Respiration

Module: 06

Divya Raidas
 Respiration
• Respiration is the process by which oxygen is taken in
and carbon dioxide is given out.
• The first breath takes place only after birth.
• Fetal lungs are non-functional.
• So, during intrauterine life the exchange of gases
between fetal blood and mother’s blood occurs
through placenta.
• After the first breath, the respiratory process
continues throughout the life.
• Permanent stoppage of respiration occurs only at
death.
❑ Respiration is classified into two types:
External respiration:
• Involves exchange of respiratory gases, i.e. oxygen and carbon
dioxide between lungs and blood.
• Within the alveoli, oxygen from the air diffuses across the thin
cell membrane and attaches to the red blood cells, which have a
low concentration of oxygen.
• At the same time, the carbon dioxide-rich deoxygenated red blood
cells release carbon dioxide, which diffuses across the
cell membrane to the area of a lower carbon dioxide concentration
(the inspired air in the lungs), for expiration.
Internal respiration:
• Involves exchange of gases between blood and tissues.
• The cells exchange gases with the red blood cells in the capillaries
in the same manner as the alveoli exchange gases.
• When this occurs in the cells, it is known as "internal respiration,"
as there is no exchange of gases with the environment outside the
body.
❑ Phases Of Respiration
• Respiration occurs in two phases:
• Inspiration: during which air enters the lungs from atmosphere
• Expiration: during which air leaves the lungs.
• During normal breathing, inspiration is an active process and
expiration is a passive process

❑ Functions
• Pulmonary ventilation means in which the inflow and outflow of
air occurs between the atmosphere and lung alveoli.
• Diffusion of oxygen and carbon dioxide among the alveoli and
the blood.
• Transport of oxygen and carbon dioxide in the blood and the
body fluid to and from the body tissue cells.
• Regulation of ventilation.
 Respiratory Tract
• Respiratory tract is the anatomical
structure through which air moves
in and out.
• It includes nose, pharynx, larynx,
trachea, bronchi and lungs
• Upper respiratory tract that
includes all the structures from
nose up to vocal cords; vocal cords
are the folds of mucous membrane
within larynx that vibrates to
produce the voice
• Lower respiratory tract, which
includes trachea, bronchi and
lungs
 Respiratory Unit
• Respiratory unit is defined as the structural and
functional unit of lung. Exchange of gases occurs only in
this part of the respiratory tract
• STRUCTURE OF RESPIRATORY UNIT:
• Respiratory unit includes:
1. Respiratory bronchioles
2. Alveolar ducts
3. Alveolar sacs
4. Antrum
5. Alveoli.
• Respiratory unit starts from the respiratory
bronchioles.
• Each respiratory bronchiole divides into alveolar ducts.
• Each alveolar duct enters an enlarged structure called the
alveolar sac.
• Space inside the alveolar sac is called antrum.
• Alveolar sac consists of a cluster of alveoli.
• Few alveoli are present in the wall of alveolar duct also.
 Alveolar Cells or Pneumocytes
• Alveolar epithelium consists of alveolar cells or
pneumocytes, which are of two types namely type
I alveolar cells and type II alveolar cells.
• Type I alveolar cells: Type I alveolar cells are the
squamous epithelial cells forming about 95% of
the total number of cells. These cells form the
site of gaseous exchange between the alveolus
and blood.
• Type II alveolar cells: Type II alveolar cells are
cuboidal in nature and form about 5% of alveolar
cells. These cells are also called granular
pneumocytes. Type II alveolar cells secrete
alveolar fluid and surfactant
 Respiratory Membrane

• Respiratory membrane is a membranous structure through

which exchange of respiratory gases takes place.
• It is formed by epithelium of respiratory unit and
endothelium of pulmonary capillary.
• Epithelium of respiratory unit is a very thin layer
• Since, the capillaries are in close contact with this
membrane, alveolar air is in close proximity to capillary
blood.
• This facilitates gaseous exchange between air and blood
• Respiratory membrane is formed by different layers of
structures belonging to the alveoli and capillaries.
• Layers of Respiratory Membrane: respiratory membrane
is very thin with an average thickness of 0.5 μ. Total
surface area of the respiratory membrane in both the lungs
is about 70 square meter.
 Layers Of Respiratory Membrane

