Respiratory System

Dr. Mohamad Nidal Khabaz

Assistant Professor of Pathology,
Pathology Department, Faculty of Medicine,
Jordan University of Science and Technology
Components of the Respiratory
System
Ventilation
The movement of air between the atmosphere
and the respiratory portion of the lungs
Perfusion
The flow of blood through the lungs
Diffusion
The transfer of gases between the air-filled
spaces in the lungs and the blood
Structural Organization of the
Respiratory System
Consists of the air passages and the lungs
Divided into two parts by function:
Conducting airways: through which air
moves as it passes between the atmosphere
and the lungs
Respiratory tissues of the lungs: where gas
exchange takes place

Structures of the Conducting
Airways
Nasal passages
Mouth and pharynx
Larynx
Trachea
Bronchi
Bronchioles
Respiratory Tree
Larynx
Trachea supplies both lungs
Primary bronchi supplies each lung
Secondary bronchi supplies each lobe
Tertiary bronchi supplies each bronchopulmonary
segment (lobule)
Bronchioles
Terminal bronchioles
Respiratory bronchiole (capable of gas exchange)
Alveolar ducts (capable of gas exchange)
Alveolar sacs with alveoli (capable of gas exchange)
Ventilation
Depends on the conducting airways:
Nasopharynx and oropharynx
Larynx
Tracheobronchial tree
Function:
Moves air in and out of the lung but does not
participate in gas exchange
Pulmonary ventilation
Inspiration is due to muscle contraction which
increases thoracic cage size.
The compliant lungs inflate due to the negative
pressure created in the pleural cavity
Expiration is due to the elasticity of the thoracic
soft tissue and the lungs themselves.
Structures of the Lungs
Soft, spongy, cone-shaped organs located side
by side in the chest cavity
Separated from each other by the mediastinum and
its contents
divided into lobes (3 in the right lung, 2 in the left).
Apex: upper part of the lung; lies against the top
of the thoracic cavity
Base: lower part of the lung; lies against the
diaphragm
Composition of the Alveolar
Structures
Type I alveolar cells
Flat squamous epithelial cells across which
gas exchange takes place
Type II alveolar cells
Produce surfactant, a lipoprotein substance
that decreases the surface tension in the
alveoli and allows for greater ease of lung
inflation
Lung Circulation
Pulmonary circulation
Arises from the pulmonary artery
Provides for the gas exchange function of the
lungs
Bronchial circulation
Arises from the thoracic aorta
Supplies the lungs and other lung structures
with oxygen
Distributes blood to the conducting airways
Warms and humidifies incoming air
Ventilation and Gas Exchange
Ventilation
The movement of gases into and out of the
lungs
Inspiration
Air is drawn into the lungs as the respiratory
muscles expand the chest cavity
Expiration
Air moves out of the lungs as the chest muscles
recoil and the chest cavity becomes smaller
Respiratory Pressures
Intrapulmonary pressure or alveolar pressure
Pressure inside the airways and alveoli of the
lungs
Intrapleural pressure
Pressure in the pleural cavity
Intrathoracic pressure
Pressure in the thoracic cavity
Lung Compliance
Lung compliance
(C) = (V)/(P)
The change in lung volume (V) that can be
accomplished with a given change in
respiratory pressure (P)
Airway Resistance
Airway Resistance
The volume of air that moves into and out of
the air exchange portion of the lungs
Directly related to the pressure difference
between the lungs and the atmosphere
Inversely related to the resistance the air
encounters as it moves through the airways

