RESPIRATORY

SYSTEM

MONICA LAISHRAM
FACULTY OF NURSING, ADTU
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 TERMINOLOGY
• RESPIRATION
• LARYNX
• DYSPNEA
• CYANOSIS
• MUCOCILARY ESCALATOR
 ORGANS OF
RESPIRATION
• NOSE
• PHARYNX
• LARYNX
• TREACHEA
• BRONCHI AND BRONHIOLES
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 NOSE
• The right halves and left halves of
the nose is called dorsum.
• The lower end of the dorsum is
round and is known as tip of nose.
• The two nostrils are separated by
a soft median, columella. This is
continous with nasal septum.
• Each nostril is bounded laterally
by ala.
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 Function of Nose
• It is a respiratory passage
• It is also the organ of smell.
• The secretion of numerous serous
glands make the air moist, while
secretion of mucous glands trap
dust and other particles. Thus the
nose acts as an air conditioner
where the inspired air is warmed,
moistened and cleaned before it is
passed onto the delicate lungs.
 Paranasal sinuses
• Paranasal sinuses are air filled
spaces present within some
bones around the nasal cavities.
• The sinuses are frontal, maxillary,
sphenoidal and ethmoidal
• All of them opened to nasal cavity.
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 Function of paranasal
sinus
• Make the skull lighter
• Warm up and humidify the inhaled
air
• These also add resonance to the
voice

• Infection of the sinus is known as

sinusitis.
• Types: Acute sinusitis and chronic
sinusitis
• Acute: two or more symptoms
• Chronic : Symptoms for 12 weeks
or more
• Common cold, allergies, nasal
polyps, asthma, nasal septal
deviation.
• Management: Decongestants and
saline nasal washes, antibiotic ,
steam inhalation
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• Rhinitis: Coryza is the
inflammation of the mucous
membrane inside the nose.
Common symptoms are stuffy
nose, runny nose, sneezing, post
nasal drip. Caused by viruses,
bacteria, irritants or allergens
• Can be managed with intranasal
corticosteroids and intranasal
anti histamines.
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 PHARYNX
• The pharynx is a wide muscular
tube, situated behind the nose, the
mouth and the larynx.
• Clinically it is a part of the upper
respiratory passages are common.
• Parts of pharynx:
• The nasal part: Nasopharynx
• The oral part: Oropharynx
• The laryngeal part: Laryngopharynx
• Inflammation of pharynx is known as
pharyngitis.
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• The upper part of the pharynx
transmits only air, the lower
part only foods but the middle
part is a common passage for
both air and food.
• The nasopharynx part
pharynx is connected to the
middle ear via the
pharyngotympanic tube.
• The eustachian tube (
pharyngotympanic tube) connects
the middle ear cavity with the
nasopharynx
• The eustachian tube connects the
middle ear and clears mucus from
the middle ear into nasopharynx.
• Opening and closing of the tube is
important.
• Normal opening equalizes the
atmospheric pressure in the
middle ear: closing of the tube
protects the middle from
unwanted pressure fluctuations
and loud sounds
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• The tube opens when you yawn or
swallow due to contraction of
tensor veli palatini muscles.
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• Boundaries:
• Superiorly: Base of the skull
• Inferiorly: The pharynx is continuous
with esophagus at the level of the 6 th
cervical vertebra.
• Posteriorly: The pharynx glides
freely on the pre vertebral fascia
which separates it from the cervical
vertebral bodies
• Anteriorly: It communicates with the
nasal cavity, the oral cavity and the
larynx.
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Nasopharynx: It is the upper most
part of pharynx. The Eustachian
tube is at the lateral wall. This
tube equalizes the pressure on
the two sides of the tympanic
membrane.
• Air passes from nasopharynx into
the larynx. Air and fluids/food
cross each other in to the
oropharynx
• If one shouts or laugh while
eating or drinking , the fluids may
enter the larynx.
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• This produces a protective
bout of cough as food/fluid is
forbidden inside the larynx/
treachea
 Oropharynx
• Lies behind oral cavity C2, C3
vertebrae. It extends between
soft palate above to the upper
border of epiglottis below.
• Oropharynx communicates
anteriorly with oral cavity; above
with nasopharynx and below with
larynopharynx .
• It gives passage both to air and
food/fluid
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 LARYNGOPHARYNX
• It lies behind larynx opposite
to the C5 and C6 vertebrae.
