Anatomy and physiology of respiratory system

The major organs of the respiratory system function primarily to provide oxygen
to body tissues for cellular respiration, remove the waste product carbon dioxide,
and help to maintain acid-base balance. Portions of the respiratory system are
also used for non-vital functions, such as sensing odors, speech production, and
for straining, such as during childbirth or coughing
This figure shows the upper half of the human body. The major organs in the
respiratory system are labeled.

Functionally, the respiratory system can be divided into a conducting zone and a
respiratory zone. The conducting zone of the respiratory system includes the
organs and structures not directly involved in gas exchange. The gas exchange
occurs in the respiratory zone.

Conducting Zone

The major functions of the conducting zone are to provide a route for incoming
and outgoing air, remove debris and pathogens from the incoming air, and warm
and humidify the incoming air. Several structures within the conducting zone
perform other functions as well. The epithelium of the nasal passages, for
example, is essential to sensing odors, and the bronchial epithelium that lines the
lungs can metabolize some airborne carcinogens.

The Nose and its Adjacent Structures

The major entrance and exit for the respiratory system is through the nose. When
discussing the nose, it is helpful to divide it into two major sections: the external
nose, and the nasal cavity or internal nose.

The external nose consists of the surface and skeletal structures that result in the
outward appearance of the nose and contribute to its numerous functions. The
root is the region of the nose located between the eyebrows. The bridge is the
part of the nose that connects the root to the rest of the nose. The dorsum nasi is
the length of the nose. The apex is the tip of the nose. On either side of the apex,
the nostrils are formed by the alae. An ala is a cartilaginous structure that forms
the lateral side of each naris (plural = nares), or nostril opening. The philtrum is
the concave surface that connects the apex of the nose to the upper lip.

Underneath the thin skin of the nose are its skeletal features (see Figure 2, lower
illustration). While the root and bridge of the nose consist of bone, the protruding
portion of the nose is composed of cartilage. As a result, when looking at a skull,
the nose is missing. The nasal bone is one of a pair of bones that lies under the
root and bridge of the nose. The nasal bone articulates superiorly with the frontal
bone and laterally with the maxillary bones. Septal cartilage is flexible hyaline
cartilage connected to the nasal bone, forming the dorsum nasi. The alar cartilage
consists of the apex of the nose; it surrounds the naris.

The nares open into the nasal cavity, which is separated into left and right
sections by the nasal septum (Figure 3). The nasal septum is formed anteriorly by
a portion of the septal cartilage (the flexible portion you can touch with your
fingers) and posteriorly by the perpendicular plate of the ethmoid bone (a cranial
bone located just posterior to the nasal bones) and the thin vomer bones (whose
name refers to its plough shape). Each lateral wall of the nasal cavity has three
bony projections, called the superior, middle, and inferior nasal conchae. The
inferior conchae are separate bones, whereas the superior and middle conchae
are portions of the ethmoid bone. Conchae serve to increase the surface area of
the nasal cavity and to disrupt the flow of air as it enters the nose, causing air to
bounce along the epithelium, where it is cleaned and warmed. The conchae and
meatuses also conserve water and prevent dehydration of the nasal epithelium by
trapping water during exhalation. The floor of the nasal cavity is composed of the
palate. The hard palate at the anterior region of the nasal cavity is composed of
bone.

The soft palate at the posterior portion of the nasal cavity consists of muscle
tissue. Air exits the nasal cavities via the internal nares and moves into the
pharynx.

Several bones that help form the walls of the nasal cavity have air-containing
spaces called the paranasal sinuses, which serve to warm and humidify incoming
air. Sinuses are lined with a mucosa. Each paranasal sinus is named for its
associated bone: frontal sinus, maxillary sinus, sphenoidal sinus, and ethmoidal
sinus. The sinuses produce mucus and lighten the weight of the skull.

The nares and anterior portion of the nasal cavities are lined with mucous
membranes, containing sebaceous glands and hair follicles that serve to prevent
the passage of large debris, such as dirt, through the nasal cavity. An olfactory
epithelium used to detect odors is found deeper in the nasal cavity.

The conchae, meatuses, and paranasal sinuses are lined by respiratory epithelium
composed of pseudostratified ciliated columnar epithelium (Figure 4). The
epithelium contains goblet cells, one of the specialized, columnar epithelial cells
that produce mucus to trap debris. The cilia of the respiratory epithelium help
remove the mucus and debris from the nasal cavity with a constant beating
motion, sweeping materials towards the throat to be swallowed. Interestingly,
cold air slows the movement of the cilia, resulting in accumulation of mucus that
may in turn lead to a runny nose during cold weather. This moist epithelium
functions to warm and humidify incoming air. Capillaries located just beneath the
nasal epithelium warm the air by convection. Serous and mucus-producing cells
also secrete the lysozyme enzyme and proteins called defensins, which have
antibacterial properties. Immune cells that patrol the connective tissue deep to
the respiratory epithelium provide additional protection.

