By – Dr.

Sushma
Dr. Ashwini
Guided by- Dr. Korde mam
 Respiratory System Functions
1. Supplies the body with oxygen and disposes of carbon
dioxide
2. Filters inspired air
3. Produces sound
4. Clears the body from excess water and heat
5. Control blood pH
 Breathing
• Breathing (pulmonary ventilation) consists of two cyclic
phases:
• Inhalation, also called inspiration - draws gases into the
lungs.
• Exhalation, also called expiration - forces gases out of
the lungs.
 Respiratory events
• Pulmonary ventilation = exchange of gases between
lungs and atmosphere
• External respiration = exchange of gases between
alveoli and pulmonary capillaries
• Internal respiration = exchange of gases between
systemic capillaries and tissue cells
 Muscles of Respiration
 INSPIRATION  EXPIRATION
• Active process • Passive process
• Diaphragm(major)+
• Accessory • Required for forcef
muscles: expiration(exercise
• External intercostal
muscle. 1. Rectus abdominus
• Scalene muscle.
2. Transverse
• Sternocleidomastoi
d. abdominus .
3. Internal intercosta
 Compliance
• Distension of lung is also called compliance.
• Lung is considered like a spring: High amount of
distension opposing forces of compliance:
• Surface tension
• Elastic recoil
• Normal compliance of lung=200ml/cmH20
• Compliance(c)=change in volume/change in pressure
• Compliance is inversely proportional to 1/Elastance
 Emphysema:
 Decrease in elastance Increased
compliance over distension of lung
 Chest radiograph: Hyperinflation of lung
 When lung is stiff Less distensible
Compliance decreases
 Eg: In restrictive lung diseases like
 Pulmonary fibrosis
 Interstitial lung diseases
 Compliance curve
• Relationship between inspiration and expiration:
 Hysteresis: Direction of inspiration is opposite to
the direction of expiration.
Hysteresis is due to surface tension forces which
is modulated by surfactant.
 As a change in volume is more during expiration,
compliance is greatest during expiration.
 Lung Volumes
• MINUTE VENTILATION (MV): MV 12 breaths/min 500mL
/breath = 6 liters/min. total lung capacity- Volume in the
lungs at maximal inflation
• TIDAL VOLUME (TV): Volume inspired or expired with
each normal breath = 500ml
• INSPIRATORY RESERVE VOLUME (IRV): Maximum
volume that can be inspired over the inspiration of a tidal
volume/normal breath. Used during exercise/exertion =
Male 3100/Female 1900ml
Cont-
• EXPIRATORY RESERVE VOLUME (ERV): Maximal
volume that can be expired after the expiration of a tidal
volume/normal breath = Male 1200ml/ Female 700 ml
• RESIDUAL VOLUME (RV): Volume that remains in the
lungs after a maximal expiration Male 1200 ml/ Female
1100ml
• Inspiratory capacity is the sum of tidal volume and
inspiratory reserve volume, IRV + TV (500 ml 3100 ml
3600 ml in males and 500 ml 1900 ml 2400 ml in
females).

• Functional residual capacity is the sum of residual

volume and expiratory reserve volume, ERV + RV (1200
ml 1200ml 2400 ml in males and 1100 ml 700 ml 1800 ml
in females).
Vital capacity is the sum of inspiratory reserve
volume, tidal volume, and expiratory reserve volume,
IRV + TV + ERV = IC + ERV (4800 ml in males and
3100 ml in females).

Total lung capacity is the sum of vital capacity and

residual volume IRV + TV + ERV + RV = IC + FRC
(4800 ml 1200 ml 6000 ml in males and 3100 ml
1100 ml 4200 ml in females).
 VENTILATION
Tidal Ventilation(vT=500ml)

• Dead Space Ventilation: In • Alveolar Ventilation: In

conducting airways. No alveoli for gas exchange
gas exchange vD=150ml VA=350ml
 Dead Space Ventilation
Dead Space Ventilation is of Three types:
1. Anatomical dead space(ADS): In conducting airways
(trachea, bronchi) ADS=150ml
2. Alveolar dead space(ALVDS): Always pathological,
absent in healthy individuals.
3. Physiological dead space(PDS):
PDS=ADS+ALVDS. Also called as Total dead space.
In healthy individuals, ADS PDS=TSOMT(since alveolar
dead space is zero)
 Blood Perfusion
• Pulmonary circulation/min: 5L/min(Entire right
heart output: Deoxygenated blood).
• Pulmonary circulation is highly distensible(high
compliance low pressure circulation).
• PA: Alveolar pressure,Pa: Arterial pressure
• PV: Venous pressure.
• Zone1: PA>Pa>Pv
Blood vessels compressed Apex of lung
Zone of no blood flow
• Zone2: Pa>PA>Pv
Intermittent flow(waterfall
effect)
Middle region of lung
• Zone3: Pa>PV>PA
Continuous flow(maximum
blood flow)Base of the lung
 Ventilation Perfusion Ratio
• It’s the ratio of alveolar ventilation to blood flow in lung.
• Ventilation perfusion mismatch will lead to diseases.
• Normal V/Q ratios
• V/Q ratio: = 4L/min/5L/min = 0.8 (normal V/Q ratio).
• Normal V/q ratios:
• Apex of Lungs : 3.2 (highest ratio)
• Alveoli are big.
• Less compliant.
• Fall in Perfusion>Ventilation.
• Less gas exchange (high PaO2,Low PCO2).
• Mycobacterium tuberculosis flourishes in this area.
• Middle of lungs 0.8.

