Respiratory System Lec 4+5

Question 1

Discuss pressure changes during breathing

Answer 1

Quiet breathing = intra alveolar pressure changes by 1 mmHg from AP
So while exercise the inspiratory pressure can reduce by 30 mmHg
And the expiration pressure can reach 100 mmHg during straining with close glottis

The transpulmonary pressure (pressure across the barrier between lung walls and pleural cavity) must always remain positive under normal conditions, if it becomes negative the lung will collapse due to elastic properties of the lung

Question 2

Explain how you measure ventilation

Answer 2

Spirometry

Subject breathed into spirometer during quiet breathing or with max effort

You can do static or dynamic measures of breathing

• static = lung volumes and capacities check up
• dynamic = rates (how fast can u blow out), volumes under forced ventilation

Question 3

What are the normal lung volumes and capacities that are usually checked for

Answer 3

Tidal volume = 500 mL

Inspiratory reserve volume =3000 mL

Question 4

What’re the major measurements that are done for a dynamic measurement (ie. forced expiratory test)

Answer 4

FVC (forced vital capacity) = total volume of air expelled from lungs (with maximum force)

FEV1 (Forced expiratory volume in one sec) = volume of air (in L) expired in 1 sec (first sec)

FEV1/FVC (FEV1%) = normally greater than 80%

Question 5

Why do we need force when breathing?

Answer 5

To over come:
Elastic recoil of lungs and thoracic wall tissue (compliance) during inspiration

Surface tension created by fluid layer lining the inner surface of the alveoli during inspiration (compliance)

Resistance to airflow in airways during both inspiration and expiration (resistance)

Frictional resistance created by deformation of the lung and thoracic wall tissue as it is deformed during inspiration (resistance)

HOWEVER THESE FACTORS ARE MINOR AND SO THE WORK OF BREATHING IS LOW (ONLY 3% EXPENDITURE OF ENERGY AT REST)

Question 6

What is meant by the compliance of the lungs?

Answer 6

A measure of the effort required to stretch or inflate the lungs

Question 7

What factors affect the complicance of the lungs?

Answer 7

Pulmonary elastic properties
- increased with high lung volumes

Alveolar surface tension

• fluid film lining of internal alveolar walls which squeezes the alveolus aiding with recoil, thus resisting expansion.
• Reducing lung compliance during inspiration
• La Place’s law = collapsing pressure increases with reduced radius, and low lung volumes

Question 8

What happens when compliance of lungs decrease?

Answer 8

This would increase the effort in ventilation because a greater charge in pressure would be required to stretch the lung (more effort)

Question 9

Explain what’s a restrictive airway disease?

Answer 9

Caused by low lung compliance (reduced lung inflation), which causes both FVC (reduced much more) AND FEV1 to decrease

STIFFER LUNGS

Question 10

Whatre the major causes of restrictive airways disease?

Answer 10

Pulmonary fibrosis
-normal lung tissue replaced by scar tissue

Eg. Asbestosis

Infant respiratory distress syndrome
- lack of surfactant

Question 11

What determines airway resistance mathematically?

Answer 11

Radius of airways key indicator

F =🔺P/R

F= airflow
🔺P= change in pressure (intra alveolar P and atmospheric)
R= resistance to flow (greater the resistance, the lower the force)

Resistance is usually so low that a very small pressure gradient will be enough for normal air flow

IAP is usually the same as AP but differs by like 1 unit

Question 12

Explain the mechanics of airway resistance during exercise

Answer 12

During exercise ventilation is increased hence the sympathetic NS causes the activation of adrenaline which causes bronchodilation, ensuring minimal resistance

Question 13

Reasons for airway resistance

Answer 13

Bronchocontriction can be cold induced or occur with asthma and COPD (narrowed lumen of bronchioles)

Question 14

Explain the impact to expiration and inspiration when there’s increased airway resistance

Answer 14

Expiration is more affected than inspiration

Inspiration = the bronchioles (that lack cartilage ring) are held open by the trans mural pressure

Expiration = the bronchioles are restricted causing increased effort (expiratory pressure) and can lead to the collapse.
Ie. asthmatic pt. Finds it hard to expire and this leads to wheezing
Ie. normal pt. Only at High force expiration and very low volumes can lead to collapse of small airways and air outflow if halted

Question 15

What’s obstructive airway disease?

Answer 15

Very similar to restrictive airway disease (relevant to surface tension and pulmonary eleastic properties) where the total volume air expired is greatly decreased (FVC) (ratio is higher) whereas, in obsfrguve airway disease we find that the FVC is only reduced a little bit

Therefore the ratio between FEV1:FVC would be very low (less than 70%)

Eg. Asthma, COPD (smoking Tb)

Question 16

How can you treat obstructive airway disease?

Answer 16

• bronchodilators (acute) = vetalin (beta receptor agonist)

- corticosteroids (long term) = reduce inflammation

Question 17

Explain the energy expenditure relevant to quiet breathing

Answer 17

Only requires 3% of total energy expenditure.

