Mechanics of Pulmonary

Ventilation

Biruk G.
Bahir Dar University
CMHS
Department of M. Physiology
[email protected]
Objectives
At the end of this system, students are expected to:

Describe functional structure of the respiratory system.

Explain the mechanisms of breathing

Differentiate static and dynamic lung volumes

June 4, 2024 2
 Introduction
What is respiration?
Respiration = the series of exchanges that leads to
the uptake of oxygen by the cells, and the release of
carbon dioxide to the lungs.
• The primary function of the lung is gas exchange, which consists
of movement of O2 into the body and removal of CO2
• The lung also plays a role for
– Defense
– Metabolic function
– Acid base balance

June 4, 2024 3
 Introduction

Exchange of gases in animals

• Unicellular organisms: simple diffusion of O2
and CO2
• Large animals:
– Gas exchange occurs by the lungs

4
 Structures of the Respiratory
System
Functional respiration in man depends on:
1. Conducting zone with air passages;
– Consists of upper and lower respiratory zones
2. Exchanging zone- lungs
3. Pleural sac- lining the lungs
4. Thoracic cage- bones and muscles of breathing
5. Control centres- neural and humoural

5
 Pathway of air
Nasal (or oral) cavity) →
pharynx
→ trachea → primary
bronchi (right & left) →
secondary bronchi → tertiary
bronchi → bronchioles →
terminal bronchioles →
respiratory bronchioles →
alveoli
Airways: - Upper - extends from mouth/nose to vocal cords of larynx
- Lower- trachea, bronchi & bronchioles
6
 Alveoli
• Each human lung is a
spongy mass composed
of 150 million alveoli
which provide about 70
m2 of surface for gas
exchange
• An alveolus is a pouch
about 0.2 to 0.5 mm in
diameter
• Are surrounded by fine
elastic fibers
• Facilitate exchange of
blood gases Fig. Enlargement of the alveoli (air sacs)
at the terminal end of the airways 7
 Alveoli Cont…

• Alveoli have 3 types of cells that make up their walls:

1) Type I pneumocytes
– Major lining cells with simple thin squamous epithelium
– Gas exchange takes place here
2) Type II pneumocytes
– Less in number and constitute thick granulocytes
– Responsible for the production of surfactants
3) Type III pneumocytes
– Large phagocytic macrophage cells found in alveolar
cavities
– Keep alveolar surfaces sterile by removing debris and
microbes
N.B. Clara cells of bronchioles also secret surfactant 8
Respiratory Membrane

9
 Stapes of External Respiration

1. Pulmonary ventilation: gas

exchange between the
atmosphere and lungs
2. Gas exchange between
the lungs and blood (O2
loading and CO2
unloading)
3. Transport of respiratory
gases
4. Gas exchange between
the capillaries and the
tissues (O2 unloading and
CO2 loading)
10
Mechanics of Ventilation

11
 Phases of Breathing
• Has 2 phases-
1. Inspiration
• Air enters the lungs from atmosphere
2. Expiration
• during which air leaves the lungs
• Inspiration requires a muscular effort and
therefore an expenditure of ATP and calories
(active process)

12
 Phases Cont…
• By contrast, normal expiration during quiet
breathing is an energy-saving passive process

• Expiration is achieved by the elasticity of the

lungs and thoracic cage

• In relaxed breathing, inspiration usually lasts

about 2 seconds and expiration about 3 seconds

13
 Respiratory Muscles

• Muscles that cause

lung expansion and
contraction:
1. Diaphragm
2. Intercostal muscles
Internal & external
3. Accessary muscles
4. Some abdominal
muscles

14
 Mechanics of Ventilation
• Air tends to move from a region of higher pressure to a
region of lower pressure

• Pressure gradients established between the alveoli and

atmosphere by cyclic respiratory muscle activity

• 3 different pressure considerations are important in

ventilation:

1. Atmospheric (barometric) pressure

2. Intra-alveolar pressure (-1 - +1mmHg)

3. Intrapleural pressure (usually -4mmHg at rest)

15
 Mechanics Cont…

Fig. Pressures important in ventilation 16

 Transpulmonary Pressure Gradient

• The force acting

across the wall of the
lung to expand it
• Pushes out on the
lungs, distending
them
• Forces the lungs to
expand to fill the
thoracic cavity

