RESPIRATORY SYSTEM

Function:
• Regulation of blood pH - alter blood pH by changing blood CO2 levels.
• Voice production - air movement past the vocal cords makes sound and speech
possible.
• Olfaction - the sensation of smell
• Innate immunity – mucus, cilia

• The upper respiratory tract includes the nose, the pharynx (throat), and the
larynx.
• The lower respiratory tract includes the trachea, the bronchi, and the lungs.

NOSE

• The external nose is the visible structure that forms a prominent feature of the
face.
• Most of the external nose is composed of hyaline cartilage, although the
bridge of the external nose consists of bone (nasal bone)
• The nares - nostrils, the external openings of the nose
 • The nasal cavity
- extends from the nares to the choanae
• choanae - the openings into the pharynx
• The nasal septum - is a partition dividing the nasal cavity into right and left
parts
• Hard palate - forms the floor of the nasal cavity, separating the nasal cavity
from the oral cavity.
• Conchae - three prominent bony ridges on the lateral walls on each side of the
nasal cavity for cleansing and humidification of air
• The nasolacrimal ducts carry tears from the eyes

• inside the nares - stratified squamous epithelium containing coarse hairs.

• The rest of the nasal cavity is lined with pseudostratified columnar epithelial
cells containing cilia and many mucus-producing goblet cells (humidifies
the air because of the mucus)
• The coarse hairs just inside the nares and the mucus produced by the goblet
cells trap large dust particles.
• Cilia sweep the debris-laden mucus toward the pharynx, where it is swallowed,
the acid in stomach will kill the pathogen

PARANASAL SINUSES
• air-filled spaces within bone.
• maxillary, frontal, ethmoidal, and sphenoidal sinuses, each named for the
bones in which they are located.
• The paranasal sinuses open into the nasal cavity and are lined with a mucous
membrane.
• They reduce the weight of the skull, produce mucus, and influence the quality
of the voice by acting as resonating chambers.
• Sinusitis – inflammation of the mucous membranes of the sinuses
SNEEZE REFLEX
• dislodges foreign substances from the nasal cavity.
• Sensory receptors detect the foreign substances, and action potentials are
conducted along the trigeminal nerves to the medulla oblongata, where the
reflex is triggered.
• During the sneeze reflex, the uvula and the soft palate are depressed, so that
rapidly flowing air from the lungs is directed primarily through the nasal
passages.

PHARYNX
• the common passageway for both the respiratory and the digestive systems.
• Air from the nasal cavity and air, food, and water from the mouth pass through
the pharynx.
• Inferiorly, the pharynx leads to the rest of the respiratory system through
the opening into the larynx and to the digestive system through the
esophagus.
• Divided into nasopharynx, oropharynx and laryngopharynx
NASOPHARYNX
• located posterior to the choanae and superior to the soft palate
• The soft palate forms the floor of the nasopharynx and is elevated during
swallowing; this movement closes the nasopharynx and prevents food from
passing from the oral cavity into the nasopharynx
• is lined with pseudostratified ciliated columnar epithelium that is continuous
with the nasal cavity.
• The auditory tubes extend from the middle ears and open into the nasopharynx.
• Contains the pharyngeal tonsil on the posterior part

OROPHARYNX
• extends from the uvula to the epiglottis, and the oral cavity opens into the
oropharynx(food and liquids passes here)
• lined with stratified squamous epithelium (for protection)
• The palatine tonsils are located in the lateral walls near the border of the oral
cavity and the oropharynx.
• The lingual tonsil is located on the surface of the posterior part of the tongue.
LARYNGOPHARYNX
• passes posterior to the larynx and extends from the tip of the epiglottis to the
esophagus.
• Food and drink pass through the laryngopharynx to the esophagus.
• A small amount of air is usually swallowed with the food and drink.
• The laryngopharynx is lined with stratified squamous epithelium and ciliated
columnar epithelium.

