Chapter 16
In With the Good Air, Out With the Bad
The Big Picture: Respiratory System
Oxygen enters the lungs and moves from the lungs to the blood to the tissues.
Carbon dioxide is produced in the tissues and moves to the blood and back to the lungs.
Take in a deep breath and let that fresh country air fill your lungs. The oxygen molecules flow
through your nose and into your lungs. They move from your lungs to your blood and are
carried to your tissues that use the oxygen for chemical reactions that keep you alive. The
reactions also produce carbon dioxide that moves from the tissues to the blood to the lungs.
When you exhale you are releasing the carbon dioxide back into the atmosphere.
That’s the respiratory system in a nutshell. However, your professor (or you) might want to
cover a bit more detail in this fascinating system. So here we go…
What’s nice about this system is that there isn't a heck of a lot of anatomy especially when
compared to the skeletal or nervous systems. Also, many students are familiar with at least
some of the structures (like the nose).
We can divide the respiratory system into the upper and lower portions. The upper respiratory
system consists of the nose and nasal cavity, the sinuses, pharynx and the part of the larynx
above the vocal cords. The lower respiratory system consists of the larynx (beginning at vocal
cords), trachea, bronchi, bronchioles, lungs and alveoli (Fig. 16.1).
Upper Respiratory System
As air moves into the nose it enters the nasal cavity. The nasal cavity is lined with a mucous
membrane that is highly vascularized (ever get a nose bleed?). There are bony bumps in the
nasal cavity called the conchae (no, not sea shells). There are three on each side (superior,
middle, inferior). The conchae create turbulent air flow that helps to clean and warm the air
before it gets further down the respiratory tract.
Right down the middle of the nasal cavity is the nasal septum (sometimes it runs off to one side
if deviated). Sometimes professors are pleased with students who know the bones that form
the septum. These include the ethmoid bone (superior portion of the septum) and the vomer
bone (inferior portion).
Once the air is nice and warm and clean it moves into the back of the nasal cavity on to the
pharynx. The pharynx is a passageway that is common to the respiratory and digestive systems.
Since it has to deal with both air and food traffic it needs some sort of management system.
The pharynx’s traffic management system consists of two structures. One is the thing that
dangles from the roof of your mouth when you open it and say “ahhh”. This is the uvula. The
other is a cartilage flap that flips over the larynx called the epiglottis.
When you swallow the uvula flips up and closes off the nasopharynx while the epiglottis flips
down and closes off the larynx. The system isn't perfect because if someone tells you an
extremely funny joke while you are swallowing your laughter can cause whatever you are
drinking to shoot out of your nose. The next time that happens you can say you learned about it
in anatomy class.
The air can now leave the pharynx and enter the larynx (Fig. 16.2). This is where the vocal cords
live. There are some cartilages in the larynx as well. These include the Adam’s apple (thyroid
cartilage) and the smaller cricoid cartilage below it. Other cartilages include the arytenoid,
corniculate and cuneiform cartilages. These cartilages are paired.
There are two parts to the vocal cords. These are the true and false vocal cords. When you
speak the true vocal cords vibrate. The false vocal cords are lateral to the true vocal cords.
When the vocal cords relax they form a triangular space called the glottis.
The air exits the larynx and moves into the trachea (Fig. 16.2). The trachea is a tube that
contains cartilage rings that are open in the back. This allows for some flexibility while
swallowing. The trachea ends with a structure called the carina. Coming off of the inferior end
of the trachea are the right and left bronchi. The bronchi branch into secondary and tertiary
branches that get smaller and smaller until they terminate at the alveoli. The alveoli are
structures that exchange gas between the lungs and the blood. They are surrounded by
capillaries.
The bronchi carry the air to the lungs. You probably know you have two lungs, a right and a left,
but do you know the differences between them? The right lung is larger because it doesn't
share the right side of the thoracic cavity with the heart. It has three lobes while the left lung
has only two. Both lungs have angular fissures called oblique fissures. The right lung has an
additional fissure called the horizontal fissure. The left lung has an indentation for the heart
called the cardiac impression. It also has an indentation for the aorta. Surrounding the lungs are
two membranes. The visceral pleural membrane is closely adhered to the surface of the lungs
while the parietal pleura lines the inside of the thoracic cavity. Both membranes secrete a slimy
fluid to help reduce friction during breathing.