Quiet breathing allows 500 mL (TV) of air to enter and leave the lungs (inspire and expired), but not all of the 500 mL will empty each time and so the lung volume (TV) remains in the mid range.
HENCE COMPLIANCE IS HIGHEST DURING QUIET BREATHING and so energy is minimised

However, this energy percentage can be increased by decrease in compliance and increase in resistance (like when doing exercise)

Question 18

What’s tidal volume

Answer 18

Amount of air that enters the nose and mouth per breath, and it’s measured by measuring the volume of air that has been expired

Question 19

Explain the relation between tidal volume and alveolar volume to anatomical dead space and alveolar ventilation

Answer 19

TV is the amount of volume of air that enters the nose and mouth right, and it’s said that the same amount leave and enter so 500 mL of air

But the TV is not the air available for gas exchange, cause like 150 ml of the conducting part of the airways are the dead space and no gas exchange occurs here

It’s the alveolar volume of air (fraction of TV) that reaches the alveoli (respiratory portion) that allows for gas exchange to occur

Question 20

How do you calculate the alveolar volume

Answer 20

AV = TV - Volume of deadspace

This determines the efficiency of breathing

So like with each breath, you take in 350 mL of air that reaches the respiratory zone

Question 21

How do you measure ventilation in terms of rate (ie. per unit time) during a normal tidal volume? Normal quiet breathing

Answer 21

Ve (total pulmonary ventilation ie. the amount of air you are breathing in per unit time)
So Ve = TV x F (respiratory frequency)
So if F = 12 breaths per min and TV = 500 mL per breath
Then Ve = 500 x 12 = 6000 mL/min

Va (alveolar volume) rate = F x (TV- deadspace)
So Va = 12 x (500-150) = 4200 ml per min

Question 22

How do you measure ventilation in terms of rate (ie. per unit time) during a low tidal volume? Short rapid breaths

Answer 22

TV= 300 mL now (lowered) F = 20 breathes per min (compensated)

Ve = 300 x 20 = 6000 ml per min (no change)
BUT
Va = 20 x (300-150) = 3000 ml per min

This shows that the Va is more affected as it’s reduced by 30% that reaches the alveoli

Question 23

How do you measure ventilation in terms of rate (ie. per unit time) during a high tidal volume? Long slow breaths

Answer 23

TV = 1000 ml F = 6 b/min

Ve = 1000 x 6 = 6000 ml/min (NO CHANGE)
BUT
Va = 6 x (1000-150) = 5100 ml/min

Here, the Va has increased by 20%

THIS SHOWS US THAT CHNAGIGN THE WAYS YOU BREATHE WILL DRastically AFFECT THE ALVEOLAR VOLUME.

Question 24

What factors effect rate of gas diffusion between the alveoli and the blood capillaries

Answer 24

• thickness of alveolar capillary boundary (usually 0.2-0.5 microm)
• surface area available for diffusion
• partial pressure gradient of oxygen gas between alveoli and capillary blood

Question 25

Explain what components form the atmosphere

Answer 25

The atmosphere isn’t fully just oxygen, as there’s greater abundance of nitrogen

There’s 79% nitrogen gas and 21% of oxygen = and the TOTAL ATMOSPHERIC PRESSURE IS 760 mmHg
So there’s like 600 mmHg of N2 and 160 mmHg of O2

Question 26

Explain the concept of partial pressure of oxygen

Answer 26

So as per the principles of equilibrium, particles move from a region of high conc to low, until equilibrium between two regions is reached

Alveolar partial pressure: O2 = 100mmHg (because its mixed in with some of the old air that wasn’t taken out during expiration and so the partial p of oxygen decreases) CO2 = 40mmHg
Blood gas pressure: O2 of 40mmHg CO2 = 45mmHg

THEREFORE
O2 moves from alv to blood until 100mmHg is reached on each side
AND
CO2 moves from blood to alv

Equilibrium is reached so fast that the blood will have only just almost passed the alveoli Where the conc of O2 in alveolus 5.20 mmol/L and 0.15 mmol/L in capillary blood. Equilibrium of partial pressure is differnt to conc equilibrium

Question 27

Explain the concept of ventilation perfusion matching

Answer 27

Ventilation = getting blood into your system and to the respiratory zone to allow gas exchange 
Perfusion = blood flow, blood flow must go through the pulmonary and getting oxygetntaged and going through systemic and going to distribute oxygen to peripheral tissues 

BUT YOU CAN GET PROBLEMS WITH THESE
ventilation problem = part of lung not getting fresh air due to muscles plug of respiratory bronchioles, lung damage of part of lung (fails to get fresh air)…blood passing through won’t get oxygenated)

Perfusion problem =Blood clot to a part of lung that doesn’t allow blood to reach a part of lung and oxygenation doesn’t occur there as a result with no blood

Question 28

How can we match ventilation and perfusion again

Answer 28

With local factors like the smooth muscle of the arteriole and the bronchioles

Question 29

Explain the local controls of the airways smooth muscle on an increase of decrease in CO2 conc in specific lung regions

Answer 29

Increase CO2 in region

• causes bronchodilation
• increase in CO2 means there’s increase in blood flow to that region of the lung which allows rate of gas diffusion to be high there THEREFORE this region must be ventilated effectively
• HENCE DILATION OF AIRWAY OCCURS (decrease resistance) to increase airflow to the region

Decrease in CO2 conc

• causes bronchocontriction
• decreased CO2 because there’s minimal blood flow to that lung region
• meaning, blood isn’t being oxygenated well
• causing the airways to constrict and cause the fresh air to reach another part of lung that has good blood flow

Question 30

Explain the local controls of the airways smooth muscle on an increase or decrease in O2 conc in specific lung regions

Answer 30

Decrease in oxygen conc in lung region

• causes vasoconstriction of arteriole
• if not enough oxygen in alveolus, the blood won’t be oxygenated sufficiently
• so if we decrease blood flow by constricting the vessel, the blood will be diverted to a region of lung that has greater oxygen conc

Increased O2 conc in lung region

• means that the airflow is really good
• causes vasodilation of arteriole as more blood can reach this region of lung and be oxygenated well
• therefore, blood flow increased