Lung Volumes
Tidal volume (TV)
Amount of air that moves into and out of the
lungs during a normal breath
Inspiratory reserve volume (IRV)
The maximum amount of air that can be
inspired in excess of the normal TV
Expiratory reserve volume (ERV)
Maximum amount of air that can be exhaled in
excess of the normal TV
Residual volume
The air that remains in the lungs after forced
respiration
Lung Capacities
Vital capacity: equals the IRV plus the TV plus the ERV
The amount of air that can be exhaled from the point of
maximal inspiration
Inspiratory capacity: equals the TV plus the IRV
The amount of air a person can breathe in beginning at
the normal expiratory level and distending the lungs to
the maximal amount
Functional residual capacity: sum of the RV and ERV
The volume of air that remains in the lungs at the end of
normal expiration
Total lung capacity: the sum of all the volumes in the
lungs
Pulmonary Function Studies
Maximum voluntary ventilation
The volume of air a person can move into and
out of the lungs during maximum effort lasting
for 12 to 15 seconds
Forced expiratory vital capacity (FVC)
Involves full inspiration to total lung capacity
followed by forceful maximal expiration.
Forced expiratory volume (FEV)
The expiratory volume achieved in a given time
period
Forced inspiratory vital flow (FIF)
The respiratory response during rapid maximal
inspiration
Processes of Pulmonary Gas
Exchange
Ventilation
The flow of gases into and out of the alveoli
of the lungs
Perfusion
The flow of blood in the adjacent pulmonary
capillaries
Diffusion
Transfer of gases between the alveoli and the
pulmonary capillaries
Types of Air Movement in the lung
Bulk flow
Occurs in the conducting airways
Controlled by pressure differences between the
mouth and that of airways in the lung
Diffusion
The movement of gases in the alveoli and across
the alveolar capillary membrane
Types of Dead Space
Anatomic dead space
That contained in the conducting airways
Alveolar dead space
That contained in the respiratory portion of
the lung
Physiologic dead space
The anatomic dead space plus alveolar dead
space
Types of Shunts
Anatomic shunt
Blood moves from the venous to the arterial side
of the circulation without moving through the
lungs
Physiologic shunt
Mismatching of ventilation and perfusion with
the lung
Results in insufficient ventilation to provide the
oxygen needed to oxygenate the blood flowing
through the alveolar capillaries
Factors Affecting Alveolar-Capillary
Gas Exchange
Surface area available for diffusion
Thickness of the alveolar-capacity membrane
Partial pressure of alveolar gases
Solubility and molecular weight of the gas
Matching Ventilation and
Perfusion
Required for exchange of gases between the air in
the alveoli and the blood in pulmonary capillaries
Two factors interfere with the process:
Dead air space and shunt
The blood oxygen level reflects the mixing of
blood from alveolar dead space and physiologic
shunting areas as it moves into the pulmonary
veins
Mechanisms of Carbon Dioxide
Transport
Dissolved in carbon dioxide (10%)
Attached to hemoglobin (30%)
Bicarbonate (60%)
Acid-base balance is influenced by the amount of
dissolved carbon dioxide and the bicarbonate
level in the blood

Control of Breathing
Automatic regulation of ventilation
Controlled by input from two types of sensors or
receptors:
Chemoreceptors: monitor blood levels of oxygen,
carbon dioxide and adjust ventilation to meet the
changing metabolic needs of the body
Lung receptors: monitor breathing patterns and
lung function
Voluntary regulation of ventilation
Integrates breathing with voluntary acts such as
speaking, blowing, and singing
These acts, initiated by the motor and premotor cortex,
cause a temporary suspension of automatic breathing
Mechanisms Involved in Dyspnea
Stimulation of lung receptors
Increased sensitivity to changes in ventilation
perceived through central nervous system
mechanisms
Reduced ventilatory capacity or breathing
reserve
Stimulation of neural receptors in the muscle
fibers of the intercostals and diaphragm and of
receptors in the skeletal joints
Respiratory Tract Infections
Areas Involved in Respiratory
Tract Infections
Upper respiratory tract
Nose, oropharynx, and larynx
Lower respiratory tract
Lower airways and lungs
Upper and lower airways
Common Respiratory Infections
Common cold
Influenza
Pneumonia
Tuberculosis
Fungal infections of the lung
Factors Affecting the Signs and
Symptoms of Respiratory Tract
Infections
The function of the structure involved
The severity of the infectious process
The persons age and general health status