Fig. 16.1.
Fig. 16.2. Trachea.
In with the good air…
Inhalation (breathing in) has to do with pressure changes inside and out of the lungs (Fig. 16.3).
You need to remember that air is a gas and gas moves according to pressure changes. Gas will
always move from an area of higher to lower pressure.
If we measured the pressure outside of the lungs we might see that it is around 760 mm Hg (at
sea level). This means that the pressure inside the lungs has to be less than 760 mm Hg in order
for air to move from outside to inside the lungs.
If this is the case then there must be some way to manipulate pressure inside of the lungs.
There is and it has to with what is known as Boyle’s law. The key to understanding Boyle’s law is
to know that pressure and volume are inversely related. In other words when volume goes up,
pressure goes down and vice versa.
Here’s how it works. At the base of the thoracic cavity is a muscle called the diaphragm. The
diaphragm moves downward when contracting. This action increases the volume of the
thoracic cavity. When volume increases guess what happens to pressure? You’re right, pressure
decreases and air moves into the lungs. The other muscles that are important in inhalation are
the intercostals, especially the external intercostals which work to expand the rib cage. This
further increases the volume of the thoracic cavity helping to lower the pressure.
That’s fine and dandy for resting inhalation but what about taking in a deep breath like when
you blow out your birthday candles? Well, using our logic you would need to expand the
thoracic cavity even more. Fortunately we have some muscles (called accessory muscles of
inspiration) that help make this happen. These include the following:
Sternocleidomastoids—helps to lift the ribcage and expand the thoracic cavity superior.
Pectoralis minors—lift and expand the ribcage superior and laterally.
Out with the bad air...
Exhaling happens pretty automatically. In other words, it is considered a passive process that
occurs without using energy. What happens is that the diaphragm and thoracic cavity spring
back into their original position causing the pressure to increase inside of the lungs and air to
move out. If you were to exhale forcefully you would recruit some accessory muscles which
include:
Internal Intercostals--work to pull the thoracic cage downward.
Abdominals--decrease volume of the abdominal cavity and push diaphragm more superior.
Respiratory Rates and Volumes
The typical adult breathes in and out about 12 to 18 times per minute. Kids are a bit more hyper
and breathe in and out about 18 to 20 times per minute. Doctors (and physiologists) can
measure the amount of air going in and coming out using a device called a spirometer. Back in
my old school days these used to be large devices with revolving drums and pens that would
record the volumes of air on a rotating graph. Also, back in those days a lot of my classmates
smoked. This was great for physiology class as we could compare the smokers’ lung volumes
with us healthy geeks. Of course now-a-days we know better—right? Also, thanks to the geeks
modern spirometers can fit in the palm of your hand (go geeks!).
If I am just relaxing and, of course breathing, the amount of air going or coming out of my lungs
is known as tidal volume (about half a liter or 500 ml).
If I take in a deep breath after a normal exhale, the amount of air going into my lungs in
addition to tidal volume is known as inspiratory reserve volume (3.3 L in males and 1.9 L in
females).
If I exhale as hard as I can after inhaling normally, the amount of air coming out of my lungs in
addition to tidal volume is known as expiratory reserve volume (about 1 L).
No matter how hard I try I cannot blow out all of the air in my lungs (once in awhile students
will ask me if they can exhale all of the air out of their lungs). There is always some air left in the
lungs. This additional air is known as residual volume (1.2 L in males and 1.1 L in females).
What we have just covered are the basic respiratory volumes. We can add these together in
various ways to get what are known as capacities.
Here are the basic respiratory capacities:
Vital capacity is the maximal amount of air that can move in and out of the lungs in a single
breath. It is the sum of tidal volume, inspiratory reserve volume and expiratory reserve volume.