Portion Layers
Alveolar portion 1. Monomolecular layer of surfactant, which
spreads over the surface of alveoli
2. Thin fluid layer that lines Alveolar portion
Between alveolar and capillary portions
Capillary portion the alveoli
3. Alveolar epithelial layer, which is
composed of thin epithelial cells resting
on a basement membrane

Between alveolar and capillary portions An interstitial space

Capillary portion 1. Basement membrane of capillary
2. Capillary endothelial cells
 External Respiration Or Pulmonary Gas Exchange:
• External respiration or pulmonary gas exchange is the diffusion of O2 from alveoli of the lungs to blood in
pulmonary capillaries and the diffusion of CO2 from blood in pulmonary capillaries to alveoli of lungs.
• Converts deoxygenated blood into oxygenated blood in the lungs.
• As blood flows through the pulmonary capillaries, it picks up O2 from lungs and unloads CO2 into lungs. This
exchange of gases depends upon the partial pressure of each gas.
• The gasses move from the area of higher partial pressure to the area where its partial pressure is low.
• In a resting person, the partial pressure of O2 (PO2) in alveoli of lungs is 105 mmHg whereas PO2 in
pulmonary capillaries is 40 mmHg.
• So the O2 diffuses from alveoli into pulmonary capillaries. Diffusion continues until the PO2in pulmonary
capillary matches thePO2in alveoli and becomes 100 mmHg.
• While O2 is diffusing from alveoli into deoxygenated blood, CO2 is diffusing in the opposite direction.
• The PCO2 in deoxygenated blood in pulmonary capillaries is 45 mmHg in a resting person and the PCO2 of
alveolar air is 40 mmHg.
• Because of this difference in PCO2, carbon dioxide diffuses from deoxygenated blood into the alveoli until the
PCO2 of the blood decreases to 40 mmHg.
• Oxygenated blood returning to the left side of the heart in the pulmonary veins thus has a PCO2 of 40 mmHg.
• The left ventricle pumps oxygenated blood into the aorta and through the systemic arteries to systemic
capillaries.
 Internal Respiration Or Systemic Gas Exchange:
• The exchange of O2 and CO2 between systemic capillaries and tissue cells is called internal
respiration or systemic gas exchange.
• As O2 leaves the bloodstream, oxygenated blood is converted into deoxygenated blood.
• Internal respiration occurs in tissues throughout the body.
• The PO2 of blood in systemic capillaries is higher(100 mmHg) than the PO2 in tissue cells (40
mmHg at rest).
• Due to this pressure difference, oxygen diffuses out of the capillaries into tissue cells and blood PO2
drops to 40 mmHg.
• While O2 diffuses from the systemic capillaries into tissue cells, CO2 diffuses in the opposite direction.
• Because tissue cells are constantly producing CO2, the PCO2 of cells (45 mmHg at rest) is higher than
that of systemic capillary blood (40 mmHg).
• As a result, CO2 diffuses from tissue cells into systemic capillaries until the PCO2 in the blood
increases to 45 mmHg.
• The deoxygenated blood then returns to the heart and is pumped to the lungs for another cycle of
external respiration.
 Exchange Of Respiratory Gases In Lungs & at Tissue Level
Exchange Of Respiratory Gases In Lungs : In the lungs, exchange of respiratory gases takes place
between the alveoli of lungs and the blood. Oxygen enters the blood from alveoli and carbon dioxide is
expelled out of blood into alveoli. Exchange occurs through bulk flow diffusion
❑ Diffusion of oxygen:
1. Diffusion of oxygen from atmospheric air into alveoli
2. Diffusion of oxygen from alveoli into blood
❑ Diffusion of carbon dioxide:
1. Diffusion of carbon dioxide from blood into alveoli
2. Diffusion of carbon dioxide from alveoli into atmospheric air

Exchange of respiratory gases at tissue level: oxygen enters the cells of tissues from blood and
carbon dioxide is expelled from cells into the blood.
1. Diffusion of oxygen from blood into the tissues
2. Diffusion of carbon dioxide from tissues into the blood
 Diffusion Of Oxygen From Atmospheric Air Into Alveoli