LARYNX
• commonly called the voice box
• located in the anterior throat and extends from the base of the tongue to the
trachea
• three main functions: it maintains an open airway, protects the airway during
swallowing, and produces the voice.
• The larynx consists of nine cartilage structures: three unpaired and three
paired
UNPAIRED
• Thyroid cartilage - Adam’s apple and attached superiorly to the hyoid bone.
• Cricoid cartilage – ring-shaped, most inferior cartilage, forms the base of the
larynx on which the other cartilages rest.
• Epiglottis - consists of elastic cartilage
• Its inferior margin is attached to the thyroid cartilage anteriorly, and the superior
part of the epiglottis projects superiorly as a free flap toward the tongue.
• epiglottis protects the airway during swallowing by covering the glottis
PAIRED
• on each side of the posterior part of the larynx
• form an attachment site for the vocal folds.
• Cuneiform – wedge-shaped, top cartilage
• Corniculate - horn-shaped cartilage, middle
• Arytenoid - ladle-shaped cartilage, articulate with the cricoid cartilage
inferiorly, bottom
VOCAL CORDS
• False Vocal Cords - the superior set of ligaments forms the vestibular folds,
come together, they prevent air from leaving the lungs, as when a person holds
his or her breath, also prevent food and liquids from entering the larynx
• True Vocal Cords - the inferior set of ligaments composes the vocal folds, the
primary source of voice production.
• Air moving past the vocal folds causes them to vibrate, producing sound,
muscles control the length and tension of the vocal folds, the force of air moving
past the vocal folds controls the loudness, and the tension of the vocal folds
controls the pitch of the voice
TRACHEA
• windpipe, membranous tube about 10 – 11 cm, 1.4 – 1.6 cm in diameter
pseudostratified columnar epithelium, containing numerous cilia and goblet cell
• connective tissue and smooth muscle, reinforced with 16–20 C-shaped pieces
of hyaline cartilage in anterior and lateral, then elastic cartilage at posterior
• begins immediately inferior to the cricoid cartilage then divides into the right
and left primary bronchi at the level of the fifth thoracic vertebra
• The esophagus lies immediately posterior to the trachea
• Carina – inferior termination of the trachea to primary bronchi, T4 – T5

COUGH REFLEX
• Contraction of the smooth muscle can narrow the diameter of the trachea,
which aids in the cough reflex.
• Sensory receptors detect the foreign substance, and action potentials travel
along the vagus nerves to the medulla oblongata, where the cough reflex is
triggered.
• During coughing, the smooth muscle of the trachea contracts, decreasing the
trachea’s diameter.
• As a result, air moves rapidly through the trachea, which helps expel mucus
and foreign substances.
• Also, the uvula and soft palate are elevated, so that air passes primarily through
the oral cavity.
BRONCHI
• The trachea divides into the left and right main bronchi, or primary bronchi,
each of which connects to a lung.
• The left main bronchus is more horizontal than the right main bronchus
because it is displaced by the heart.
• Foreign objects that enter the trachea usually lodge in the right main
bronchus, because it is wider, shorter, and more vertical than the left main
bronchus and is more in direct line with the trachea.
• lined with pseudostratified ciliated columnar epithelium and are supported
by C-shaped pieces of cartilage

LUNGS
• are the principal organs of respiration.
• Each lung is cone-shaped, with its base resting on the diaphragm and its apex
extending superiorly to a point about 2.5 cm above the.
• The right lung has three lobes: the superior lobe, the middle lobe, and the
inferior lobe and two fissures: Oblique fissure and horizontal fissure
• The left lung has two lobes, called the superior lobe and the inferior lobe and
one fissure only – Oblique fissure
 • Each lobe is divided into bronchopulmonary segments separated from one
another by connective tissue septa, but these separations are not visible as
surface fissures.
• Because major blood vessels and bronchi do not cross the septa, individual
diseased bronchopulmonary segments can be surgically removed, leaving the
rest of the lung relatively intact.
• There are nine bronchopulmonary segments in the left lung and ten in the
right lung