It is about 4800 ml in males and 3400 ml in females.
Inspiratory capacity is the amount of air that can move into the lungs after resting inhalation
and exhalation. Inspiratory capacity is the sum of tidal volume and inspiratory reserve volume.
Functional residual capacity is the air remaining in the lungs after a resting inhalation and
exhalation. Functional residual capacity is the sum of expiratory reserve volume and residual
volume.
Total lung capacity is the total volume of air in the lungs. It is the sum of vital capacity and
residual volume. It is about 6000 ml in males and 4500 ml in females.
Partial Pressure of a Gas
We tend to think of air as containing oxygen. Yup, it’s in there but there are also a few other
gasses in air. Actually, air is mostly nitrogen (78.6%). Oxygen accounts for about 20.9% and
carbon dioxide about 0.4%.
Remember our 760 mm Hg pressure of air at sea level. Well, not all of that pressure is due to
oxygen. In fact since air is only about 21% oxygen then oxygen only accounts for 21% of the 760
mm Hg. This works out to about 159 mm Hg. This is known as the partial pressure of oxygen or
PO2.
Why do we need to know about partial pressures? Well, it is useful to know about partial
pressures when we study how oxygen and carbon dioxide are exchanged between the lungs,
blood and tissues. This is our next topic.
Big Picture: Respiratory Physiology
Everything goes where it needs to go…
Yes, I know it sounds a bit stupid and simplistic but bare with me. Let’s elaborate:
Oxygen travels from the lungs to the blood to the tissues.
Carbon dioxide travels from the tissues to the blood to the lungs.
So how do oxygen and carbon dioxide move from lungs to blood to tissues to blood to lungs?
They follow partial pressure gradients. We can think of partial pressures as being analogous to
concentration. Substances always move from areas of higher to lower concentration. We can
apply this thinking to partial pressures and say that oxygen and carbon dioxide move from areas
of higher partial pressure to lower partial pressure. Or, to summarize:
Oxygen moves from areas of higher PO2 to areas of lower PO2.
Carbon dioxide moves from areas of higher PCO2 to areas of lower PCO2.
So we just need to follow oxygen and carbon dioxide through the system. Let’s start with
oxygen. The partial pressure of oxygen is greatest at the source of oxygen which is the lungs.
Alveolar PO2 is the greatest PO2 in the system at about 104 mm Hg. As deoxygenated blood
moves into the lungs (from the pulmonary arteries to the capillaries surrounding the alveoli) it
has a PO2 of about 40 mm Hg. Oxygen can then diffuse from the higher PO2 (104 mm Hg) to
the lower PO2 (40 mm Hg)(Fig. 16.3).
Oxygen diffuses into the blood causing the PO2 to rise to 104 mm Hg. The blood mixes with
some blood from the bronchial veins which causes the PO2 to decrease to about 95 mm Hg.
This is the PO2 that leaves the lungs and moves to the rest of the body.
When blood reaches the tissues it needs to diffuse from the capillaries to the tissues so the
tissue PO2 must be less than that of the blood. Tissue PO2 is about 40 mm Hg so oxygen can
easily diffuse from blood to the tissues. Since oxygen moves out of the blood the PO2 decreases
back to 40 mm Hg.
The tissues need oxygen for chemical reactions and they produce carbon dioxide which must be
removed. So let’s look at how carbon dioxide moves through the system.
Let’s start at the source of carbon dioxide where the PCO2 is the greatest. The source of carbon
dioxide is the tissues with a PCO2 of about 45 mm Hg. The PCO2 of oxygenated blood is about
40 mm Hg. When oxygenated blood meets the tissues, carbon dioxide diffuses from the tissues
to the blood. This brings the PCO2 of deoxygenated blood leaving the tissues up to 45 mm Hg.
The deoxygenated blood moves to the lungs where the alveolar PCO2 is at about 40 mm Hg.
When the deoxygenated blood with a PCO2 of 45 mm Hg meets the alveoli (at PCO2 of 40 mm
Hg) carbon dioxide diffuses into the lungs and is exhaled out of the body (Fig. 16.4).