• It extends between epiglottis
and cricoid cartilage and
anteriorly it is in the inlet of
larynx.
• It gives passage only to
food/fluids.
 WALDEYER’S LYMPHATIC
RING
• It is a ringed arrangement of
lymphoid organs in the pharynx.
• It surrounds the naso and
oropharynx with tonsilar tissue
located above and below the soft
palate.
 STRUCTURE
• 1 pharyngeal tonsil
• 2 tubal tonsils on each side
• 2 palatine tonsils (tonsil)
• Lingual tonsil
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CLINICAL SIGNIFICANCE
• Inflammation of tonsil is known as
tonsillitis.
• Removal of tonsil is known as
tonsillectomy.
FUNCTIONS OF PHARYNX
• Gives passage for air, foods and
fluids
• Warms/ cools and humidified
inspired air
• Helps in speech as it causes
resonance in voice
• Helps in hearing
• Protects the lymphoid tissue
forming waldeyer ring
LARYNX
 LARYNX
• The larynx lies in the anterior
midline of the neck, extending
from the root of the tongue to
the trachea.
• The length of the larynx is 44
mm in male and 36 mm in
females.
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• At puberty, the male larynx
grows rapidly and becomes
larger ( adam’s apple) which
makes voice louder and low
pitched.
• In adult male, it lies in front of
the third to sixth cervical
vertebrae.
• In children and adult female, it
lies at a little higher level ( C1
to C4)
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• The larynx is made up of
skeletal framework of
cartilages. The cartilages are
connected by joints, ligaments
and membranes.
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CARTILAGES OF LARYNX
• The larynx
contains nine
cartilages, of
which three
are unpaired
and three are
paired.
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• Paired cartilages:
• Arytenoid cartilage
• Corniculate
• Cuneiform

• Unpaired cartilage:
• Thyroid cartilage
• Cricoid cartilage
• Epiglotic
 CAVITY OF LARYNX
Within the cavity of larynx, there
are two folds of mucous
membrane on each side.
The upper fold is the vestibular fold
and the lower fold is the vocal fold
The space between the right and
left vestibular folds is the rima
vestibuli
The space between the vocal folds
is the rima glottidis.
 FUNCTION OF LARYNX
• Acts as sphincter for lower
respiratory passage
• Produces voice/ sound
TRACHEA
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• The trachea is a non
collapsible , wide tube
forming the beginning of the
lower respiratory passage due
to C shaped cartilaginous ring
• The posterior wall of trachea
is deficient of cartilage. This
is made of muscles and
fibrous tissue for expansion of
the esophagus during passage
of food.
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• The trachea is about 10-15 cm
long. Its upper half lies in the
neck and its lower half in the
superior mediastinum.
• The diameter is about 2 cm in
male and 1.5 cm in female.
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• The trachea is supplied by
branches from the inferior
thryroid arteries. Its vein drain
into the left brachiocephalic
vein.
• Lymphatic drain into the pre
tracheal and para tracheal
nodes.
HISTOLOGY OF TRACHEA
• The trachea is lined by pseudo
stratified ciliated columnar
epithelium. The cells are of
varying height, giving a false
appearance of more than a layer
of cells.
• Deep to the epithelium are mucus
and serous glands.
• The main bulk is formed by the C
shaped hyaline cartilages to keep
it permanently patent.
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FUNCTION OF C SHAPED CARTILAGE:
C shaped cartilage keep the airway
patent.
The smooth muscles joining 2 ends
of c helps the esophagus to dilate
during the passage of bolus.
These provide flexibility to trachea
Ciliary escalator helps to remove
the mucus swallowed into
laryngopharynx or expectorated.
 COUGH REFLEX
• If irritated, the nerve endings in
larynx, trachea, bronchi pass
impulses by 10th nerve to
respiratory center in brain stem.
• There is deep inspiration, closure
of vocal cords, contraction of
abdominal and thoracic
respiratory muscles and the
increased pressure in lungs leads
to abduction of vocal cords to
expel the irritant through mouth.
 LUNGS
• Lungs are two voluminous
cone shaped organs
occupying most of the
thoracic cavity leaving a small
space for the heart.
• Each lung cavity is enclosed
within pleural cavity which
contain serous fluid which
helps in expansion and
contraction of lungs.
