The lung is elastic and returns passively to its pre-inspiratory volume during resting
breathing. It is remarkably easy to distend. A normal breath of about 500 ml, for example,
requires a distending pressure of less than 3 cm water. By contrast, a child’s balloon may need a
pressure of 30 cm water for the same change in volume.
The pressure required to move gas through the airways is also very small. During normal
inspiration, an air flow rate of 1 liter/s requires a pressure drop along the airways of less than 2
cm water. Compare a soda straw, which may need a pressure of about 500 cm water or the same
flow rate.
Airways
Divided into a conducting zone and a respiratory zone
Volume of the anatomic dead space is about 150 ml
Volume of the alveolar region is about 2.5 to 3.0 liters
Gas movement in the alveolar region is chiefly by diffusion
BLOOD VESSELS AND FLOW
The pulmonary blood vessels also form a series of branching tubes from the pulmonary
artery to the capillaries and back to the pulmonary veins. Initially, the arteries, veins, and bronchi
run close together, but toward the periphery of the lung, the veins move away to pass between
the lobules, whereas the arteries and bronchi travel together down the centers of the lobules. The
capillaries form a dense network in the walls of the alveoli (Figure 1.6). The diameter of a
capillary segment is about 7 to 10 µm, just large enough or a red blood cell. The lengths of the
segments are so short that the dense network forms an almost continuous sheet of blood in the
alveolar wall, a very efficient arrangement for gas exchange. Alveolar walls are not often seen
face on, as in Figure 1.6. The usual, thin microscopic cross section (Figure 1.7) shows the red
blood cells in the capillaries and emphasizes the enormous exposure of blood to alveolar gas,
with only the thin blood-gas barrier intervening (compare Figure 1.1).
Figure 1.6. View of an alveolar wall (in the frog) showing the dense network of
capillaries. A small artery (left) and vein (right) can also be seen. The individual capillary
segments are so short that the blood forms an almost continuous sheet.
Figure 1.7. Microscopic section of dog lung showing capillaries in the alveolar walls.
The blood-gas barrier is so thin that it cannot be identified here (compare Figure 1.1). This
section was prepared from lung that was rapidly frozen while being per used.
The extreme thinness of the blood-gas barrier means that the capillaries are easily
damaged. Increasing the pressure in the capillaries to high levels or infating the lung to high
volumes, for example, can raise the wall stresses of the capillaries to the point at which
ultrastructural changes can occur. The capillaries then leak plasma and even red blood cells into
the alveolar spaces.
The pulmonary artery receives the whole output of the right heart, but the resistance of
the pulmonary circuit is astonishingly small. A mean pulmonary arterial pressure of only about
20 cm water (about 15 mmHg) is required or a flow of 6 liter/min (the same flow through a soda
straw needs 120 cm water).
Blood-Gas Interface
Extremely thin (0.2 to 0.3 µm) over much of its area
Enormous surface area of 50 to 100 m2
Large area obtained by having about 500 million alveoli
So thin that large increases in capillary pressure can damage the barrier
Each red blood cell spends about 0.75 s in the capillary network and during this time
probably traverses two or three alveoli. So efficient is the anatomy or gas exchange that this brief
time is sufficient for virtually complete equilibration of oxygen and carbon dioxide between
alveolar gas and capillary blood.
The lung has an additional blood system, the bronchial circulation that supplies the
conducting airways down to about the terminal bronchioles. Some of this blood is carried away
from the lung via the pulmonary veins, and some enters the systemic circulation. The flow
through the bronchial circulation is a mere fraction of that through the pulmonary circulation,
and the lung can function fairly well without it, for example, following lung transplantation.
Blood Vessels
The whole of the output of the right heart goes to the lung.
The diameter of the capillaries is about 7 to 10 µm.
The thickness of much of the capillary walls is less than 0.3 µm
Blood spends about 0.75 s in the capillaries.
To conclude this brief account of the functional anatomy of the lung, let us glance at two
special problems that the lung has overcome.
STABILITY OF ALVEOLI
The lung can be regarded as a collection of 500 million bubbles, each 0.3 mm in
diameter. Such a structure is inherently unstable. Because of the surface tension of the liquid
lining the alveoli, relatively large forces develop that tend to collapse alveoli. Fortunately, some
of the cells lining the alveoli secrete a material called surfactant that dramatically lowers the
surface tension of the alveolar lining layer (see Chapter 7). As a consequence, the stability of the
alveoli is enormously increased, although collapse of small air spaces is always a potential
problem and frequently occurs in disease.
REMOVAL OF INHALED PARTICLES
With its surface area of 50 to 100 square meters, the lung presents the largest surface of
the body to an increasingly hostile environment. Various mechanisms for dealing with inhaled
particles have been developed (see Chapter 9). Large particles are filtered out in the nose.
Smaller particles that deposit in the conducting airways are removed by a moving staircase of
mucus that continually sweeps debris up to the epiglottis, where it is swallowed. The mucus,
secreted by mucous glands and also by goblet cells in the bronchial walls, is propelled by
millions of tiny cilia, which move rhythmically under normal conditions but are paralyzed by
some inhaled toxins.
The alveoli have no cilia, and particles that deposit there are engulfed by large wandering
cells called macrophages. The foreign material is then removed from the lung via the lymphatics
or the blood flow. Blood cells such as leukocytes also participate in the defense reaction to
foreign material.
KEY CONCEPTS
1. The blood-gas barrier is extremely thin with a very large area, making it ideal or gas
exchange by passive diffusion.
2. The conducting airways extend to the terminal bronchioles, with a total volume of about 150
ml. All the gas exchange occurs in the respiratory zone, which has a volume of about 2.5 to
3 liters.
3. Convective flow takes inspired gas to about the terminal bronchioles; beyond this, gas
movement is increasingly by diffusion in the alveolar region.
4. The pulmonary capillaries occupy a huge area of the alveolar wall, and a red cell spends
about 0.75 s in them.
CLINICAL VIGNETTE
A 50-year-old man, who has smoked two packs of cigarettes per day since the age of 18,
was well until a year ago when he developed hemoptysis (coughing up blood). At bronchoscopy
during which a lighted tube with a camera on the end was passed down into his airways, a mass
lesion was seen in the left main bronchus, the main airway supplying the left lung. When this
was biopsied, it was shown to be malignant. A computed tomography (CT) scan revealed that the
cancer had not spread. He was treated by left pneumonectomy in which the entire left lung was
removed.
When he was assessed 6 months later, the volume of his lung was found to be reduced by
one-third of the preoperative value. The ability of his lung to transfer gases across the blood-gas
barrier was reduced by 30% compared with the preoperative value. (This test is known as the di
using capacity or carbon monoxide and is discussed in Chapter 3.) The pulmonary artery
pressure was normal at rest but increased more during exercise than preoperatively. His exercise
capacity was reduced by 20%.
Why was lung volume reduced by only one-third when one of his two lungs was removed?
How can the 30% reduction in the ability of the blood-gas barrier to transfer gases be
explained?
Why did the pulmonary artery pressure increase more on exercise than preoperatively?
Why was the exercise capacity reduced?