Airway, airflow,

ventilation and
diffusion
DR RENU YADAV
Physiology
Learning Objectives
At the end of the session, students should be able to…
1. Know the functional anatomy of respiratory System
2. Know the innervation of respiratory system and associated
muscles
3. Describe pulmonary Ventilation
4. Describe mechanics of breathing
5. Define lung compliance and role of surfactant
6. Define gas law and solubility of gases
Functional Anatomy of the respiratory system

❖ Upper Respiratory
Tract
1. Nose
2. Paranasal sinuses
3. Pharynx
4. Larynx and glottis
Functional Anatomy of the respiratory system
❖ Lower Respiratory Tract
1. Airway tree
• Conducting zone (16-17 gen)
• Respiratory zone (17-23 gen)

2. Lungs

Functional unit for respiration is…

 the alveolus.
No.- 300 millions
Each size- 0.2 millimeter (200-500 µm)
Surface area= 50-100 sqm
Innervation of Respiratory passage
• Sympathetic control:
Circulating NE & E acts on β2
adrenergic receptors to causes
dilation of the bronchial tree
(relax smooth muscle)

• Parasympathetic:
Constriction of the
Bronchioles: These smooth muscle cells
have muscarinic M3 receptors

❖ The vagus nerves

(parasympathetic nerve)
penetrate the lung
parenchyma
Factors regulating airway diameter
 Airway Resistance
Airway Resistance In the respiratory
system, as in the cardiovascular system,
flow is inversely proportional to resistance
(Q = ΔP/R). Resistance is determined by
Poiseuille law. Thus, R = 8ηl/π r4

It would seem that the smallest airways

would provide the highest resistance to air
flow, based on the inverse fourth-power
relationship between resistance and
radius. However, because of their parallel
arrangement, the smallest airways do not
have the highest collective resistance.
But, medium-sized bronchi are the sites
of highest airway resistance (bcoz of
series connection).
Ventilation
Steps of respiration
Pulmonary ventilation
Chest wall structure
 Pleural fluid
Pleural fluid: between thorax
and lung (pleural cavity)

Lubricates the pleura:

- Parietal pleura
- Visceral pleura

Creates the negative Pressure

(-2.5 to -10 cmH2O)
Air Pressure
• Atmospheric air pressure 760 mm Hg (at sea level=0 mmHg)

• Negative air pressure - LESS than 760 mmHg (-ve)

• Positive air pressure - MORE than 760 mmHg (+ve)

• Intrapleural pressure - pressure within the pleural "balloon"

which surrounds the lung

• Intrapulmonary pressure - pressure within the alveoli (tiny

sacs) of the lung itself
Three pressures maintains the respiratory mechanics
Respiratory pressures and volume

Strong inspiratory efforts: IP

as low as –30 mm Hg
 Compliance
• Compliance: Distensibility of the lungs
• Compliance = change in lung volume/ change in
lung pressure
• Cpulm = Dvpulm / DPpulm
• The extent of lung expansion is dependent on
increase in transpulmonary pressure
• Normal static compliance is 200 ml of air/cm of
H2O transpulmonary pressure for both lungs
together
 Determinants of compliance diagram
• Compliance of the lungs only ► Elastic forces of the lungs
- Normal Value 0.2 L/cm
►Elastic forces of
H2O
• Compliance of the lungs & the the lung tissue
thoracic wall - Normal value itself
0.11 L/cm H2O ►Elastic &
collagen
Compliance of the combined
lung-thorax system is almost interwoven
exactly one half that of the among lung
lungs alone parenchyma