Then the process repeats...
One way to think of this is my dump truck analogy. I thought of this a few years ago while
playing with my daughter. We have two dump trucks. One truck is a bright red oxygen truck
while the other is a pretty blue carbon dioxide truck. The dispatcher calls the oxygen truck and
asks it to fill up with oxygen at the lungs. The driver says that he can because he only has a
partial load of 40 units. He drives to the lungs (following the veins and pulmonary arteries) to
the lungs where he “fills up” with oxygen to 104 units. He then drives to the tissues (following
the pulmonary veins and systemic arteries) to “dump” the oxygen. Along the way the road is
bumpy so he loses a bit and he arrives at the tissues with only 95 units. He only delivers a
partial load and still has 40 units when he is finished. He then travels back to the lungs and gets
another load and so on.
The pretty blue carbon dioxide truck has a similar job. He has to go to the tissues to “fill up”
with carbon dioxide. His truck is partially full as well and he begins with only 40 units of carbon
dioxide. He follows the systemic arteries to the tissues where he “fills up” partially to 45 units.
He then heads to the lungs following the systemic veins and pulmonary arteries where he
partially “dumps” his load to 40 units. He then heads back to the tissues and starts over (vroom
vroom).
Fig. 16.3. Oxygen exchange.
Fig. 16.4. Carbon dioxide exchange.
Carbon Dioxide Storage
Big Picture: Carbon dioxide storage
Carbon dioxide is stored in the blood three different ways:
1. Dissolved in plasma
2. Attached to hemoglobin
3. Hidden in the bicarbonate ion
Now that we've seen how carbon dioxide moves into the blood, what happens to it once it gets
there? Carbon dioxide is transported in the blood three different ways. Two of these are
relatively simple and the other is a bit trickier.
One way carbon dioxide is transported is that some of it is dissolved in blood plasma. Only
about 7% of the carbon dioxide carried in blood is dissolved in plasma. Another way that carbon
dioxide is transported is by way of a hemoglobin compound called carbaminohemoglobin (use
this word to impress your friends or win at scrabble). Red blood cells contain hemoglobin which
is famous for transporting oxygen. Hemoglobin can also transport some carbon dioxide (about
23%).
The final way is the tricky one, and the most important of all. Most of the carbon dioxide is
transported in blood by way of the bicarbonate ion (HCO3-).
Here is the way it works. Carbon dioxide moves into the blood and comes in contact with red
blood cells where it diffuses into the cells. Red blood cells contain an enzyme called carbonic
anhydrase. When carbon dioxide meets carbonic anhydrase and water it forms a molecule of
carbonic acid. The carbonic acid is ionically bonded so it can dissociate (break apart) in water to
form the bicarbonate ion and hydrogen ions (Fig. 16.5).
Fig. 16.5. Storage of carbon dioxide in bicarbonate ions. Some carbon dioxide binds with hemoglobin.
Carbon dioxide also combines with water and carbonic anhydrase to form carbonic acid that dissociates
into bicarbonate and hydrogen ions. Bicarbonate ions move out of the red blood cell with chloride ions
moving in to maintain ionic stability. Hydrogen ions bind with hemoglobin. Carbon dioxide also enters
the red blood cell and combines with hemoglobin. This process occurs in areas of high PCO2 where
carbon dioxide needs to be transported.
The reaction that forms carbonic acid which dissociates into hydrogen and bicarbonate ions
also occurs outside of the red blood cell in the blood, but without carbonic anhydrase. This
brings up an interesting point. The more carbon dioxide builds up in the blood the more it is
stored in the bicarbonate ion and the more hydrogen ions are produced. Remembering your
chemistry you know that a high concentration of hydrogen ions makes things acidic. So when
carbon dioxide builds up in the blood the blood also becomes acidic. If this happens because
the respiratory system is unable to expel carbon dioxide then we have a condition called
respiratory acidosis.
