Dr. Niranjan Murthy H.

L
Assistant Professor of Physiology
 Learning objectives
• To learn physiological anatomy of the lung
• To learn the muscles involved in
respiration
• To learn various pressure changes during
respiration
• To learn in detail, the mechanics of
respiration
• To appreciate the clinical correlation of
mechanics of respiration
INTRODUCTION

• Components of
respiratory system-
(ii) Respiratory tract
(iii) Alveolo-capillary
membrane
(iv) Blood
(v) Peripheral cells
Components of respiratory tract-
Nose
Pharynx
Larynx
Bronchi
Bronchioles
Alveoli
Alveolo-capillary membrane
• Pulmonary membrane is involuted deep
inside thorax
• Fragile but protected
• Respiratory movements for oxygen intake
and CO2 removal
• More particular for CO2 homeostasis
• Inefficient system
 Development of the lung
• Begins as a groove in ventral wall of gut in
<1 month
• 60gm at birth and 700gm in adult
• Filled with lung fluid in fetus
• Respiratory movements as early as
5months
• Highly resistant circulatory system in fetus
Links in processes involved in gas
exchange-
• Ventilation
• Diffusion
• Matching of ventilation & perfusion
• Pulmonary blood flow
• Blood gas transport
• Transfer of gases between capillaries &
cells
• Utilization of O2 in cells
8) Structure-function relationships of lung
9) Lung mechanics
10) Control of ventilation
11) Metabolic functions of lung
12) Respiration in unusual environments
13) Tests of lung function
 Structure-function relationship
Weibel’s model-
• Swiss anatomist
• 23 generations
• Conducting zone- 16 generations
• Respiratory zone- 7 generations
 Histology
trachea Initial Terminal Resp alveol
bronchi bronchiol bronchiol i
Cartilag Rings20 present e
absent e
absent absen
e no def t
Smooth post
little Little Largest More
muscles absen
t
Lining Columna Columna Cuboidal Cuboidal Simpl
Epitheliu r r e
m
(1) Cilia Present Present Present Present Squa
Absen
mous
t
(2) present Present absent Absent Absen
Glands t
Mucous
membra
ne
Alveoli
• Smallest airway of conducting zone is
terminal bronchiole
• Respiratory zone begins with respiratory
bronchiole
• Alveoli made of collagen and elastin
• Gas exchange barrier is 50-100m2
• Alveoli is held expanded by intrapleural
pressure
MECHANICS OF BREATHING
• It includes forces that support and move
the chest wall & the lung, together with
resistances they overcome and the
resulting flows
Muscles of respiration
 Muscles of respiration cont..
• Muscles of inspiration-
2) Diaphragm
- attached to lower ribs,
sternum & vertebral column
- dome shaped
- moves down on contraction
- supplied by phrenic nerve
- increase vertical dimension of
thorax
- cause ribs to move outward &
upward
2) External intercostals-
- between adjacent ribs
- runs downwards &
forwards
- increase in AP & lateral
diameter
3) Accessory muscles of
inspiration
(i) scalenei- elevate first
two ribs
(ii) sternocleidomastoids-
elevate sternum
• Muscles of
expiration
• Internal
intercostals- run
downwards &
backwards
• Abdominal
muscles
-external oblique
-internal oblique
-rectus
abdominis
-transversus
abdominis
Abdominal muscles
INSPIRATION
• Bucket handle
movement- lower
ribs(7-10) move out
increasing
transverse
diameter
• Pump handle
movement- upper
ribs(2-6) move
forwards and
upwards increasing
AP diameter
EXPIRATION
 Pressure changes during
respiration

• Intrapleural pressure

• Intra-alveolar pressure

• Transpulmonary pressure
 Intrapleural pressure
• Lungs tend to collapse and chest wall tend
to expand
• Pleurae are held together by a thin layer of
fluid
• Intrapleural space is continuously drained
by lymphatics
• -2mm of Hg at the end of expiration to
-6mm of Hg at the end of inspiration
• It is sub-atmospheric throughout
respiratory cycle
inspiration expiration
 Factors affecting intra-pleural
pressure
I. Physiological factors
(i) deep inspiration
(ii) sudden forceful expiratory
movements
(iii) gravity
V. Pathological factors
(i) emphysema
(ii) injury to thoracic wall
 Measurement of intrapleural
pressure
• Direct measurement by inserting a needle
into the pleural space
• Intra-esophageal pressure measurement
 Intra-alveolar pressure
• Reduces from 0 to inspiration expiration
-1mm of Hg during
inspiration and comes +1
back to 0 at the end of
inspiration
0
• Increases to +1mm of
Hg and comes back to
-1
0 at the end of
expiration
 Factors affecting intrapulmonary
pressure
• Valsalva manoeuvre- forced expiration
against closed glottis.
• Muller’s manoeuvre- forced inspiration
against closed glottis
 Transpulmonary pressure

• Distending pressure
• Difference between
intrapleural and intra-
alveolar pressures
 Inspiration
Contraction of diaphragm/ external intercostal muscles