Elastic forces caused by surface tension of the fluid that lines

the inside walls of the alveoli and other lung air spaces
 Compliance-Elastic tissue

more compliance for less elastance and less compliance for more elastance
 Compliance
1. Distensibility and elastic recoil: More the lung
is distensible and elastic more is the
compliance. A stiff lung has less compliance.
2. Lung volume: The pressure-volume curve of
the lung is nonlinear, which indicates that the
compliance is not equal at all lung volumes.
The compliance is high at low lung volumes
and low at high lung volumes.
3. Lung size: In general, compliance is
proportionate to the size of the lung. Thus, the
lung of rat has less compliance than the lung of
elephant. Children lung is less compliant than
adult
4. At the apex, transpulmonary pressure is
therefore more, which causes the alveoli in the
apical region to be more distended. This
decreases compliance of lung at the apex.
Thus, the apex of the lung is less distensible.
Thus, at the base of the lung, there is a larger
change in volume for the same pressure
change, which ensures greater expansibility.
(Effect of Gravity)
 Compliance
• Different compliances for inspiration &
expiration based on the elastic forces of lungs
– Compliance reduced by higher or lower lung
volumes, higher expansion pressures, venous
congestion, alveolar edema, atelectasis &
fibrosis
– Compliance increased with age (loss of elastic
tissue mass), bronchial asthma & emphysema
secondary to alterations of elastic fibers
lung compliance

↑Compliance
1. Old age
2. COPD, Emphysema
↓ Compliance
3. Pulmonary
congestion
4. Interstitial
pulmonary fibrosis
5. Pulmonary edema
Factors affecting only the lung compliance
► Lung volume
►Individual with one lung?
▪ Phases of respiratory cycle
▪ ↓ with inflation and with deflation
▪ Effect of gravity
▪ In the standing position, less compliance at
the apices of the lungs as more distended
alveoli at the apex and less in base
▪ Surface tension- more, less js the compliance
Compliance Diagram of the Normal Lungs

Compliance diagram in a healthy person

 Hysteresis loop

Comparison of the compliance diagrams of saline-filled & air-filled lungs when

the alveolar pressure is maintained at atmospheric pressure (0 cm H 2O) &
pleural pressure is changed
According to the change in pleural pressure, change in lung volume (Compliance
curve)
 Hysteresis loop
Hysteresis is very less in saline lung than in air-lung indicating that in saline-lung,
pressure needed to inflate was almost same as to deflate.
Also, the slope of inflation limb of saline-lung was steeper than air-lung since
static compliance is very high in saline-lung (as lung was inflated with much less
pressure) indicating that the lung was more compliant due to elimination of
surface tension (no air-water interface).
Compliance curve is less steeper in air filled lung (more hysteresis). thus, lung is
less compliant which is due to more surface tension (air-water interface).
This is somehow reduced by surfactant synthesized within the alveoli.
 Source of surfactant
• Synthesized by type II pneumocytes
• Surfactant synthesis starts at about 34 weeks of pregnancy,
which is completed by about 90% at term (38−40 weeks).

• Hormones like glucocorticoids, thyroxin, insulin facilitates

surfactant synthesis.

• Lungs are last organ to develop in IUL. Thus, preterm

babies are likely to suffer from difficulty in breathing bcoz
of decreased compliance of the lung. (atelectasis)

• Increases the force to breathe (work of breathing)

 Surface tension, collapse of the alveoli

• In lungs, all alveoli do

not have same diameter
and the size of alveoli
also changes during
inspiration and
expiration.
• When radius surface
tension
• Surfactant is constant
per unit surface area.
• Therefore, volume
remains same.
Surface tension, collapse of the alveoli
 Functions of surfactant
▪ Lowers the surface tension: As alveoli radius
decreases, surfactant’s ability increases to lower the
surface tension.

▪ Reduce the work of breathing by reducing surface

tension forces.
▪ Prevent collapse and sticking of alveoli upon expiration
as surface tension is decreased
▪ surfactant contributes to the stability of the architecture
of the lung.
▪ Prevents edema
Surfactant Vs lung compliance
 Work of breathing

WE = 65%
W Tissue Resistance = 7%
W Airway Resistance = 28%
 Muscles of respiration
Inspiratory muscles Expiratory muscles