Transpulmonary Pressure

17
 Mechanics Cont…
• To make air flow into the lungs, it is necessary
only to lower the intrapulmonary pressure below
the atmospheric pressure

• Raising the intrapulmonary pressure above the

atmospheric pressure makes air flow out again

• These changes are created as skeletal

muscles of the thoracic and abdominal walls
change the volume of the thoracic cavity
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 as the lung volume increases both
alveolar and pleural pressures
decrease
 Changes in:
 Lung volume
 Alveolar pressure
 Pleural pressure, and
 Transpulmonary
pressure during
normal breathing

• Transpulmonary pressure =
 Pressure difference
across the wall of the
lungs

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 Muscles Cont…

The lungs can be

expanded and
contracted in two ways:
1. By downward and
upward movement of
diaphragm
 Lengthen or shorten the
chest cavity
2. By elevation and
depression of the ribs
 Increase and decrease
the anteroposterior
diameter of the chest
cavity

21
 Muscles Cont…

• Normal quiet breathing is accomplished almost entirely

by movement of the diaphragm

• During inspiration, contraction of the diaphragm pulls the

lower surfaces of the lungs downward

• During expiration, the diaphragm simply relaxes, and the

elastic recoil of the lungs, chest wall, and abdominal
structures compresses the lungs and expels the air

• During heavy breathing extra force is achieved mainly

by contraction of the abdominal muscles

22
 Muscles Cont…

• The most important muscles that raise the rib

cage are the external intercostals, but others
that help are:

– Sternocleidomastoid muscles, which lift

upward on the sternum

– Anterior serrati, which lift many of the ribs

– Scaleni, which lift the first two ribs

Fibers of the external intercosal muscle run obliquely forward and downward
from the rib tubercle to the costal cartilage. Fibers of the inner intercostal
muscles run obliquely backward and downward from the sternum to the angle of
the rib. 23
 Muscles Cont…

• The muscles that pull

the rib cage
downward during
expiration are mainly
– Abdominal muscles:-
pull downward on the
lower ribs and push
abdominal contents
upward
– Internal intercostals

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 Ventilation
cycle

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 Types of Breathing - Abdominal and Thoracic
 Movement of chest wall Thoracic breathing.

 Movement of diaphragm displacement of abdominal

viscera and abdominal wall Abdominal breathing

 At rest, abdominal breathing accounts for 70% and

thoracic breathing for 30% of the ventilation.
Ventilation is the mechanical process of air movement in and out of the lungs.
Respiration is the broader metabolic process of gas exchange and energy
production at the cellular level.
Ventilation is an essential component of the overall respiratory process, but
respiration encompasses a wider range of physiological mechanisms beyond just
the movement of air.
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 In pregnancy, the growing uterus and fetus exert pressure on the diaphragm, limiting its ability to fully contract and move
downward during inhalation. In ascites, the accumulation of fluid in the abdominal cavity also compresses the diaphragm,
restricting its movement.
Types of Breathing…
Vital capacity is the maximum volume of air that can be exhaled after a maximum
inhalation.

 During vital capacity measurement, thoracic

breathing accounts for 70% of the air moved.

 In pregnancy and ascites, breathing is mainly thoracic.

 During deep breathing both abdominal and thoracic

breathing are equal in magnitude.

 The work of breathing is higher in thoracic than in

abdominal breathing.

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 Air Flow
 Air flow occurs whenever there is a pressure gradient.

 Bulk flow of air, like blood flow, is directed from areas of

higher pressure to areas of lower pressure
 Air flow in the respiratory tract obeys the same rule as blood
flow:
Flow (F) ~ ΔP /R where, ΔP =change in P
R= resistance
 Changes in intrapulmonary pressure occur as a result of changes
in lung volume.
Pressure of gas is inversely proportional to its volume (Boyle’s Law of
gases).
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P1V1= P2V2 Where, P = pressure and V= volume 28
 Forces Opposing Air flow

1. Resistance (R): flow term pertaining to airways

 Opposition to motion

2. Elastance (E): volume term pertaining to

connective tissue

Ability of tissue to return to its original shape

(recoil or retract) after deformed by some
external force.