Likewise the reaction can go the other way. Let’s say that for some reason the lungs are getting
rid of lots of carbon dioxide. The hydrogen ion concentration will decrease causing the blood to
become alkaline. If this is due to the respiratory system expelling too much carbon dioxide then
wet have a condition called respiratory alkalosis.
You can induce a state of respiratory acidosis or alkalosis right now if you’d like. To produce
respiratory acidosis, simply hold your breath. Your tissues still produce carbon dioxide (hey,
you’re still alive) but it can’t get out of your lungs so it builds up in the blood. Fortunately your
nervous system will sense the buildup of carbon dioxide and hydrogen ions and cause an
overwhelming urge to inhale.
Likewise you can induce a state of respiratory alkalosis by hyperventilating. Your lungs will get
rid of lots of carbon dioxide which decreases the hydrogen ion concentration making your
blood more alkaline.
Okay, we've talked a lot about carbon dioxide but what about oxygen? A little bit of oxygen
dissolves in blood plasma but by far the majority of oxygen is transported via hemoglobin. Up
to four oxygen molecules can bind with one hemoglobin molecule and there is something like
300 million hemoglobin molecules in one red blood cell.
One way to understand how hemoglobin works is to look at the oxygen-hemoglobin saturation
curve (Fig. 16.7).
Fig. 16.6. Hemoglobin saturation curve.
Notice that PO2 is on the horizontal axis and percent saturation of hemoglobin in on the
vertical axis. In order to further understand what’s going on here I will invoke one of my
universal physiology rules one more time:
Everything goes where it needs to go…
Let’s apply the rule to the curve. First of all in areas of low oxygen what do you think
hemoglobin should do? It can either hang on to the oxygen or let go of it so oxygen can move
into the tissues. Our tissues need oxygen so you should say that hemoglobin lets go of oxygen
so it can move into the tissues. Now let’s use fancy physiology terminology to describe this:
Hemoglobin decreases its affinity for oxygen binding in areas of low PO2.
Likewise what should hemoglobin do in areas of high levels of oxygen such as in the lungs?
Should hemoglobin want to bind with oxygen or let go of it? Well we know that oxygen needs
to go from the lungs to the blood to the tissues so if you said hemoglobin wants to bind with
oxygen you were right. Again using fancy terminology we can say:
Hemoglobin increases its affinity for oxygen binding in areas of high PO2.
In fact hemoglobin is almost completely saturated (98%) in the lungs.
Now hemoglobin is a bit tricky but that’s a good thing. Let’s say that I am doing my aerobic
workout. Logically my tissues would need more oxygen, right? Well, my hemoglobin can help
me with this. It can actually change how it works based on my body’s need for oxygen. In the
case of exercise hemoglobin actually releases more oxygen in areas of low PO2 (my oxygen-
wanting tissues that are producing more CO2 and becoming acidic--low pH) while still becoming
almost completely saturated in the lungs. We can say that the saturation curve shifted to the
right. The change in hemoglobin’s affinity for oxygen binding is called the Bohr effect.
At the same time my tissues need more oxygen they are also making more carbon dioxide.
Hemoglobin helps out here too. Remember that some carbon dioxide binds with hemoglobin.
Well, during periods of increased demand for oxygen such as in exercise hemoglobin also wants
to bind with more carbon dioxide in areas of higher carbon dioxide (PCO2). Hemoglobin helps
us out by helping to transport more carbon dioxide from the tissues to the blood so that it can
be removed by the lungs. This is known as the Haldane effect.
Exercise isn't the only thing that triggers the change in hemoglobin. Increases in temperature
can also cause hemoglobin to change how it functions.
How Respiration is controlled by the Nervous System
Big Picture: Respiratory Centers
There are four respiratory centers in the brainstem:
1. The medulla oblongata contains the dorsal and ventral respiratory groups.
2. The pons contains the pontine respiratory group and the apneustic center.
We need a control system in order to adjust our breathing to maintain just the right amount of
oxygen and carbon dioxide in our blood. The control system is located in the nervous system,
specifically in the brainstem. There are four main respiratory centers located in the pons and
medulla oblongata.