Pharynx

The pharynx is a tube formed by skeletal muscle and lined by mucous membrane
that is continuous with that of the nasal cavities . The pharynx is divided into
three major regions: the nasopharynx, the oropharynx, and the laryngopharynx.

The nasopharynx is flanked by the conchae of the nasal cavity, and it serves only
as an airway. At the top of the nasopharynx are the pharyngeal tonsils. A
pharyngeal tonsil, also called an adenoid, is an aggregate of lymphoid reticular
tissue similar to a lymph node that lies at the superior portion of the
nasopharynx. The function of the pharyngeal tonsil is not well understood, but it
contains a rich supply of lymphocytes and is covered with ciliated epithelium that
traps and destroys invading pathogens that enter during inhalation. The
pharyngeal tonsils are large in children, but interestingly, tend to regress with age
and may even disappear. The uvula is a small bulbous, teardrop-shaped structure
located at the apex of the soft palate. Both the uvula and soft palate move like a
pendulum during swallowing, swinging upward to close off the nasopharynx to
prevent ingested materials from entering the nasal cavity. In addition, auditory
(Eustachian) tubes that connect to each middle ear cavity open into the
nasopharynx. This connection is why colds often lead to ear infections.

The oropharynx is a passageway for both air and food. The oropharynx is
bordered superiorly by the nasopharynx and anteriorly by the oral cavity. The
fauces is the opening at the connection between the oral cavity and the
oropharynx. As the nasopharynx becomes the oropharynx, the epithelium
changes from pseudostratified ciliated columnar epithelium to stratified
squamous epithelium. The oropharynx contains two distinct sets of tonsils, the
palatine and lingual tonsils. A palatine tonsil is one of a pair of structures located
laterally in the oropharynx in the area of the fauces. The lingual tonsil is located at
the base of the tongue. Similar to the pharyngeal tonsil, the palatine and lingual
tonsils are composed of lymphoid tissue, and trap and destroy pathogens
entering the body through the oral or nasal cavities.

The laryngopharynx is inferior to the oropharynx and posterior to the larynx. It

continues the route for ingested material and air until its inferior end, where the
digestive and respiratory systems diverge. The stratified squamous epithelium of
the oropharynx is continuous with the laryngopharynx. Anteriorly, the
laryngopharynx opens into the larynx, whereas posteriorly, it enters the
esophagus.

Larynx

The larynx is a cartilaginous structure inferior to the laryngopharynx that connects

the pharynx to the trachea and helps regulate the volume of air that enters and
leaves the lungs . The structure of the larynx is formed by several pieces of
cartilage. Three large cartilage pieces—the thyroid cartilage (anterior), epiglottis
(superior), and cricoid cartilage (inferior)—form the major structure of the larynx.
The thyroid cartilage is the largest piece of cartilage that makes up the larynx. The
thyroid cartilage consists of the laryngeal prominence, or “Adam’s apple,” which
tends to be more prominent in males. The thick cricoid cartilage forms a ring, with
a wide posterior region and a thinner anterior region. Three smaller, paired
cartilages—the arytenoids, corniculates, and cuneiforms—attach to the epiglottis
and the vocal cords and muscle that help move the vocal cords to produce
speech.

The epiglottis, attached to the thyroid cartilage, is a very flexible piece of elastic
cartilage that covers the opening of the trachea (see Figure 3). When in the
“closed” position, the unattached end of the epiglottis rests on the glottis. The
glottis is composed of the vestibular folds, the true vocal cords, and the space
between these folds (Figure 7). A vestibular fold, or false vocal cord, is one of a
pair of folded sections of mucous membrane. A true vocal cord is one of the
white, membranous folds attached by muscle to the thyroid and arytenoid
cartilages of the larynx on their outer edges. The inner edges of the true vocal
cords are free, allowing oscillation to produce sound. The size of the membranous
folds of the true vocal cords differs between individuals, producing voices with
different pitch ranges. Folds in males tend to be larger than those in females,
which create a deeper voice. The act of swallowing causes the pharynx and larynx
to lift upward, allowing the pharynx to expand and the epiglottis of the larynx to
swing downward, closing the opening to the trachea. These movements produce
a larger area for food to pass through, while preventing food and beverages from
entering the trachea.