E= strain /stretch = Δp/V

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 Airway Resistance (R)
Determines the rate of gas flow (F) for a given pressure
gradient (ΔP)
 According to Ohm’s law, F ~ ΔP /R
There are 3 factors that affect resistance to air flow:
1. Airway radius (r)- main component of airway
resistance
The upper airway offers significant resistance, and
then declines rapidly from the 4th through the 10th
generation.
Poiseuille’s law

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 Airway Resistance…..

2. Lung volume
At low lung volume, the cross-sectional area is reduced
and airway resistance increases.
• For example, patients with pulmonary fibrosis have low
lung compliance and low resting lung volume; high
airway resistance
3. Turbulent gas flow
 Increases airway resistance.
High velocity causes turbulent flow

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 Airway Resistance….
 Maximum R is in medium sized
bronchi then drops as cross
sectional area increases.
NB:
 Air flow resistance through
nose and naso-pharynx = 2/3
of total resistance.

 R of airways distal to 12th

generation of branching =10%
of total resistance.

 Largest fraction of Raw and

greatest pressure gradient
occur between trachea and
bronchi. which are the medium sized bronchi 32
 Airway Resistance…..

 As airway resistance(Raw) rises, breathing movements

become more strenuous.

 Severely constricted or obstructed bronchioles:

Can prevent life-sustaining ventilation

Can occur during acute asthma attacks which stops

ventilation

June 4, 2024 33
 Airway Resistance Cont…

• Physical, neural, and chemical factors affect

airway radii and therefore resistance
 Physical factors
– Transpulmonary pressure
• Distending force on the airways
– Lateral traction
• The elastic connective-tissue fibers that link the
outside of the airways to the surrounding alveolar
tissue
• Reduces airway resistance
• High lung volumes are associated with greater
traction and decreased airway resistance

34
 Airway Resistance…

 Chemical Factors: a variety of neuroendocrine and

paracrine factors can influence airway smooth muscle
and thereby airway resistance
 Hormone epinephrine relaxes airway smooth muscle by
an effect on beta-adrenergic receptors

 Leukotrienes, members of the eicosanoid family

produced in the lungs during inflammation, contract the
muscle.

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 Pulmonary Compliance (CL)
 It describes the distensibility of the lungs and chest wall
 Describes elastic (stretch) properties of lungs and thorax.
• The change in lung volume per unit pressure change in
transpulmonary pressure

– At rest, the average CL for the lungs alone is about 200

ml/cm H2O
• Inversely related to elastance and stiffness
• Is the slope of the pressure–volume curve.
• The greater the lung compliance, the easier it is to expand the
lungs at any given change in transpulmonary pressure
Elastance is the inverse of compliance. It represents the change in transpulmonary
pressure per unit change in lung volume.
Stiffness is a measure of the lungs' resistance to deformation or expansion. It is
36
directly proportional to elastance.
 The diagram shows:
 Changes in lung
volume during
changes in
transpulmonary
pressure

Compliance diagram in a healthy person

June 4, 2024 37
 Lung volume and compliance (CL)
At high lung volumes, CL
decreases because lung
tissue is already stretched
At small lung volumes, CL
decreases because lung
acini are collapsed
At FRC, CL is maximum
when all respiratory
Pressure volume loop
muscles are relaxed
• Hysteresis: difference between inspiratory and expiratory compliance
Functional Residual Capacity (FRC) refers to the volume of air that remains in the lungs at
June 4, 2024 40
the end of a normal expiration, before the next inhalation begins.
 Compliance of the Combined Lung–Chest
Wall System
• Is less than the lungs alone or the
chest wall alone
• Is the change in lung volume per unit
change in transrespiratory pressure
• Is almost one half of the lungs alone,
110 ml/cmH2O
• The collapsing force on the lungs
and expanding force on chest wall
equilibrates at FRC
Fig: Compliance of the Combined
Lung–Chest Wall System
Compliance of chest wall = change in
chest volume per unit pressure change in
transthorasic pressure
42
 Pulmonary Compliance…