TRACHEOBRONCHIAL TREE
• consists of the main bronchi and many branches
• Each main bronchus divides into lobar bronchi (or secondary bronchi), as
they enter their respective lungs and conduct air to each lung lobe. (two lobar
bronchi in the left lung and three lobar bronchi in the right lung.)
• The lobar bronchi in turn divide into segmental bronchi (or tertiary bronchi)
- lead to the bronchopulmonary segments of the lungs.
• The bronchi continue to branch many times, finally giving rise to bronchioles.
• The bronchioles also subdivide numerous times to give rise to terminal
bronchioles, which then subdivide into respiratory bronchioles.
• Each respiratory bronchiole subdivides to form alveolar ducts, long,
branching ducts with many openings into alveoli
• Alveoli are small air-filled chambers where the air and the blood come into
close contact with each other.
• The alveoli become so numerous that the alveolar duct wall is little more than
a succession of alveoli.
• The alveolar ducts end as two or three alveolar sacs, which are chambers
connected to two or more alveoli.
• There are about 300 million alveoli in the lungs.
TRACHEOBRONCHIAL TREE
• Primary bronchus/main bronchus → lobar bronchus/secondary bronchus
→tertiary bronchus/segmental bronchus →bronchioles → terminal bronchioles
→ respiratory bronchioles → alveolar ducts → alveolar sacs → alveoli
• The smaller the bronchioles become the less they contain elastic tissue but
more smooth muscles

RESPIRATORY MEMBRANE
• where gas exchange between the air and blood takes place, thin
• formed mainly by the walls of the alveoli and the surrounding capillaries.
• The respiratory membrane consists of two layers of simple squamous
epithelium, including secreted fluids, called alveolar fluid, and separating
spaces
• The elastic fibers surrounding the alveoli allow them to expand during
inspiration and recoil during expiration
• a thin layer of alveolar fluid
• the alveolar epithelium, composed of a single layer of cells—simple
squamous epithelium
• the basement membrane of the alveolar epithelium
• a thin interstitial space
• the basement membrane of the capillary endothelium
• the capillary endothelium, also composed of a single layer of cells—simple
squamous epithelium
PLEURAL CAVITIES
• Cavity where the lungs are located
• Each pleural cavity is lined with a serous membrane called the pleura.
• The parietal pleura lines the walls of the thorax, diaphragm, and mediastinum.
• The visceral pleura covers the surface of the lungs.
• The pleural cavity, between the parietal and visceral pleurae, is filled with a
small volume of pleural fluid produced by the pleural membranes. The pleural
fluid performs two functions: It acts as a lubricant and it helps hold the pleural
membranes together.

• Asthma
• is characterized by abnormally increased constriction of the trachea and
bronchi in response to various stimuli, which decrease ventilation efficient .
• Symptoms include rapid and shallow breathing, wheezing, coughing, and
shortness of breath.

• Smoker’s Cough

• Constant, long-term irritation of the trachea by cigarette smoke can cause the
tracheal epithelium from pseudostratified columnar epithelium ciliated to
change to stratified squamous epithelium.
• The stratified squamous epithelium has no cilia and therefore cannot clear the
airway of mucus and debris.
• The accumulations of mucus provide a place for microorganisms to grow,
resulting in respiratory infections.
• Constant irritation and inflammation of the respiratory passages
stimulate the cough reflex
VENTILATION
• Ventilation or breathing is the process of moving air into and out of the lungs.
• regulated by changes in thoracic volume, which produce changes in air
pressure within the lungs.
• The muscles associated with the ribs are responsible for ventilation
• Inspiration, or inhalation, is the movement of air into the lungs
• Expiration, or exhalation, is the movement of air out of the lungs