Rhinitis and Sinusitis
Rhinitis
Inflammation of the nasal mucosa
Sinusitis
Inflammation of the paranasal sinuses
Types of Sinuses
Paranasal sinuses
Air cells connected by narrow openings or ostia with
the superior, middle, and inferior nasal turbinates of
the nasal cavity
Maxillary sinus
Inferior to the bony orbit and superior to the hard
palate
Its opening is located superiorly and medially in the
sinus, a location that impedes drainage
Frontal sinuses
Open into the middle meatus of the nasal cavity
Types of Sinuses (cont.)
Sphenoid sinus
Just anterior to the pituitary fossa behind the
posterior ethmoid sinuses
Its paired openings drain into the sphenoethmoidal
recess at the top of the nasal cavity
Ethmoid sinuses
Comprise 3 to 15 air cells on each side, with each
maintaining a separate path to the nasal chamber
Classifications of Rhinosinusitis
Acute rhinosinusitis
May be of viral, bacterial, or mixed viral-bacterial
origin
May last from 5 to 7 days up to 4 weeks
Subacute rhinosinusitis
Lasts from 4 weeks to less than 12 weeks
Chronic rhinosinusitis
Lasts beyond 12 weeks
Allergic Rhinosinusitis
Occurrence
Occurs in conjunction with allergic rhinitis
Mucosal changes are the same as allergic rhinitis
Symptoms
Nasal stuffiness, itching and burning of the nose,
frequent bouts of sneezing, recurrent frontal
headache, watery nasal discharge
Treatment
Oral antihistamines, nasal decongestants, and
intranasal cromolyn
Types of Influenza Viruses
Type A
Most common type
Can infect multiple species
Causes the most severe disease
Further divided into subtypes based on two surface
antigens: hemagglutinin (H) and neuraminidase (N)
Type B
Has not been categorized into subtypes
Antiviral Drugs
Amantadine
Rimantadine
Zanamivir
Oseltamivir
Types of Influenza Vaccinations
Trivalent inactivated influenza vaccine (TIIV)
Developed in the 1940s
Administered by injection
Live, attenuated influenza vaccine (LAIV)
Approved for use in 2003
Administered intranasally