• Partial pressure of oxygen in the

atmospheric air is 159 mm Hg and in
the alveoli, it is 104 mm Hg.
• Because of the pressure gradient of 55
mm Hg, oxygen easily enters from
atmospheric air into the alveoli
 Diffusion Of Oxygen From Alveoli Into Blood
• When blood passes through pulmonary
capillary, RBC is exposed to oxygen only
for 0.75 second at rest and only for 0.25
second during severe exercise.
• So, diffusion of oxygen must be quicker and
effective. This possible because of pressure
gradient.
• Partial pressure of oxygen in the
pulmonary capillary is 40 mm Hg and in
the alveoli, it is 104 mm Hg.
• Pressure gradient is 64 mm Hg. It facilitates
the diffusion of oxygen from alveoli into the
blood

Diffusion of oxygen from alveolus to pulmonary capillary

 Diffusion of Carbon Dioxide from Blood into Alveoli

• Partial pressure of carbon dioxide in alveoli is

40 mm Hg whereas in the blood it is 46 mm Hg.
• Pressure gradient of 6 mm Hg is responsible for
the diffusion of carbon dioxide from blood into
the alveoli

Diffusion of carbon dioxide from pulmonary

capillary to alveolus
Diffusion Of Carbon Dioxide From Alveoli Into Atmospheric Air

• In atmospheric air, partial pressure of carbon

dioxide is very insignificant and is only about
0.3 mm Hg whereas, in the alveoli, it is 40
mm Hg.
• So, carbon dioxide enters passes to atmosphere
from alveoli easily.
 Diffusion Of Oxygen From Blood Into The Tissues
• Partial pressure of oxygen in the arterial end of systemic
capillary is only 95 mm Hg.
• It may be because of physiological shunt in lungs.
• Due to venous admixture in the shunt , 2% of blood reaches
the heart without being oxygenated.
• Average oxygen tension in the tissues is 40 mm Hg.
• It is because of continuous metabolic activity and constant
utilization of oxygen.
• Thus, a pressure gradient of about 55 mm Hg exists between
capillary blood and the tissues so that oxygen can easily
diffuse into the tissues.
• Oxygen content in arterial blood is 19 mL% and in the
venous blood, it is 14 mL%.
• Thus, the diffusion of oxygen from blood to tissues is 5
mL/100 mL of blood.
Diffusion Of Oxygen From Capillary To Tissue
 Diffusion Of Carbon Dioxide From Tissues Into The Blood

• Due to continuous metabolic activity, carbon

dioxide is produced constantly in the cells of
tissues.
• So, the partial pressure of carbon dioxide is
high in the cells and is about 46 mm Hg.
• Partial pressure of carbon dioxide in arterial
blood is 40 mm Hg.
• Pressure gradient of 6 mm Hg is responsible for
the diffusion of carbon dioxide from tissues to
the blood.
• Carbon dioxide content in arterial blood is 48
mL%.
• And in the venous blood, it is 52 mL%.
• So, the diffusion of carbon dioxide from tissues
to blood is 4 mL/100 mL of blood Diffusion Of Carbon Dioxide From Tissue To Capillary
 Oxygen-hemoglobin Dissociation Curve