1. Diaphragm 1. Abdominal muscle

2. External intercostal 2. Internal intercostal M
muscle 3. Neck/ back muscle
3. Accessory muscle
a. scaleni
b. Sternocleidomastoid
c. neck/back muscle
 Muscle of respiration
► The primary muscles : ► There is no primary muscle of
Diaphragm expiration
► secondary muscles that raise the rib
cage (upward and outward) for
inspiration are; ► Secondary muscle: The muscles that
1) external intercostals, but others that pull the rib cage inward during
help are the expiration are
2) sternocleidomastoid muscles, 1) abdominal recti, which have the
powerful effect of pulling downward
3) anterior serrati,
2) Internal intercostals.
4) scaleni,

Phrenic nerves innervates the diaphragm- from C- 3, C- 4, & C - 5.

• C3 and Above: A ventilator is needed, the diaphragm is affected, and the ability to cough or sneeze is
eliminated.
• C4-C5: A ventilator may be needed some of the time, the patient retains partial diaphragm function, their
abdominal and intercostal muscles don’t work, and their ability to sneeze or cough is eliminated.
• C6-C8: The diaphragm is functional; however, the abdominal and intercostal muscles do not work.
 Mechanics of breathing
Expiration:
Inspiration:
• Active process Passive Process
• Descent of diaphragm • Diaphragm relax
(diaphragmatic including all inspiratory
movement) muscle
• Movements of ribs • Movement of rib inward
outwards & upwards (rib • Gas flows passively out of
movements) the lung
• Expiration - active during
hyperventilation, exercise
and pathological condition
Respiratory process
 Inspiration
Contraction of diaphragm (inspiratory
muscles)

Expansion of thoracic cage

Intrapleural pressure becoming more

negative (towards -7cmH2O)

Increase in transpulmonary pressure

Inflation of lung

Decrease in alveolar pressure

Air flows into airways

Cessation of contraction of muscles

 Expiration
Relaxation of inspiratory muscles.

Dropping of rib cage

Intrapleural pressure becoming less

Negative (-5 cmH2O)
decrease in transpulmonary pressure
deflation of stretched lung

Decrease in alveolar diameter

Increase in alveolar pressure

Air is pushed out of the lungs

Airflow continue till alveolar pressure =

atm pressure
 Pulmonary ventilation
Due to
Inspiration : Air moves into the lungs change in
pressure in
Expiration : Air moves out of the lungs lungs
Pump Handle movement
Bucket Handle movement
Respiratory pressures and volume change

Strong inspiratory efforts: IP

as low as –30 mm Hg
 Non Respiratory Function
1.Reservoir
2. Filtration of emboli
• Thrombi, microaggregates etc
• Dust and other particles in air entering in the lungs

3. Removal of biochemical substances- PGE

4. Olfactory function
5. Processing of inhaled air
6. Defense function
• IgA secretion into bronchial mucus
 Non Respiratory Function

7. Metabolic function activation:

⮚ angiotensin I II

inactivation:
⮚ noradrenaline
⮚ bradykinin
⮚ 5 H-T (serotonin)
⮚ some prostaglandins

9. Speech
10. Drug administration
Diffusion of Gases
 Respiratory membrane

► respiratory membrane (pulmonary

membrane)
–membranes of all the terminal portions
of the lungs
–alveoli themselves.
► Gas exchange depends on
a. The thickness of the membrane,
b. The surface area of the membrane,
c. The diffusion coefficient of the gas in
the substance of the membrane
(solubility), and
d. the partial pressure difference v·gas=A/T XD X(P1-P2)
 Gases Laws
Boyle’s laws
at constant temp. P α 1/V
Charles’ laws
P α T (at constant volume)

V α T (at constant pressure)

Gas Equation: PV = nRT
Avogadro’s hypothesis
Equal volume of different gases at the same pressure and temp.
contain the same number of molecules