Expansion of thoracic cage

intrapleural pressure decreases

Intrapulmonary pressure decreases

Air flows into the lungs

 Expiration
Relaxation of diaphragm / intercostal muscles

Elastic recoil of thoracic cage

Intrapulmonary pressure increases

Air flows out of the lungs

Elastic properties of the lung
• Elastic behaviour of lung is due to the
presence of
(i) elastin fibers
(ii) collagen fibers
(iii) surfactant
 Pressure-volume relationship
Hooke’s law- length
is directly proportion
to force till elastic
limits
It can be applied to
the lung and chest
wall
 COMPLIANCE
• Volume changes per unit change in
pressure
• Measure of stiffness
• Ltr/cm of H2O
• Hysteresis
• Compliance of lung and compliance of
chest wall
Compliance of lung
 Compliance of lung
 Inspiratory & expiratory compliance curve
Normal value- 200ml/cm of H2O
 Specific compliance- compliance per unit
volume (expressed as a function of FRC)
 Characteristics of compliance diagram is
due to-
(i) elastin fibers- nylon stocking
arrangement
(ii) surface tension
 Surface tension
• Force acting across an imaginary line 1cm
long on liquid surface
• Develops because of cohesive force
between water molecules
• Inner surface of alveoli are lined by a thin
layer of fluid
• Lining fluid tend to collapse and push the
air out
• Laplace law- P=T(1/r1+1/r2)
where P is distending pressure, T is
tension in the vessel wall and r is radius
• In alveoli- P=2T/r
• Small bubbles tend to blow up larger
bubble
• This doesn’t occur in the lung because of-
(i) surfactant
(ii) interdependence of alveoli
T
P1

r1

T
P2

r2
 Surfactant

• Von neergard’s
experiment, 1929
• Pattle, 1955
• Clements, 1962
Clements experiment
 Surfactant
• Secreted by type II alveolar cells
• Dipalmitoyl phosphatidyl
choline+lipids+proteins
• Lipid surface lowering agent
• Hyaline membrane disease/IRDS
• Smoking, 100% O2- reduce surfactant
• Glucorticoid receptors in lung
• Atelectasis following surgery
 Surfactant
• Physiological advantages-
2. Increases compliance
3. Promotes stability of alveoli
4. Keeps alveoli dry
Surface tension of-
(ii) Pure water- 72 dynes/cm
(iii) Alveolar fluid- 50 dynes/cm
(iv) Alveolar fluid with surfactant- 5 to 30
dyne/cm
 Elastic properties of chest wall
• Elastic recoil of
chest wall is
outwards
• Outward recoil
of chest wall
balances
inward recoil of
the lung
 Factors affecting compliance
1. Lung volume-
directly
proportional
2. Respiratory
phase- more
during deflation
3. Surfactant levels
4. Gravity
5. Age
Regional alveolar distension
Clinical significance
 Airway resistance
• Ohm’s law- I=E/R
so, R=E/I
• When applied to airflow- Raw= ΔP/V where
Raw is airway resistance,
ΔP is pressure difference, and
V is volume of airflow
• ΔP= Pmouth-Palveoli
• Poiseuille-Hagen formula: V= ΔPπr4/8ηl
where r is radius of tube,
η is viscosity, and
l is length of the tube
• R=8ηl/πr4
• radius of the tube has critical importance
• Reynolds number- Re=Vdρ/η
• Laminar flow
• Turbulent flow- Re > 2000
• Trachea and bigger
airways upto 7th
generation-80% of Raw

• Small airways
represent silent zone
Factors affecting airway resistance

• Lung volume
• Density and viscosity of the gas
• Tone of the bronchial smooth muscle-
(i) autonomic nerves
(ii) hormones
(iii) drugs
(iv) environmental factors
• Type of flow
• Phase of respiration
 TISSUE RESISTANCE
• Viscous forces of tissue
• 20% of total resistance in young
• Increased in certain diseases
• Tissue resistance + airway resistance=
pulmonary resistance
 Dynamic lung compression
• Subject expire hard
from TLC to RV and
flow rate is plotted
against volume
• Flow rate is

flow
independent of effort
over most part
volume
• Reasons for independence of flow rate-
(i) driving pressure remains constant
(ii) elastic recoil forces reduce with
reducing volume
(iii) resistance of peripheral airways
increase with decreasing volume
 Clinical significance
• In emphysema, there is reduction in the
traction on airways as well as driving
pressure
• In fibrosis, maximal flow rate for given lung
volume is higher
Flow limitation in emphysema

normal emphysema
 Airway closure
• Occurs at low lung volumes in young
adults
• In elderly, it may be as high as FRC
• It occurs at high lung volumes in chronic
lung diseases leading to defective air
exchange
 Work of breathing
• Compliance or elastic work 65%
• Tissue resistance work 7%
• Airway resistance work 28%
• Work done by respiratory muscles
• Work required by lung-thorax system is
twice that of lung alone
• In normal breathing, most energy is used
to expand lungs
• During heavy breathing, most energy is
used to overcome airway resistance
• In restrictive diseases, compliance and
tissue resistance works are increased
Calculation of work done
 Significance of understanding
mechanics of respiration
• Acute R espir ato ry D istr ess
Syndrome of In fa ncy

• Assist ed v entila tion

• Obstr uctive sle ep a pnoea

• COPD & Asthma

• Lung vo lume re ductio n su rg ery