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• Pleura: It is a closed
serous sac which encloses
the lungs. It has two
layers, parietal pleura and
visceral pleura.
• The pleural fluid prevent
friction during breathing.
PARTS OF LUNGS
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• Apex: It is rounded and rise
into the root of neck about 2.5
cm above the level of the
middle third of clavicle.
• Base: It is the concave part
related with diahpragm.
• Costal surface: It is the
surface related with ribs,
intercostal muscles.
• Mediastinal surface: It is
related to the hilum.
 Right lung vs left lung
• It has 2 • It has 1 fisure
fissures and 3 and 2 lobes
lobes • Smaller and
• Larger and lighter ,
heavier, weighs about
weighs about 600 gms
700 gms • Longer and
• Shorter and narrower
broader • Anterior
• Anterior border is
border is interrupted by
straight cardiac notch
 PORTION OF LUNGS
• Lungs are made up of two
portions, a conducting portion
and respiratory portion
• CONDUCTING PORTION: The
primary bronchus enters the
lung at the hilum.
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• In the right lung it divides into
three secondary bronchi for each
three lobes i.e upper, middle and
lower separated by obligue and
horizontal fissures.
• The three secondary bronchi are
divided into 10 segmental bronchi.
• Left lung contains two lobes that
is upper lobe and lower lobe
separated by oblique fissures.
Therefore there are only two
secondary bronchi. There are 10
segmental bronchi in upper and
lower lobe
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• Each segmental bronchus divides
repeatedly till its diameter
becomes 1.0 mm.
• At this level it is called terminal
bronchiole, with no cartilage.
• RESPIRATORY PORTION: terminal
bronchiole divides further and
forms respiratory bronchiole,
alveolar sac and finally the
alveoli. Here the wall becomes
thinner.
• Alveoli are lined by two types of
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• There are as many as 700 million
alveoli in each lungs, where they
facilitate gaseous of oxygen and
carbon dioxide exchange.
• Type 1 pneumocytes
• Types 2 pneumocytes which
secretes fluid called surfactant
which prevent the alveoli from
collapsing by decreasing surface
tension
 PULMONARY
• SURFACTANT
Because of the huge force of
surface tension in the lungs, the
airway may collapse after
expiration.
• It can further can make re-
inflation during inspiration much
more difficult.
• So the type II pneumocytes
secrete a substance called
SURFACTANT to reduce the force
of surface tension due to water
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• The fetus in the womb receives
oxygen from the mother. The
lungs of the fetus are not fully
functional, the lungs don’t
produce surfactant until 35 weeks
of fetal development.
• This is the reason that premature
newborn infants are at an
increased risk of respiratory
distress syndrome due to airway
collapse
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• It could be fetal and result in
dead.
• This can be treated through
pulmonary surfactant
replacement therapy and
mechanical ventilation.
• Collapse of the lungs is known as
atelactasis.(complete or partial
collapse of a lung or section of
(lobe)
• Anaesthesia, blockage of air
passage (bronchus or
 MUSCLES OF
RESPIRATION
• For quiet inspiration,
daiphragm, external
intercostal muscles.
• Deep inspiration – erector
spinae, scalene muscles,
pectoral muscles.
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 PULMONARY
VENTILATION
• It is the movement of air in
and out of alveoli
• It is the process of flow of air
into the lungs during
inspiration and out of the
lungs during expiration
• Air flows because of pressure
differences between the
atmosphere and the gases
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• The primary function of
pulmonary ventilation is to make
oxygen available to the blood,
which is transported by the
cardiovascular system throughout
the body to all the cells
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• Air like other gases, flows from a
region with higher pressure to a
region with lower pressure.
• Involves 3 pressures
• Atmospheric pressure: pressure
of air outside the body
• Intraalveolar (intrapleural
)pressure: pressure within the
alveoli.
• Intrapleural pressure: pressure
within the pleural cavity
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• During inspiration, the diaphragm
contracts and the thoracic cavity
increases its volume. This
decreases the intraalveolar
pressure so that air flows into the
lungs.
• During expiration, the relaxation
of the diaphragm and elastic
recoils of the tissues decreases
the thoracic volume and increases
the intraalveolar pressure. This
pushes the air out of the lungs.
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 PHYSIOLOGY OF
RESPIRATION
• The respiratory cycle consists of
inspiration, expiration and
diffusion of gases. In normal quite
breathing, there are about 15
complete respiratory cycles per
minutes, i.e respiratory rate of
normal adult is 12-16
breathes/minute.
