method.
• In Holger-Nielson's method of artificial respiration the patient is laid on stomach facing downwards.
• The head rests on the hands.
• The therapist places his hands on both sides of the back.
• Spreading the fingers apart the therapist puts pressure on the back of patient. This pressure assists in
exhalation.
• For inhalation the patient’s arms are moved forward. The entire process is repeated roughly around ten to
twelve times in a minute.
 Mouth to Mouth Respiration Method
• This method is one of the finest methods of artificial respiration.
• In mouth-to-mouth respiration, the therapist kneels near the patient’s head.
• A pillow is given to place below the shoulder of the patient, it helps in extension
of the neck. This opens up respiratory passage.
• The therapist closes nostrils of the patient with his left hand.
• The operator then breathes deep, put his mouth to patient’s mouth and blows
deep into his mouth, it is to be continued till the chest seems to rise.This is
forced inspiration.
• Then he removes his mouth away and allows the patient to have passive
expiration.
• Close the patient’s mouth by upward thrust of the jaw. Thus allow the patient’s
expiration only through nose , closing his mouth.
• Repeat this 10-12 times per min in adult.
In case of an infant:
 Child under 1 year of age, the operator can put his mouth on infant’s
nose and blow air.
 Operator of course, takes his own breath i.e inspiration from outside.
 Puff in expiratory air like this about 25-30 times a minute. Continue for
many minutes and watch results.
 If no good result comes, start at once cardiac massage.
 External cardiac massage is done by pressing very hard on the sternum
40-50 times a minute.
 This may help the heart to continue beat.
II. Mechanical Methods of Artificial Respiration

• This method is also known as the instrumental method which uses machines
to help patients to breathe.
• A ventilator is a machine that is used to push air into the lungs of the patient
having difficulty in breathing.
• Ventilators also help in maintaining oxygen level in bloodstream. But it is
essential to have access to the lungs of the patient.
• To gain access to the lungs a tube is inserted into the nose or mouth of the
patient.
• Sometimes, doctors use tracheostomy in which a tear is made near the opening
of the windpipe to insert a tube.
• Cardiopulmonary resuscitation (CPR)
It is an emergency procedure consisting of chest compressions often
combined with artificial ventilation in an effort to manually preserve
intact brain function until further measures are taken to restore
spontaneous blood circulation and breathing in a person who is in
cardiac arrest.