Changes in lung
compliance:
• Affect the volume-
pressure curve
• When lung compliance
decreases, the volume-
pressure curve shifts to
the right
• When lung compliance
increases, the volume-
pressure curve shifts to
the left

43
Determinants of Lung Compliance
• There are two major determinants of lung
compliance.
1. Stretchability of the lung tissues (elastic forces
of the lung tissue)
– Determined mainly by elastin and collagen fibers
interwoven among the lung parenchyma
– thickening of the lung tissues decreases lung
compliance
2. Surface tension at the air–water interfaces
within the alveoli

44
 Alveolar Surface Tension
• Tension exerted by the fluid of alveoli
• Resists inspiration and promotes expiration
• Such a force draws the walls of the alveoli inward toward
the lumen

• Surfactants reduce surface tension by disrupting the

hydrogen bonds
• Equalize pressure of small and large alveoli
 keeps alveoli normally distended 46
 Alveolar Surface Tension Cont…

Surface tension is primarily a result of the cohesive forces between water molecules in the alveolar lining.
Surfactant molecules, with their amphipathic (having both hydrophilic and hydrophobic regions) structure, are able to disrupt the
hydrogen bonds between the water molecules in the alveolar lining.The hydrophobic regions of the surfactant molecules orient
towards the air, while the hydrophilic regions interact with the water molecules.This disruption of the hydrogen bonding network
between the water molecules reduces the overall cohesive forces, leading to a decrease in surface tension. 47
 Alveolar Surface Tension Cont…

Fig. Stabilizing effect of surfactant. P is pressure inside the alveoli, T is a surface

tension, and r is the radius of the alveolus 48
 Surface Tension Cont…

• Premature infants often have a deficiency of

pulmonary surfactant and experience great
difficulty breathing

• The resulting respiratory distress syndrome is often

treated by administering artificial surfactant

49
 Elastance
• Refers to the ability of a body to return to its original
shape when a deforming force is removed
– the ability to resist being deformed
• Elastance is the reciprocal of compliance

Fig. Elastic properties of the lungs. Over the physiologic range, volume changes vary
directly with pressure changes. Once the elastic limits are reached, however, little or no50
volume change occurs in response to pressure change.
 Cont…

• Lung collapse is resisted by three forces:

1. Surfactant
2) Distending pressure of alveoli
• Generated by alveolar surface forces
• Predicted from LaPlace’s law:
– P= 2T/r for one surface, where T= tension in wall, r =
radius of alveolus
3) Mechanical interdependence of alveoli
• Alveolus tending to collapse pulls away from
its neighboring alveoli thus increasing stress
on their walls

51
 Work of Breathing
• Under resting conditions, the respiratory
muscles normally perform “work” to cause
inspiration but not to cause expiration
• The work of inspiration can be divided into three
fractions:
1. Compliance work or elastic work – the work
required to expand the lungs against the lung
and chest elastic forces
• 65% of total work

52
 Work of Breathing Cont…
The tissue viscosity of the lung refers to the resistance to
deformation and flow within the various structural components of
the lung tissue itself.

2. Tissue resistance work (viscous resistance

work) - the work required to overcome the viscosity
of the lung and chest wall structures
• 7% of total work
3. Airway resistance work - the work required to
overcome airway resistance to movement of air
into the lungs
• 28% of total work

53
 Measurement of Ventilation

• Pulmonary function can be measured by having

a subject breathe into a device called a
spirometer
• Spirometer recaptures the expired breath and
records such variables as
• The rate and depth of breathing
• Speed of expiration
• Rate of oxygen consumption