• Oxygen-hemoglobin dissociation curve

demonstrates the relationship between partial
pressure of oxygen and the percentage
saturation of hemoglobin with oxygen.
• It explains hemoglobin’s affinity for oxygen.
• Normally in the blood, hemoglobin is saturated
with oxygen only up to 95%.
• Saturation of hemoglobin with oxygen depends
upon the partial pressure of oxygen.
• When the partial pressure of oxygen is more,
hemoglobin accepts oxygen and when the partial
pressure of oxygen is less, hemoglobin releases
oxygen
 Factors Affecting Oxygen-hemoglobin Dissociation Curve
• Oxygen-hemoglobin dissociation curve is shifted to left or right by various
factors:
• Shift to left indicates acceptance (association) of oxygen by hemoglobin
• Shift to right indicates dissociation of oxygen from hemoglobin.
Shift to right Oxygen-hemoglobin dissociation curve is shifted to right in the
following conditions:
1. Decrease in partial pressure of oxygen
2. Increase in partial pressure of carbon dioxide (Bohr effect)
3. Increase in hydrogen ion concentration and decrease in pH (acidity)
4. Increased body temperature
5. Excess of 2,3-diphosphoglycerate (DPG) in RBC. It is also called
2,3-biphosphoglycerate (BPG). DPG is a byproduct in Embden-Meyer
hofpathway of carbohydrate metabolism. It combines with β-chains of
hemoglobin.
• In conditions like muscular exercise and in high attitude, the DPG increases in
RBC. So, the oxygen hemoglobin dissociation curve shifts to right to a great
extent.
Shift to left Oxygen-hemoglobin dissociation curve is shifted to left in the
following conditions:
1. In fetal blood because, fetal hemoglobin has got more affinity for oxygen
than the adult hemoglobin
2. Decrease in hydrogen ion concentration and increase in pH (alkalinity).
 Bohr Effect
• Bohr effect is the effect by which presence of carbon
dioxide decreases the affinity of hemoglobin for
oxygen.
• Bohr effect was postulated by Christian Bohr in 1904.
• In the tissues, due to continuous metabolic activities,
the partial pressure of carbon dioxide is very high and
the partial pressure of oxygen is low.
• Due to this pressure gradient, carbon dioxide enters the
blood and oxygen is released from the blood to the
tissues.
• Presence of carbon dioxide decreases the affinity of
hemoglobin for oxygen.
• It enhances further release of oxygen to the tissues and
oxygen dissociation curve is shifted to right.
• Factors influencing Bohr effect are All the factors, which
shift the oxygen-dissociation curve to right enhance the
Bohr effect.
 Transport Of Carbon-dioxide
• Carbon dioxide is transported by the blood from cells
to the alveoli.
• Carbon dioxide is transported in the blood in four
ways:
1. As dissolved form (7%)
2. As carbonic acid (negligible)
3. As bicarbonate (63%)
4. As carbamino compounds (30%).
❑ As Dissolved Form
• Carbon dioxide diffuses into blood and dissolves in the fluid of plasma forming a simple solution.
• Only about 3 mL/100 mL of plasma of carbon dioxide is transported as dissolved state.
• It is about 7% of total carbon dioxide in the blood.

❑ As Carbonic Acid
• Part of dissolved carbon dioxide in plasma combines with the water to form carbonic acid.
• Transport of carbon dioxide in this form is negligible.
❑ As Bicarbonate

• About 63% of carbon dioxide is transported as bicarbonate.

• From plasma, carbon dioxide enters the RBCs.
• In the RBCs, carbon dioxide combines with water to form carbonic acid.
• The reaction inside RBCs is very rapid because of the presence of carbonic anhydrase.
• This enzyme accelerates the reaction.
• Carbonic anhydrase is present only inside the RBCs and not in plasma.
• That is why carbonic acid formation is at least 200 to 300 times more in RBCs than in plasma.
• Carbonic acid is very unstable.
• Almost all carbonic acid (99.9%) formed in red blood corpuscles, dissociates into bicarbonate and
hydrogen ions.
• Concentration of bicarbonate ions in the cell increases more and more.
• Due to high concentration, bicarbonate ions diffuse through the cell membrane into plasma.
Transport of carbon dioxide in blood in the form of bicarbonate and chloride shift
 Chloride Shift or Hamburger Phenomenon
• Chloride shift or Hamburger phenomenon is the exchange of a chloride ion for a bicarbonate ion across
RBC membrane.
• It was discovered by Hartog Jakob Hamburger in 1892.
• Chloride shift occurs when carbon dioxide enters the blood from tissues.
• Sodium chloride is present abundantly in plasma. It dissociates into sodium and chloride ions .
• When the negatively charged bicarbonate ions move out of RBC into the plasma, the negatively charged
chloride ions move into the RBC in order to maintain the electrolyte equilibrium (ionic balance).
• Anion exchanger 1 (band 3 protein), which acts like antiport pump in RBC membrane is responsible for the
exchange of bicarbonate ions and chloride ions.
• Bicarbonate ions combine with sodium ions in the plasma and form sodium bicarbonate. In this form, it is
transported in the blood.
• Hydrogen ions dissociated from carbonic acid are buffered by hemoglobin inside the cell
 Reverse Chloride Shift
• Reverse chloride shift is the process by which chloride ions are
moved back into plasma from RBC shift. It occurs in lungs.
• It helps in elimination of carbon dioxide from the blood.
• Bicarbonate is converted back into carbon dioxide, which has
to be expelled out.
• It takes place by the following mechanism: When blood reaches
the alveoli, sodium bicarbonate in plasma dissociates into sodium
and bicarbonate ions. Bicarbonate ion moves into the RBC.
• It makes chloride ion to move out of the RBC into the plasma,
where it combines with sodium and forms sodium chloride.
• Bicarbonate ion inside the RBC combines with hydrogen ion forms
carbonic acid, which dissociates into water and carbon dioxide.
Carbon dioxide is then expelled out.
 ❑ As Carbamino Compounds