 Respiratory movements
• The anteroposterior diameter is
increased
• The transverse diameter is
increased
• The vertical diameter is increased
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• Before inspiration, intrapulmonary
pressure equals atmospheric
pressure at about 760 mmHg
 PULMONARY
CIRCULATION
• Pulmonary circulation moves
the blood between the heart
and the lungs. It transport
deoxygenated blood to the
lungs to absorb oxygen and
release CO2. The oxygenated
blood the flows back to the
heart.
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• Pulmonary artery
divides into two,
each branch
carrying
deoxygenated
blood to the lungs.
Within the lung
tissues, the
pulmonary artery
divides and
redivides into
dense capillary
network around
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• The pulmonary circulation
begins at the pulmonary valve,
making the vascular exit from
the right side of the heart and
extends to the orifices of the
pulmonary veins in the wall of
left atrium, which marks the
entrance into the left side of
the heart.
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• The pulmonary circulation is
supplied with both sympathetic
and para symphathetic
innervation
• The exchange of gases between
air in the alveoli and the blood in
the capillaries takes place
• Capillaries join up to form
pulmonary veins in each lung.
They leave the hilum and carry
oxygenated blood to heart.
 REGULATION OF
RESPIRATION
• Physiologically, the respiration is
controlled by respiratory center –
group of neurons present bilaterally
in medulla oblongata and pons.
• Respiratory control is an involuntary
process.
• The respiratory center: The
respiratory center is formed by
group of nerve cells( medulla
oblongata and pons) which controls
the rate and depth of respiration.
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• The active inspiratory center
nerves to the inspiratory
muscles, the phrenic nerve to
the diaphragm and intercostal
nerves to the external
intercostal muscles. These
muscles contract and lead to
expansion of the thorax and
the air is drawn into the lungs.
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• When the inspiratory center
neurons are not active, the
stimulus to the muscles stops and
the muscles relax. At this point
expiration occurs passively. This
rhythmic pattern continues till
any other stimulus affects the
neurons of inspiratory center.
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Chemical control: Irritant receptors:
These are present between the
epithelial cells. These receptors get
stimulated by irritant gases or dust
particles. Activation of receptors
causes coughing and increased
mucus secretion
• Chemoreceptors: In the body, few
receptors are present which respond
to changes in PH, pO2 and pCO2. The
sensitivity of chemoreceptors to
raised arterial CO2 concentration is
most important factor in maintaining
homeostasis of blood gases.
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The chemoreceptors are located in
the medulla oblongata. They
monitor the level of CO2 and O2.
The types of chemoreceptors are
peripheral chemoreceptors and
central chemoreceptors:
The peripheral chemoreceptors are
present in the aortic bodies(
located in the arch of aorta) and
carotid bodies( located at
common carotid artery).
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• They are sensitive to change in
H+, PCO2 and PO2 in blood. Nerve
impulses from the peripheral
chemoreceptors are conveyed by
the glossopharyngeal and vagus
nerves to the medulla. It
stimulates the respiratory center.
The result is immediate increase
in the depth and rate of
respiration.
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• The central chemoreceptors:
They are present on the surface
of medulla oblongata. They
respond to changes in PCO2 and
H+ in CSF. These respond by
stimulating the respiratory center.
They increases the ventilation of
lungs and reduce arterial PCO2 .
This control normal blood gas
levels.
 OTHER FACTORS THAT
INFLUENCE RESPIRATION
• Limbic system: Emotional anxiety or
anticipation of activity, both may stimulate the
limbic system. This ends the input to the
inspiratory center. It increases the rate and
depth of ventilation.
• Blood pressure: The carotid and aortic sinuses
contain baroreceptors. It detects the change in
blood pressure. It also affects respiration.
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• For example, increase in blood
pressure decreases the
respiration. Decrease in blood
pressure increases respiration.
• Temperature: Increase in body
temperature will increase the rate
of respiration. A decrease in body
temperature decreases the
respiratory rate.
• Pain: sudden, severe pain causes
apnea. Prolonged pain results in
increase of respiratory rate.
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• Irritation of airway:
Mechanical irritation of the
pharynx or larynx stoppage of
breathing for a while. It leads
to coughing or sneezing
• Stretching of the anal
sphincter muscle: This
increases the respiratory rate.