• Base of lungs :0.6 (lowest Ratio).

• Small alveoli.
• Highly compliant.
• Increase in perfusion is more than ventilation
• Region of maximum blood flow
 V/Q = Zero(v= 0, no V/Q = Infinity(q= 0,no
air) blood flow)

1. Only blood is present : 1. Only air is present :

Shunt blood. Anatomical Dead
2. Pathologically, collapsed Space(ADS).
airway : Due to foreign 2. Pathologically
body obstruction. obstructed vessel : Due
to pulmonary embolism.
 Diffusion of Gases
• It is a passive process, no need for ATP.
• It is the simplest of all the transport processes, hence
called simple diffusion.
• According to Fick’s law, diffusion(D) α concentration
gradient i.e., gases move from high concentration to low
concentration.
• The area of the respiratory membrane is very
important, as it is available surface area for
diffusion, therefore , D α area

• Dα

• Dα
 Transport of Gases
• Oxygen Transport • CO2 Transport

• Major Form: O2 Combined • Major Form:

with Hb(97%) Bicarbonate form(70%)
• Minor Form: • Minor form :
Dissolved form (3%) CO2 combined with Hb
(30%)
 Oxygen Transport
• Oxygen does not dissolve in water, so only about 1.5% of inhaled O 2 is dissolved in blood
plasma, which is mostly water.
• About 98.5% of blood O2 is bound to hemoglobin in red blood cells.
• Each 100ml of oxygenated blood contains the equivalent of 20ml of gaseous O 2.
• The heme portion of hemoglobin contains four atoms of iron .
• Each capable of binding to a molecule of O2. The
98.5% of the O2 that is bound to hemoglobin.
• Oxygen and hemoglobin bind in an easily reversible
reaction to form oxyhemoglobin. O2 +Hgb=4Hgb O2
• As blood flows through tissue capillaries the iron-
oxygen reaction reverses.
• Hemoglobin releases oxygen, which diffuses first into
the interstitial fluid and then into cells.
 Factors Affecting the Affinity of
Hemoglobin for Oxygen
• Although PO2 is the most important factor that determines
the percent O2 saturation of hemoglobin. The following
four factors affect the affinity of hemoglobin for O2 .
1. Acidity(pH).
2. Partial pressure of carbon dioxide.
3. Temperature.
4. 2,3 - biphosphoglycerate (BPG).
 Acidity
• As acidity increases (pH decreases), the affinity of
hemoglobin for O2 decreases and O2 dissociates more
readily from hemoglobin.
• When H+ ions bind to amino acids in hemoglobin, they
alter its structure slightly, decreasing its oxygen-carrying
capacity. Thus, lowered pH drives O2 off hemoglobin,
making more O2 available for tissue cells.
 Partial pressure of Carbon Dioxide
• CO2 enters the blood it is temporarily converted to
carbonic acid (H2CO3).
• It dissociates and form hydrogen ions and bicarbonate
ions. So in red blood cells the H+ concentration
increases, pH decreases.
• Thus and increased PCO2 produces a more acidic
environment, which helps release O2 from Hemoglobin.
• CO2 + H2O
 Temperature
• Heat is a by-product of the metabolic reactions of all cells,
and the heat released by contracting muscle fibers tends
to raise body temperature.
• Metabolically active cells require more O2 and liberate
more acids and heat.
 2,3- biphosphoglycerate (BPG)
(Diphosphoglycerate)

• BPG is formed in red blood cells when they break down

glucose to produce ATP in a process called glycolysis.
When BPG combines with hemoglobin, it unloads or
decreases the bonding with oxygen.
 O2-Hb Dissociation Curve
• Right Shift
• Causes – Hypoxia--- increased CO2 (Hypercarbia)---
Increased H+ (Acidosis)
• Release of O2 at the level of tissues leading to Right Shift
–BOHR’S EFFECT
• Other causes-
• High altitude
• Exercise
• Increased 2, 3 DPG
• LEFT SHIFT
• In lungs, loading of O2 leading to unloading of CO2-
HALDANES EFFECT
• Causes- Hypocarbia---reduced H+ (Alkalosis)
• CO poisoning
• HbF
• Stored blood
 CO2 Transportation

• Normal resting conditions, each 100 mL of deoxygenated

blood contains the equivalent of 53mL of gaseous CO2 ,
which is transported in the blood in three main forms.