Pneumonia
Definition
Respiratory disorders involving inflammation of the
lung structures (alveoli and bronchioles)
Causes
Infectious agents: such as bacteria and viruses
Noninfectious agents: such as gastric secretions
aspirated into the lungs
Factors Facilitating Development of Pneumonia
An exceedingly virulent organism
A large inoculum
Impaired host defenses
Tuberculosis
Infectious disease caused by the bacterium
Mycobacterium tuberculosis
Symptoms include fever, night sweats, weight
loss, a racking cough, and splitting headache
Treatment entails a 12-month course of
antibiotics
Positive Tuberculin Skin Test
Results from a cell-mediated immune response
Implies that a person has been infected with M.
tuberculosis and has mounted a cell-mediated
immune response
Does not mean the person has active tuberculosis
Disorders of Ventilation
and Gas Exchange
Disorders of Lung Inflation
Causes
Conditions that produce lung compression or
lung collapse
Compression of the lung by an accumulation of fluid
in the intrapleural space
Complete collapse of an entire lung as in
pneumothorax
Collapse of a segment of the lung as in atelectasis
Pleural Effusion
Definition
An abnormal collection of fluid in the pleural cavity
Types of fluid
Transudate
Exudate
Purulent drainage (empyema)
Chyle
Blood
Pleural Effusion
Diagnosis and Treatment
Diagnosis
Chest radiographs, Chest ultrasound
Computed tomography (CT)
Treatment: Directed at the cause of the
disorder
Thoracentesis
Injection of a sclerosing agent into the pleural cavity
Open surgical drainage
Pneumothoraxes: Types
Spontaneous pneumothorax
Occurs when an air-filled blister on the lung surface
ruptures
Traumatic pneumothorax
Caused by penetrating or non-penetrating injuries
Tension pneumothorax
Occurs when the intrapleural pressure exceeds
atmospheric pressure
Atelectasis
Definition
The incomplete expansion of a lung or portion of a
lung
Causes
Airway obstruction
Lung compression such as occurs in pneumothorax or
pleural effusion
Increased recoil of the lung due to loss of pulmonary
surfactant
Types of Atelectasis
Primary: Present at birth
Secondary: Develops in the neonatal period or later in
life
Chronic Obstructive Pulmonary
Diseases (COPD)
COPD are Asthma, Chronic bronchitis, Emphysema,
Cystic fibrosis, Bronchiectasis.
Patients have a history of:
Smoking
Dyspnea, where labored breathing occurs and gets
progressively worse
Coughing and frequent pulmonary infections
COPD victims develop respiratory failure accompanied by
hypoxemia, carbon dioxide retention, and respiratory
acidosis
Asthma
Chronic inflammatory disorder characterized by
hyperactive airways leading to episodic, reversible
bronchospasms owing to increased responsiveness of the
tracheobronchial free to various stimuli.
It has been divided into two basic types:
1. Extrinsic asthma.
2. Intrinsic asthma.
Characterized by dyspnea, wheezing, and chest tightness
Airways thickened with inflammatory exudates and
occluded by thick mucous, which magnify the effect of
bronchospasms
Asthma
Extrinsic Asthma: Initiated by type 1 hypersensivity
reaction induced by exposure to extrinsic antigen.
Subtypes include:
atopic (allergic) asthma.
occupational asthma.
allergic bronchopulmonary aspergillosis.
Intrinsic Asthma: Initiated by diverse, non-immune
mechanisms, including ingestion of aspirin, pulmonary
infections, cold, inhaled irritant, stress and exercise.
Asthma
Factors Contributing to the Development of an
Asthmatic Attack
Allergens
Respiratory tract infections
Exercise
Drugs and chemicals
Hormonal changes and emotional upsets
Airborne pollutants
Gastroesophageal reflux
Emphysema
Enlargement of air spaces and destruction of lung tissue
Types: centriacinar and panacinar
Smoking history
Age of onset: 40 50 years
Often dramatic barrel chest
Weight loss
Decreased breath sounds
Normal blood gases until late in disease process
Cor pulmonale only in advanced cases
Slowly debilitating disease
Chronic Bronchitis
Obstruction of small airways
Smoking history
Age of onset 30 40 years
Barrel chest may be present
Shortness of breath predominant early symptom
Rhonchi often present
Sputum frequent early manifestation
Often dramatic cyanosis
Hypercapnia and hypoxemia may be present
Frequent cor pulmonale and polycythemia
Numerous life threatening episodes due to acute
exacerbations
Cystic Fibrosis
Definition
An autosomal recessive disorder involving fluid
secretion in the exocrine glands, the epithelial
lining of the respiratory, gastrointestinal and
reproductive tracts
Cause
Mutations in a single gene on the long arm of
chromosome 7 that encodes for the cystic
fibrosis transmembrane regulator (CFTR), which
functions as a chloride (Cl
-
) channel in epithelial
cell
Manifestations of Cystic Fibrosis
Pancreatic exocrine deficiency
Pancreatitis
Elevation of sodium chloride in the sweat
Excessive loss of sodium in the sweat
Nasal polyps
Sinus infections
Cholelithiasis
Diffuse Interstitial Lung Diseases
Definition
A diverse group of lung disorders that produce
similar inflammatory and fibrotic changes in the
interstitium or interalveolar septa of the lung
Types
Sarcoidosis
The occupational lung diseases
Hypersensitivity pneumonitis
Lung diseases caused by exposure to toxic drugs
Pulmonary Embolism
Development
A blood-borne substance lodges in a branch of the
pulmonary artery and obstructs the flow
Types
Thrombus: air accidentally injected during
intravenous infusion
Fat: mobilized from the bone marrow after a
fracture or from a traumatized fat depot
Amniotic fluid: enters the maternal circulation after
rupture of the membranes at the time of delivery
Prevention of Pulmonary
Embolism
Identification of persons at risk
Avoidance of venous stasis and
hypercoagulability states
Early detection of venous thrombosis
Secondary Pulmonary Hypertension
Signs and Symptoms
Dyspnea and fatigue
Peripheral edema
Ascites
Signs of right heart failure (cor pulmonale)

Cor Pulmonale
Right heart failure resulting from primary lung
disease and long-standing primary or secondary
pulmonary hypertension
Involves hypertrophy and the eventual failure of
the right ventricle
Manifestations include the signs and symptoms
of the primary lung disease and the signs of
right-sided heart failure
Causes of ARDS
Aspiration of gastric contents
Major trauma (with or without fat emboli)
Sepsis secondary to pulmonary or non-
pulmonary infections
Acute pancreatitis
Hematologic disorders
Metabolic events
Reactions to drugs and toxins
Causes of Respiratory Failure
Impaired ventilation
Upper airway obstruction
Weakness of paralysis of respiratory muscles
Chest wall injury
Impaired matching of ventilation and
perfusion
Impaired diffusion
Pulmonary edema
Respiratory distress syndrome
Signs and Symptoms of Hypercapnia
Increased PCO
2

Headache
Conjunctival hyperemia
Flushed skin
Increased sedation
Tachycardia
Diaphoresis
Mild to moderate increase in blood pressure