 LUNG VOLUMES AND
CAPACITIES
• Lung volume is the static volume
of air breathed by an individual i.e
volume of air present in lung
under specific position of the
thorax. Lung volumes depends on
age, weight and gender and body
position. When two or more
volumes combine this is called
capacity.
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• Dead space: It is constituted
by air, which doesn’t
participate in diffusion,i.e air
present in nose, trachea and
bronchial tree. Normally it is
150 ml.
• Tidal volume: Volume of gas
inspired or expired in each
breath during normal quiet
respiration. It is 400-500 ml.
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• Alveolar ventilation: It is the
volume of air that moves into and
out of alveoli per minutes.
Alveolar ventilation: Tidal volume-
anatomical dead
space)*respiratory rate
500-150*15=5.25L/min
Inspiratory reserve volume: It is the
maximum volume of gas, which a
person can inhale from end
inspiratory position. Its 2,400-
2,600ml.
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• Expiratory reserve volume:
Maximum volume of gas that can
be exhaled after normal
expiration. It is 1200-1500ml
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• Vital capacity: It is the
maximum amount of gas that
can be exhaled after
maximum inhalation, i.e it is
IRV+TV+ERV, 4,200- 4,500 ML.
Residual volume: It is the
volume of gas still present in
lungs after maximal
expiration. It is 1,200-1,500 ml
 LUNG CAPACITIES
• Inspiratory capacity: Amount of
gas inspired into the lungs after
normal tidal expiration.
IC=TV+IRV
• Functional residual capacity
(FRC): Amount of gas remains in
the lungs after normal expiration.
FRC=ERV+RV (2500ml)
• Vital capacity (VC): Amount of gas
expired from the lungs after a
maximum inspiration.
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• Total lung capacity (TLC max):
Amount of gas inspired to
expand the lungs to its
maximum extends. ( TLC=
TV+IRV+ERV+RV) 6000ML
• Minute volume : It is the tidal
volume*respiratory rate. It is
500*12=6000 ml/min
• Total lung volume:
IRV+TV+ERV+RV. It is 5,500-
6,000ml.
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 MECHANISM OF
RESPIRATION
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 PULMONARY FUNCTION
TEST
• PFTs are a group of tests that
measures how well your lungs
work that is how well the lungs
take in and exhale air, and how
efficiently they transfer oxygen
into the blood.
• They are useful in assessing the
functional and pathological
conditions. It is based on the
measurement of lung volumes of
air breathed in and out in normal
breathing and forced breathing. It
 PURPOSES OF PFTs
• Detect disease and serves as a
diagnostic tool, and has
investigation role
• Evaluates severity, extent and
monitor the course of disease
• Evaluates treatment
• Measures effects and results of
treatment exposures.
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• Helps to diagnose asthma,
chronic bronchitis, respiratory
infections, lung fibrosis,
bronchiectasis, allergy,
emphysema, cystic fibrosis,
asbestosis which is the
inflammation of lungs, liver, lymph
nodes, eyes, skin
• Used to evaluate physiological
aspect of breathing from
respiratory muscle function to the
diffusion of gas at the alveolar
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• Helps physiotherapy to distinguish
between obstructive and
restrictive lung problem and to
select appropriate treatment
• Measures the effect of the given
treatment
 PROCEDURE
• Sit up straight
• Get a good seal around the mouth
piece
• Rapidly inhale maximally
• Without any delay blow out as
hard as fast as possible
• Continue the exhale until the
patient cannot blow no more
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• Expiration should continue at
least 6 sec in adult and 3 sec
children under 10 years
• Repeat at least three technically
acceptable times ( without cough,
air leak and false start)
 SPIROMETRY
• In order to do spirometry, an
instrument that is spirometer is
used. Spirometer measures the air
capacity of the lungs during
controlled ventilatory maneuvers.
• Spirometer is used to measure the
air flow, ventilatory regulation,
ventilatory mechanics and lung
volume during a forced expiratory
maneuver from full inspiration.
 LUNG EXAMINATION AND
LUNG SOUNDS
• Lung examination includes vital
signs and cardiac examination.
There are four elements-
observation, palpation,
percussion, ascultation.
• Lung sounds:
• Bronchial breath sounds: Normal
sounds when listemning over
large airways like trachea is
bronchial breath sounds
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• It can be present when a person is in the
setting of dense com