• About 30% of carbon dioxide is transported as carbamino

compounds.
• Carbon dioxide is transported in blood in combination with
hemoglobin and plasma proteins.
• Carbon dioxide combines with hemoglobin to form carbamino
hemoglobin or carb-hemoglobin. And it combines with plasma
proteins to form carbamino proteins.
• Carbamino hemoglobin and carbamino proteins are together called
carbamino compounds.
• Carbon dioxide combines with proteins or hemoglobin with a loose
bond so that, carbon dioxide is easily released into alveoli, where
the partial pressure of carbon dioxide is low.
• Thus, the combination of carbon dioxide with proteins and
hemoglobin is a reversible one.
• Amount of carbon dioxide transported in combination with plasma
proteins is very less com pared to the amount transported in
combination with hemoglobin.
• It is because the quantity of proteins in plasma is only half of the
quantity of hemoglobin
 Carbon Dioxide Dissociation Curve

• Carbon dioxide is transported in blood as physical

solution and in combination with water, plasma
proteins and hemoglobin.
• The amount of carbon dioxide combining with
blood depends upon the partial pressure of carbon
dioxide.
• Carbon dioxide dissociation curve is the curve that
demonstrates the relationship between the
partial pressure of carbon dioxide and the
quantity of carbon dioxide that combines with
blood.
 Normal Carbon Dioxide Dissociation Curve
• Normal carbon dioxide dissociation curve shows that the
carbon dioxide content in the blood is 48 mL/dL when
the partial pressure of carbon dioxide is 40 mm Hg - in
Lungs and it is 52 mL/dL when the partial pressure of
carbon dioxide is 46 mm Hg- near Periphery.
• Carbon dioxide content becomes 70 mL% when the
partial pressure is about 100 mm Hg .
Haldane Effect
• Haldane effect is the effect by which combination of
oxygen with hemoglobin displaces carbon dioxide from
hemoglobin.
• It was first described by John Scott Haldane in 1860.
• Excess of oxygen content in blood causes shift of the
carbon dioxide dissociation curve to right.
❑ Causes for Haldane effect
• Due to the combination with oxygen, hemoglobin becomes strongly acidic.
• It causes displacement of carbon dioxide from hemoglobin in two ways
• Highly acidic haemoglobin has low tendency to combine with carbon dioxide. So, carbon dioxide is
displaced from blood.
• Because of the acidity, hydrogen ions are released in excess.
• Hydrogen ions bind with bicarbonate ions to form carbonic acid.
• Carbonic acid in turn dissociates into water and carbon dioxide.
• Carbon dioxide is released from blood into alveoli.

❑ Significance of Haldane effect

• Haldane effect is essential for:
1. Release of carbon dioxide from blood into the alveoli of lungs
2. Uptake of oxygen by the blood.
 Pulse Oximeter
• Pulse oximetry is a way to measure how much oxygen your
blood is carrying.
• By using a small device called a pulse oximeter, your blood
oxygen level can be checked without needing to be stuck with
a needle.
• The blood oxygen level measured with an oximeter is called
your oxygen saturation level (abbreviated O2sat or SaO2).
• This is a percentage of how much oxygen your blood is
carrying compared to the maximum it is capable of
carrying.
• Normally, more than 89% of your red blood should be
carrying oxygen.
• A pulse oximeter is composed of the sensor (or probe) and the monitor with the display.
• The probe is on the finger and is detecting the flow of blood through the finger. This is displayed as a pulse
wave on the monitor.
• A pulse wave must be present to demonstrate that a pulse is being detected.
• All pulse oximeter probes (finger or ear) have light emitting diodes (LEDs) which shine two types of red
light through the tissue.
• The sensor on the other side of the tissue picks up the light that is transferred through the tissues.
• The oximeter can determine which of the hemoglobin is in pulsatile blood (arterial) and can then determine
the SpO2 of arterial blood in the peripheral circulation
 Terms

• Hypotension: Low blood pressure

• Hypothermia: Low body temperature (less than 36°C)
• Hypoventilation: Breathing at a rate and/or depth that is less than required
• Hypovolaemia: Reduced blood volume
• Hypoxia: Abnormally low levels of oxygen in the body