• Dissolved CO2, the smallest percentage- about 7% - is

dissolved in blood plasma. On reaching the lungs, it
diffuses into alveolar air
Carbamino compounds:- About 23% of CO2, combines
with the amino groups of amino acids and proteins in blood
to form carbamino compounds. The main CO2 binding sites
are the terminal amino acids in the two alpha and two beta
globin chains . Hemoglobin that has bound CO2 is termed
carbaminohemoglobin(Hb-CO2):
Hb + CO2 Hb-CO2
hemoglobin carbon dioxide carbaminohemoglobin
• 3. Bicarbonate ions. The greatest percentage of
CO2 about 70% --is transported in blood plasma as
-
bicarbonate ions(HCO3 ).

• CO2 diffuses into systemic capillaries and enters red

blood cells, it reacts with water in the presence of
the enzyme carbonic anhydrase (CA) to form
+ -
carbonic acid, which dissociates into H and HCO3 .
 Neural
Regulation of
Respiration
 Brain area and Functions
• Pre Botzinger Complex :Pacemaker – Rhythm
Generation
• Pneumotaxic center : Limits inspiration(inhibits
apneustic center).Controls respiratory rate.
• Apneustic center : Prolongs inspiration.
• Dorsal Respiratory group(DRG):Generates RAMP
signal for smooth rise in tidal volume during inspiration.
• Ventral respiration group(VRG) :Controls forceful
expiration during exercise.
 Chemical Regulation Of Respiration
• Chemoreceptors – Chemical control :
• Central Chemoreceptors : In ventral surface of medulla
sensitive to high Pco2 in Blood.
Directly stimulated by CSF H+ ions.
• Peripheral chemoreceptors : In Carotid and Aortic bodies.
sensitive to low PO2 (Hypoxia)>
Have oxygen sensors (Glomus cells).
• Common Stimuli to both chemoreceptors: Rise in H+ ions.
Chemoreceptor activation : Chemoreflex.
Cause hyperventailation to lower PCO2, H+ and rise PO2.
 PULMONARY FUNCTION TEST
Pulmonary function tests(PFTs) are a group of tests
that measures how well your lungs works, how well
the lungs take in and exhale air, and how efficiently
they transfer oxygen into the blood.
• PFT or LFT are useful on assessing the functional
status of the respiratory system both in
physiological and pathological condition.
• It is based on the measurements of volumes of air
breathed in and out in normal breathing and forced
breathing.
• It is carried out by using a spirometer
 Spirometry
• It is an Instrument for measuring the air capacity of the lungs
• Measurement of the pattern of air in and out of the lungs during ventilation
• Spirometer is used to measure the air flow, ventilatory regulation , and lung
volume during a forced expiratory maneuver from full inspiration .
 PFT procedure
• Forced expiratory maneuver is the common clinical
approach
• Results are found in patients chart/monitor
• Common spirometric values are FEV1 and FVC
FEV1/FVC ratio.
• Lung volume and peak expiratory flow rate (PEF or
PEFR) are measured to differentiate obstructive or
restrictive problems
• Forced expiratory flow (FEF)
 Forced expiratory volume in
1second(FEV1)
• FEV1 is the volume of air that can forcibly be blown out in
one second, after full inspiration.
• Average values for FEV1 in healthy people depend mainly
on sex and age height and mass.
• Values between 80% and 120% are considered normal.
 FVC and Ratio
• Forced vital • FEV1/FVC ratio(FEV1%)
capacity(FVC)

• Forced vital capacity is the • FEV1/FVC(FEV1%) is the

volume of air that can ratio of FEV! To FVC in
forcibly be blown out after healthy adults this should
full inspiration be approximately 75-80%
 Forced expiratory flow (FEF)
• Forced expiratory flow is the flow ( or speed ) of air
coming out of the lung during the middle portion of a
forced expiration.
• Generally defined by fraction, the usual intervals are
25%,50% and 75% (FEF25,FEF50 and FEF75)
 Identify an obstructive problem
• Obst : disorders (asthma, copd) air flow reduces because
of narrowing of air ways
• FEV1 is reduced
• Spirogram is continued to 6sec to empty lung FVC also
reduced because gas is trapped behind the obstructed
bronchi
• Cardinal feature of obstructive defect is reduction in the
FEV1/FVC ratio
• In obstructive diseases (asthma, COPD, chronic
bronchitis, emphysema) FEV1 is diminished because of
increased airway resistance to expiratory flow.
• The FVC may be decreased due to the premature closure
of airway in expiration
• This generates a reduced value(<80%, often 45%).
60 - 80 % - mild
40 - 60 % - moderate
< 40% - severe obstructions
 Restrictive problem
• Restrictive disorders can be cause by disease of the lung
parenchyma (lung fibrosis) and chest wall
disease(kyphoscoliosis)
• This prevent the full expansion of the lungs therefore FVC
maybe reduced
• FEV1 will increased because of the stiffness of the fibrotic
lungs increases the expiratory pressure
• Hence expired air comes out very quickly resulting with a
high FEV1/FVC ratio
THANK YOU