Continuous with the laryngopharynx, the superior portion of the larynx is lined
with stratified squamous epithelium, transitioning into pseudostratified ciliated
columnar epithelium that contains goblet cells. Similar to the nasal cavity and
nasopharynx, this specialized epithelium produces mucus to trap debris and
pathogens as they enter the trachea. The cilia beat the mucus upward towards
the laryngopharynx, where it can be swallowed down the esophagus.

Trachea

The trachea (windpipe) extends from the larynx toward the lungs (Figure 8a). The
trachea is formed by 16 to 20 stacked, C-shaped pieces of hyaline cartilage that
are connected by dense connective tissue. The trachealis muscle and elastic
connective tissue together form the fibroelastic membrane, a flexible membrane
that closes the posterior surface of the trachea, connecting the C-shaped
cartilages. The fibroelastic membrane allows the trachea to stretch and expand
slightly during inhalation and exhalation, whereas the rings of cartilage provide
structural support and prevent the trachea from collapsing. In addition, the
trachealis muscle can be contracted to force air through the trachea during
exhalation. The trachea is lined with pseudostratified ciliated columnar
epithelium, which is continuous with the larynx. The esophagus borders the
trachea posteriorly.

The top panel of this figure shows the trachea and its organs. The major parts
including the larynx, trachea, bronchi, and lungs are labeled.

Bronchial Tree
The trachea branches into the right and left primary bronchi at the carina. These
bronchi are also lined by pseudostratified ciliated columnar epithelium containing
mucus-producing goblet cells (Figure 8b). The carina is a raised structure that
contains specialized nervous tissue that induces violent coughing if a foreign
body, such as food, is present. Rings of cartilage, similar to those of the trachea,
support the structure of the bronchi and prevent their collapse. The primary
bronchi enter the lungs at the hilum, a concave region where blood vessels,
lymphatic vessels, and nerves also enter the lungs. The bronchi continue to
branch into bronchial a tree. A bronchial tree (or respiratory tree) is the collective
term used for these multiple-branched bronchi. The main function of the bronchi,
like other conducting zone structures, is to provide a passageway for air to move
into and out of each lung. In addition, the mucous membrane traps debris and
pathogens.

A bronchiole branches from the tertiary bronchi. Bronchioles, which are about 1
mm in diameter, further branch until they become the tiny terminal bronchioles,
which lead to the structures of gas exchange. There are more than 1000 terminal
bronchioles in each lung. The muscular walls of the bronchioles do not contain
cartilage like those of the bronchi. This muscular wall can change the size of the
tubing to increase or decrease airflow through the tube.

Respiratory Zone

In contrast to the conducting zone, the respiratory zone includes structures that
are directly involved in gas exchange. The respiratory zone begins where the
terminal bronchioles join a respiratory bronchiole, the smallest type of bronchiole
which then leads to an alveolar duct, opening into a cluster of alveoli.
Alveoli

An alveolar duct is a tube composed of smooth muscle and connective tissue,

which opens into a cluster of alveoli. An alveolus is one of the many small, grape-
like sacs that are attached to the alveolar ducts.

An alveolar sac is a cluster of many individual alveoli that are responsible for gas
exchange. An alveolus is approximately 200 μm in diameter with elastic walls that
allow the alveolus to stretch during air intake, which greatly increases the surface
area available for gas exchange. Alveoli are connected to their neighbors by
alveolar pores, which help maintain equal air pressure throughout the alveoli and
lung. The alveolar wall consists of three major cell types: type I alveolar cells, type
II alveolar cells, and alveolar macrophages. A type I alveolar cell is a squamous
epithelial cell of the alveoli, which constitute up to 97 percent of the alveolar
surface area. These cells are about 25 nm thick and are highly permeable to gases.
A type II alveolar cell is interspersed among the type I cells and secretes
pulmonary surfactant, a substance composed of phospholipids and proteins that
reduces the surface tension of the alveoli. Roaming around the alveolar wall is the
alveolar macrophage, a phagocytic cell of the immune system that removes
debris and pathogens that have reached the alveoli.

The simple squamous epithelium formed by type I alveolar cells is attached to a

thin, elastic basement membrane. This epithelium is extremely thin and borders
the endothelial membrane of capillaries. Taken together, the alveoli and capillary
membranes form a respiratory membrane that is approximately 0.5 mm thick.
The respiratory membrane allows gases to cross by simple diffusion, allowing
oxygen to be picked up by the blood for transport and CO2 to be released into the
air of the alveoli.