The medulla contains the medullary rhythmicity center. The medullary rhythmicity center
consists of two groups of neurons called the dorsal and ventral respiratory groups.
The dorsal respiratory group consists of two groups of neurons located in the posterior area of
the medulla oblongata. This group is primarily responsible for contraction of the diaphragm for
regulation of breathing rate. The neurons receive input from other parts of the brain and
receptors that sense changes in concentrations of gases and pH.
The ventral respiratory group stimulates the external and internal intercostals and abdominal
muscles. This group works with the dorsal respiratory group in forceful breathing.
The pons contains the pneumotaxic center (now called the pontine respiratory group). This
center works with the centers in the medulla and helps to fine tune breathing rate and rhythm.
The pneumotaxic center also receives input from other centers in the brain.
The apneustic center also resides in the pons. The pneumotaxic center inhibits the apneustic
center to help control exhalation. However if damage to the brainstem occurs the person can
exhibit what is known as apneustic breathing. This consists of a very slow respiration rate with a
deep inhalation held for ten to twenty seconds followed by shallow and brief exhalations that
provide little pulmonary ventilation.
Breathing is not entirely unconscious. We can decide to take in a deep breath or hold our
breath. The cerebral cortex provides connections to the brainstem centers for breathing. The
limbic system also affects breathing. For example strong emotions elicited in the limbic system
can speed up breathing.
All of the above respiratory centers innervate the phrenic and intercostal nerves.
A Protective Mechanism
Have you ever wondered whether you could burst your lungs by taking in a deep breath? I
remember taking a fitness test in my younger years and I really thought my lungs were going to
burst from my breathing so hard. Fortunately we have a protective mechanism that does not
allow our lungs to burst.
The Hering-Breuer reflex is a protective mechanism and prevents overinflation of the lungs.
Stretch receptors on the walls of the bronchi and bronchioles send impulses to the vagus nerve
to the medulla oblongata. The impulses inhibit the respiratory centers and produce exhalation.
The Role of Surfactant
Big Picture: Surfactant
Surfactant is secreted by alveolar cells in order to reduce surface tension.
Before we get into what surfactant does, we need to cover the concept of surface tension.
Surface tension is a force that exists on the surface of a fluid (like water). It is produced by
chemical bonds that occur between water molecules. You might remember from chemistry that
water molecules are polar, meaning they have a slight negative charge on one end and a slight
positive charge on the other. (Fig. 16.8)
Fig. 16.7.
Water molecules have a partial positive and partial negative charge. The dotted lines represent
the polar covalent bonds between water molecules.
The positive and negative charges cause the water molecules to stick together by forming polar
covalent bonds. These bonds produce a force called surface tension. If you were to spill a drop
of water on a table, you would see that the drop is in the shape of a dome. This is caused by the
surface tension pulling the water molecules toward the center.
So what the heck does this have to do with the lungs? Well it turns out that there is a law
discovered by a scientist by the name of Pierre-Simon Laplace (1749-1827) called, you guessed
it, Laplace’s law. Laplace’s law relates the shape of the alveolus to the pressure caused by
surface tension. The actual law (Simon-Laplace Law) is a non-linear differential equation (a bit
much for this book). The main idea is that assuming the alveolus is a spherical structure there is
an inverse relationship between the small size of the alveolus and the pressure needed to
balance the surface tension force causing it to collapse. In other words if all we had was mucous
lining our alveoli they would collapse.
So why are we not walking around with collapsed lungs? Well fortunately Mother Nature finds
a way to prevent this. Our alveoli have special cells (Type II cells) that secrete a substance that
reduces surface tension. This substance is known as surfactant.
So why do we need to know this? Well, it turns out that premature infants risk lung collapse
because their type II cells are not developed enough to secrete surfactant. They run the risk of
what is known as respiratory distress syndrome (RDS).
Image Credits
Chapter 16
16.1 From: [Link]
16.2 From: [Link]
16.4 Author
16.5 Derivative from: RBC from: [Link] and Hemoglobin Molecule from:
[Link]
16.6 Author
16.7 From: [Link]