Thus, a gram molecule of any gas at STPD (0 ⁰C, 760 mmHg

pressure dry) occupies a volume of 22.4 litres.
Law of diffusion

The process of movement of a gas is from higher

pressure to the area at lower pressure

Dalton’s law of partial pressure

P = P1 + P2 + p3
Henry’s law

Conc. of a gas in solution at equilibrium directly proportional to its

partial pressure in the gas phase

Conc. (ml gas/ml solution) = Absorption coefficient x tension

(pressure in atmosphere)
Absorption coefficient of gas (in blood at 37 ⁰C)
O2 = 0.024
CO2 = 0.57
N2 = 0.012

Water vapour pressure (at 37 ⁰C) = 47 mmHg

 Solubility & Diffusion coefficient
Gases
Solubility coefficient Relative Diffusion coefficient
(1 atm) = 760 mm Hg

Oxygen
0.024 1 (Perfusion limited)

Carbondioxide
0.57 20.3

carbonmonoxide
0.018 0.81 (Diffusion Limited)

Nitrogen
0.012 0.53

Helium
0.008 0.95
Diffusion of Gases
1. Perfusion limited: If the substance equilibrates between the capillary and
interstitium, it is said to be in a perfusion-limited situation. eg, O2, NO

2. Diffusion limited: If the substance does not equilibrate between the

capillary and interstitium, it is said to be in a diffusion-limited situation.
eg, CO is diffusion limited gas
clinical significance: DL(rate of CO diffusion) decreases in emphysema
and fibrosis but increases during exercise
Argon & Helium 0.06 % Gas= 0.0006 x 760
mmHg= 0.3 mmHg
CO2 .04 % PCO2 = 0.0004 x 760
mmHg= 0.5 mmHg
Solubility of gases
 Solubility of gases
Gases Solubilit RDC Gas conc in alveoli arterial Venous
y blood blood
coeffici PO2=95 PO2=40
ent mmHg mmHg

O2 0.024 1 PO2=100 mmHg 0.3 ml/dl 0.12 ml/dl

0.024x100/760
mmHg
0.003ml/ml of
blood
0.3 ml/100 ml of
blood
 Reference books required
►USMLE Step 1 Lecture notes (Kaplan medical physiology)-2021

►Ganong's Review of Medical Physiology 26th ed 2019

►Guyton and Hall Physiology 13th Ed 2016

►BRS Physiology (Linda S Costanza, 7th Edition)

►Understanding medical Physiology (Bijlani, 4th edition)

 Practice Quizzes
A 20 years old man visited to the outpatient department for his general
body check up. Physical examination of respiratory system showed
normal respiratory rate of 12 cycle/min. What is the expected volume
of air that is expired during normal expiration?
a. 3 L
b. 2.5 L
c. 2 L
d. 1.5 L
e. 0.5 L
A 34-year-old male sustains a bullet wound to the chest that causes a pneumothorax.
Which of the following best describes the changes in intrapleural pressure and
transpulmonary pressure in this man, compared to normal?
Intrapleural pressure Transpulmonary pressure
A. Decreased Decreased
B. Decreased Increased
C. Decreased No change
D. Increased Decreased
E. Increased Increased
The respiratory passageways have smooth muscle in their walls. Which of the
following best describes the effect of acetylcholine and epinephrine on the
respiratory passageways?
Acetylcholine Epinephrine
A. Constricts via m-cholinoreceptors Dilates via beta-2
B. Constricts via m-cholinoreceptors Dilates via beta-1
C. Constricts via n-cholinoreceptors Dilates via beta-2
D. Constricts via n-cholinoreceptors Dilates via beta-1
E. Dilates via m-cholinoreceptors Constricts via beta-2
A 76-year-old patient with chronic obstructive pulmonary disease
will most likely experience which of the following?

A. Increased elasticity and decreased compliance

B. Decreased elasticity and increased compliance
C. No change in elasticity and decreased compliance
D. Decreased elasticity and no change in compliance
E. Decreased chest wall compliance resulting in difficulty during
inspiration.
Considering the normal lung, which of the following correctly describes
the solubility coefficient of carbondioxide?

a. 0.008
b. 0.012
c. 0.018
d. 0.024
e. 0.57
THANK
YOU
1. E
2. D
3. A
4. B
5. E