INHALATION
• The muscles of inspiration include the diaphragm and the muscles that elevate
the ribs and sternum, such as the external intercostals.
• During quiet inspiration, muscles of inspiration contract to increase the
volume of the thoracic cavity.
• Contraction of the diaphragm causes the top of the diaphragm to move
inferiorly – results in the most significant thoracic volume
• Contraction of the external intercostals also elevates the ribs and sternum
to increase thoracic cavity volume
• Changes in volume result in changes in pressure – as the volume in
thoracic cavity increases, the pressure in thoracic cavity decreases
• Air flows from an area of higher pressure to an area of lower pressure -
the greater the pressure difference, the greater the rate of airflow.
• Air flows through the respiratory passages because of pressure differences
between the outside of the body and the alveoli inside the body.
• These pressure differences are produced by changes in thoracic volume.
• During inspiration, the volume of the thoracic cavity increases when the
muscles of inspiration contract.
• The increased thoracic volume decreases the pressure in the alveoli
below atmospheric pressure and the air flows into the alveoli (greater to
lesser pressure)
• At the end of inspiration, the thorax and alveoli stop expanding.
• When the alveolar pressure and atmospheric pressure become equal, airflow
stops.
EXHALATION
• muscles of expiration.
• the internal intercostals and depress the ribs and sternum.
• Expiration occurs when the thoracic cavity volume decreases.
• During quiet expiration, the diaphragm and external intercostals relax.
• The elastic properties of the thorax and lungs cause them to recoil into a
relaxed state
• During expiration, the thoracic cavity volume decreases.
• Consequently, alveolar pressure increases above atmospheric pressure,
and air flows out of the alveoli (greater to lesser pressure)
• At the end of expiration, alveolar pressure, which is the air pressure within the
alveoli, is equal to atmospheric pressure, which is the air pressure outside the
body.
• No air moves into or out of the lungs because alveolar pressure and
atmospheric pressure are equal

LABORED BREATHING
• During labored breathing, there is a much greater increase in thoracic cavity
volume.
• All the inspiratory muscles are active, and they contract more forcefully than
during quiet breathing.
• Also during labored breathing, the internal intercostals and the abdominal
muscles contract forcefully, this decreases thoracic cavity volume more
quickly (and results in greater pressure, hence air won’t go in) and to a greater
degree than during quiet breathing.

LUNG RECOIL
• the tendency for an expanded lung to decrease in size
• due to the elastic properties of its tissues and because the alveolar fluid
has surface tension
• During quiet expiration, thoracic volume and lung volume decrease because of
lung recoil.
• Surface tension exists because the oppositely charged ends of water
molecules are attracted to each other - as the water molecules pull together,
they also pull on the alveolar walls, causing the alveoli to recoil and become
smaller.

SURFACTANT
• a mixture of lipoprotein molecules produced by secretory cells of the alveolar
epithelium.
• Produced by Type II pneumocytes
• The surfactant molecules form a single layer on the surface of the thin fluid layer
lining the alveoli, reducing surface tension.
• Without surfactant, the surface tension causing the alveoli to recoil can be ten
times greater than when surfactant is present.
• Thus, surfactant greatly reduces the tendency of the lungs to collapse.
 PLEURAL PRESSURE
• the pressure in the pleural cavity
• Normally, pleural pressure is lower than alveolar pressure
• This difference in pressures—lower pleural pressure than alveolar
pressure—keeps the alveoli expanded.
• Pleural pressure is lower than alveolar pressure because of a suction effect
caused by fluid removal by the lymphatic system and by lung recoil.

ALVEOLAR VOLUME
• the pressure in the pleural cavity
• Normally, pleural pressure is lower than alveolar pressure
• This difference in pressures—lower pleural pressure than alveolar
pressure—keeps the alveoli expanded.
• Pleural pressure is lower than alveolar pressure because of a suction effect
caused by fluid removal by the lymphatic system and by lung recoil.

ALVEOLI VENTILATION
• Inspiration – pleural pressure decreases because of increased thoracic
volume and increased lung recoil. As pleural pressure decreases, alveolar
volume increases, alveolar pressure decreases, and air flows into the lungs.
• Expiration - pleural pressure increases because of decreased thoracic
volume and decreased lung recoil. As pleural pressure increases, alveolar
volume decreases, alveolar pressure increases, and air flows out of the lungs.