54
 Wet Spirometer

Digital spirometers

Fig. Spirometer. During expiration, the air enters the

spirometer from lungs. Inverted drum moves up and
the pen draws a downward curve on the recording
drum. 55
 Measurement Cont…
• Respiratory volumes: Four measurements
the volume of air that moves in and out of the lungs during a single
 Tidal volume (TV) respiratory cycle, without any additional effort to inhale or exhale more
deeply.
 the additional volume of air that can be
Inspiratory reserve volume (IRV) inhaled forcibly after a normal tidal inspiration.
 Expiratory reserve volume (ERV), andthe additional volume of air that can
be exhaled forcibly after a normal
 Residual volume (RV) the volume of air that remainstidalin the
expiration
lungs after a maximal
expiratory effort.
• Respiratory Capacities
• Obtained by adding two or more of the respiratory
FRC : the volume of air
volumes: present in the lungs at the
 Vital capacity = TV + IRV + ERV end of a normal tidal
expiration, when the
 Inspiratory capacity = TV + IRV respiratory muscles are at
rest.
 Functional residual capacity = RV + ERV
 Total lung capacity = RV + VC
the maximum volume of air that the lungs can hold at the end of a maximal inspiratory effort.

RV, FRC and TLC can not measure directly with simple spirometer.
56
Fig. A spirogram showing respiratory excursions during normal breathing and
during maximal inspiration and maximal expiration (for young adult man)57
 Terms Used to Describe Lung Volumes and Capacities

6/4/2024 58
Normal lung volumes and capacities in adult male and female
Volume /Capacity ♂ male ♀ female
TV 700 ml 500 ml
IRV 3.3L 2.2L
ERV 1.0 L 0.8 L
RV 1.5 L 1.3 L
TLC 6.5 L 4.8 L
VC 5.0 L 3.5 L
FRC 2.5 L 2.1 L
IC 4.0 L 2.7L
All pulmonary volumes and capacities are:
• Usually about 20 - 25% less in women than in men
• Greater in large and athletic people than in small and asthenic
people 59
June 4, 2024
 Respiratory Volume and Capacity….

 RV, FRC and TLC can not measure directly with simple
spirometer.
 Techniques used to estimate FRC, TLC etc.
►Closed circuit He dilution technique
Self
►Open circuit N2 wash out technique reading
►Body plethysmography

June 4, 2024 60
 Dynamic measurements of lung
volumes and capacities
 Forced vital capacity (FVC) - volume of air that can be exhaled
forcefully and rapidly after a maximal inspiration
• Normally FVC is equal to VC

 Forced expiratory volume (FEV) is the volume of air, which

can be expired forcefully in a given unit of time (after a
deep inspiration)
• FEV1 is the volume of air that can be expired in the first
second of a forced maximal expiration.
• FEV1 is normally 80% of the forced vital capacity
FEV1/FVC = 0.8
61
 VC is measured with a slow, complete exhalation, while FVC is measured with a forced, rapid, and
complete exhaled .VC reflects the overall volumetric capacity of the lungs, while FVC provides
information about the individual's ability to generate and sustain a forced expiratory effort.VC is
useful in4,the
June 2024assessment of overall lung function, while FVC is particularly valuable in the diagnosis
62
and monitoring of obstructive and restrictive lung diseases.
 Dynamic Measurements…

• In obstructive lung disease, such as asthma, FEV1 is

reduced more than FVC so that FEV1/FVC is decreased
• In restrictive lung disease, such as fibrosis, both FEV1 and
FVC are reduced and FEV1/FVC is either normal or is
increased

Fig. Forced vital capacity (FVC) and FEV1 in normal subjects and in patients with lung disease.
FEV1 = volume expired in first second of forced maximal expiration.
63
 Dynamic Measur…
Maximum Expiratory Flow
• Maximum flow beyond which the flow cannot be
increased any more

Fig. Effect of lung volume on the maximum expiratory air flow, showing
decreasing maximum expiratory air flow as the lung volume becomes smaller.
64
 Dynamic Measur…

 Forced Expiratory Flow25%–75% (FEF25%–75%)

• Average flow rate that occurs during the middle 50%
of FVC measurement
• Reflects condition of medium- to small-sized airways
• The average FEF25%–75% is about 4.5 L/sec and 3.5
L/sec for normal healthy men and women aged 20 to
30 years, respectively
• Decreases with age and in obstructive and restrictive
lung disease
65
 Dynamic Measur…

 Forced Expiratory Flow200–1200 (FEF200–1200)

• Average flow rate that occurs between 200 and 1200
mL of the FVC
• A good index of the integrity of large airway function
(above the bronchioles)
• The average FEF200–1200 is about 8 L/sec, and 5.5
L/sec for normal healthy men and women aged 20
to 30 years, respectively
• Decreases with age and in obstructive lung disease
66
 Dynamic Measur…

 Peak expiratory flow rate (PEFR) = peak flow rate

• The maximum rate at which the air can be expired after
a deep inspiration
– the maximum flow rate that can be achieved during
FVC maneuver

• Average PEFR is about 10 L/sec, and 7.5 L/sec for

normal healthy men and women aged 20 to 30

years, respectively
• Decreases with age and in obstructive lung disease

67
 Cont…

Factors affecting lung volumes and capacities

►Pulmonary resection, tumours, pneumonia,
lung collapse, oedema and fibrosis, etc.
e.g. 1. FRC is caused by hyperinflation,
emphysema, asthma, etc.
2.  TLC is caused by restrictive pulmonary
disease, interstitial fibrosis, etc.
3. RV increases in age groups > 35 years with
impaired exhalation.

June 4, 2024 69
 Cont….

Restrictive Disease:  Obstructive Disease

• Makes it more difficult to • Make it more difficult to
get air in to the lungs. get air out of the lungs.
• Restrict inspiration. • Decrease VC; Increased
• Decreased VC, TLC, RV, TLC, RV, and FRC
FRC • Includes:
• Includes: Emphysema
 Fibrosis Chronic bronchitis
 Sarcoidosis Asthma
 Muscular diseases
 Chest wall deformities

June 4, 2024 70
June 4, 2024 71
 Minute Ventilation and Alveolar Ventilation
Minute Ventilation Alveolar ventilation
• Volume of air moving in Is the room air delivered to the
and out of respiratory tract in respiratory zone per minute.
a given unit of time during VA = (TV - VD)f
quiet breathing
VA - Alveolar ventilation
MV = TV x f or MV = VA +VD
TV - Tidal volume
MV – minute ventilation
VD- Dead space volume
TV – tidal volume
The dead space volume is the portion of the tidal
f – breathing frequency volume (the volume of air inhaled and exhaled
during normal breathing) that does not reach the
alveoli and does not contribute to gas exchange.

Breathing frequency = 12 breaths /min in adults and 14-16 breaths /min

in new bornes The anatomical dead space includes the conducting
airways, such as the trachea, bronchi, and bronchioles,
which do not participate in gas exchange.
June 4, 2024 72
 Dead Space
1. Anatomic dead space
• Conduction air ways are fixed dead space (150 ml)
2. Alveolar dead space
with blood
• Unperfused but ventilated alveoli
• Increased by pulmonary embolism
3. Physiologic dead space

• Sum of anatomic and alveolar dead space

• In diseases this becomes large resulting hypercapnea
and hypoxemia abnormally elevated
carbon dioxide (CO2)
abnormally low level of oxygen in the blood.
levels in the blood.

73
 Dynamic Measur…

Maximal voluntary ventilation (MVV)

• Largest volume of gas that can be moved into and out of

the lungs in 1 min by voluntary effort

• Normal values range from 140 to 180 L/min for healthy

adult males

• Evaluates performance of respiratory muscles strength,

compliance of the lung and thorax, airway resistance,
and neural control mechanisms

• Decreases with age and chronic obstructive pulmonary

disease 74
 Limitations of Spirometry

 The patterns are not disease-specific, i.e. record does

not specify the disease as asthma, emphysema, etc.

 Additional information are needed to make a

diagnosis

 Cannot be done with 100% accuracy because of

limited cooperation of study subject or patient

June 4, 2024 75
 Applications of Spirometry
• Pulmonary function vs. sex, age, body
size, race and physical training
• Detection of pulmonary diseases
• Follow-up study
• Evaluation study of preoperative risks or
postoperative results.
• Assessment of the effect of medical
treatment
• Evaluation of disability
• Epidemiologic survey

76
 END
June 4, 2024 77