RESPIRATORY VOLUMES
• Tidal volume is the volume of air inspired or expired with each breath. At rest,
quiet breathing results in a tidal volume of about 500 milliliters (mL). –
INCREASES DURING PHYSICAL ACTIVITY
• Inspiratory reserve volume is the amount of air that can be inspired forcefully
beyond the resting tidal volume (about 3000 mL).
• Expiratory reserve volume is the amount of air that can be expired forcefully
beyond the resting tidal volume (about 1100 mL).
• Residual volume is the volume of air still remaining in the respiratory passages
and lungs after maximum expiration (about 1200 mL)\
•
RESPIRATORY CAPACITIES
• Functional residual capacity is the expiratory reserve volume (1100 ml)
plus the residual volume (1200 ml). This is the amount of air remaining in the
lungs at the end of a normal expiration (about 2300 mL at rest).
• Inspiratory capacity is the tidal volume (500 ml) plus the inspiratory reserve
volume. (3000 ml) This is the amount of air a person can inspire maximally
after a normal expiration (about 3500 mL at rest).
• Vital capacity is the sum of the inspiratory reserve volume (3000 mL), the
tidal volume (500 ml), and the expiratory reserve volume. (1100 mL) It is the
maximum volume of air that a person can expel from the respiratory tract after
a maximum inspiration (about 4600 mL).
• Total lung capacity is the sum of the inspiratory(3000 mL) and expiratory
reserves (1100 mL) and the tidal (1100 mL) and residual volumes (about
5800 mL). The total lung capacity is also equal to the vital capacity plus the
residual volume
 FACTORS AFFECTING RESPIRATORY CAPACITIES
• The vital capacity of adult females is usually 20–25% less than that of adult
males and reaches its maximum amount in young adults and gradually
decreases in the elderly.
• Tall people and thin people have a greater vital capacity than short people, and
obese people.
• Well-trained athletes can have a vital capacity 30–40% above that of untrained
people.
• In patients whose respiratory muscles are paralyzed by spinal cord injury or
diseases such as poliomyelitis or muscular dystrophy, the vital capacity can be
reduced to values not consistent with survival (less than 500–1000 mL).

GAS EXCHANGE
• Anatomic Dead Space specifically refers to the volume of air located in the
respiratory tract segments that are responsible for conducting air to the
alveoli and respiratory bronchioles but do not take part in the process of gas
exchange itself.
• Physiological dead space can be thought of as areas of the lung that are well
ventilated but poorly perfused.

FACTORS AFFECTING GAS EXCHANGE

• Respiratory membrane thickness – if thickness is increased, gas exchange
is decreased
• Total surface area - about 70 square meters (m2) in the normal adult,
decrease surface area of lungs, decrease gas exchange
• Partial pressure - is the pressure exerted by a specific gas in a mixture of
gases, such as air (Nitrogen, Oxygen etc)
• gas molecules move randomly from higher concentration to lower concentration
until an equilibrium is achieved
• Oxygen diffuses from the alveoli into the pulmonary capillaries because the
Po2 in the alveoli is greater than that in the pulmonary capillaries (which
contains deoxygenated blood)
• CO2 diffuses from the pulmonary capillaries into the alveoli because the Pco2
is greater in the pulmonary capillaries than in the alveoli (where oxygen is)
• The air entering and leaving the alveoli keeps the Po2 higher in the alveoli
than in the pulmonary capillaries
• Increasing the rate of breathing also makes the Pco2 lower in the alveoli
than it is during normal, quiet breathing.
RHYTHMIC BREATHING
• The normal rate of breathing in adults is between 12 and 20 breaths per minute.
• In children, the rates are higher and may vary from 20 to 40 per minute.
• The rate of breathing is determined by the number of times respiratory muscles
are stimulated.

RESPIRATORY AREAS
• The medullary respiratory center consists of two dorsal respiratory groups and
two ventral respiratory groups
• The dorsal respiratory group is primarily responsible for stimulating
contraction of the diaphragm.
• The ventral respiratory group is primarily responsible for stimulating the
external intercostal, internal intercostal, and abdominal muscles.
• A part of the ventral respiratory group, the pre-Bötzinger complex, is now
known to establish the basic rhythm of breathing.
• The pontine respiratory group is a collection of neurons in the pons .
• It has connections with the medullary respiratory center and appears to play a
role in switching between inspiration and expiration
 Starting inspiration
• The neurons in the medullary respiratory center that promote inspiration are
continuously active.
• The medullary respiratory center constantly receives stimulation from many
sources, such as receptors that monitor blood gas levels and the movements
of muscles and joints.
• stimulation can come from parts of the brain concerned with voluntary
respiratory movements and emotions.

Increasing inspiration
• Once inspiration begins, more and more neurons are activated.
• The result is progressively stronger stimulation of the respiratory muscles,
which lasts for approximately 2 seconds (s).

Stopping inspiration.
• The neurons stimulating the muscles of respiration also stimulate the neurons
in the medullary respiratory center that are responsible for stopping inspiration.
• The neurons responsible for stopping inspiration also receive input from the
pontine respiratory neurons, stretch receptors in the lungs, and probably
other sources.
• When the inputs to these neurons exceed a threshold level, they cause the
neurons stimulating respiratory muscles to be inhibited.
• Relaxation of respiratory muscles results in expiration, which lasts
approximately 3 s.
NERVOUS CONTROL OF BREATHING
• The Hering-Breuer reflex
• Supports rhythmic respiratory movements by limiting the extent of
inspiration – to prevent overstretching
• As the muscles of inspiration contract, the lungs fill with air.
• Sensory receptors that respond to stretch are located in the lungs, and as the
lungs fill with air, the stretch receptors are stimulated.
• Action potentials from the lung stretch receptors are then sent to the medulla
oblongata, where they inhibit the respiratory center neurons and cause
expiration.

• CHEMICAL CONTROL
• the level of CO2 in the blood is the major driving force regulating breathing
• Hypercapnia – increase in carbon dioxide in blood
• Receptors in the medulla oblongata called chemoreceptors are sensitive to
small changes in H+ concentration, blood CO2 combines with water, which
increases H+ concentration.
• Thus, it is the H+ that is detected by the medullary chemoreceptors, hydrogen
is the indirect measurement of increase in Carbon Dioxide
• there are O2-sensitive chemoreceptors in the carotid and aortic bodies
• Hypoxia – decrease oxygen level in the blood
• the aortic and carotid bodies are strongly stimulated by hypoxia
• They send action potentials to the respiratory center and produce an increase
in the rate and depth of breathing, which increases O2 diffusion from the
alveoli into the blood.
• Decrease CO2 levels → blood pH will become more basic (due to loss of
Hydrogen) and increase → decrease respiratory rate (to retain CO2 which is
converted to H and Hydrogen makes the blood acidic)
• Increase CO2 levels → blood PH will become more acidic (due to CO2
retention which convert H+) and decrease → increase respiratory rate (to get
rid of CO2 which will bring the pH less acidic
EFFECT OF EXERCISE
• Breathing increases abruptly - at the onset of exercise, the rate of breathing
immediately increases
• Breathing increases gradually - after the immediate increase in breathing,
breathing continues to increase gradually and then levels off within 4–6 minutes
after the onset of exercise.
• If the exercise intensity becomes high enough to exceed the anaerobic
threshold, skeletal muscles produce lactate through the process of anaerobic
respiration
• In response to training, athletic performance increases because the
cardiovascular and respiratory systems become more efficient at delivering O2
and picking up CO2

EFFECT OF AGING
• Vital capacity, maximum ventilation rates, and gas exchange decrease with
age.
• With age, mucus accumulates within the respiratory passageways – decrease
of cilia movement
• Vital capacity decreases with age because of reduced ability to fill the lungs
(decreased inspiratory reserve volume) and to empty the lungs (decreased
expiratory reserve volume).
• Residual volume increases with age as the alveolar ducts and many of the
larger bronchioles increase in diameter

Prepared by:

Albert Christian C. Borbon, RMT, MD, Member PSAi

NOT FOR DISTRIBUTION AND MASS PRODUCTION, For PERSONAL USE ONLY