Pulmonary 1

Lung structure and function

• Conducting zone of the lungs
o Mouth/nasal
o Trachea
o Bronchi
o bronchioles
• Respiratory zone of the lungs
o Terminal bronchioles
o Respiratory
o Alveolar ducts
o Alveoli
• Surfactant
o The alveoli are fragile and thin require a special type of substance surfactant that helps to maintain the
alveoli surface tension and integrity
o Surfactant line the alveoli and can move to adjacent alveoli through pores called pores of Kohn
o Prevents alveolar collapse
o Pores of Kohn – allow even distribution of surfactant
Respiratory muscles and breathing
• Normal resting tidal breathing inspiration
o Diaphragm
o Intercostal muscles
• During exercise to get air in and out of the lungs faster
o Accessory muscles

▪ Net muscles can get involved with breathing

• Importance of two things for determining the rate of airflow the lungs
o Pressure gradient

▪ The flow will be faster if the pressure difference from one end of the respiratory tube to the
other
• More air into lungs create more negative pressure = air faster in lungs
o Resistance to flow within the air way

▪ Smaller vessels create greater resistance

▪ Higher airway resistance = less air flow at the same pressure difference
• There are two things that can cause air way resistance

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o Bronchial constriction
o Inflammation of the airways– allergic reaction

▪ Increase mucus production

▪ Roughen tubes = Air does not move smoothly through the lungs
Lung volumes
• A dot over the V means there is a rate over time – usually something in L/min or mL/min
o VO2max should have a dot over the V
• Total lung capacity = residual volume + inspired Volume + expired volume + tidal volume
• FEV1.0
o Assessing lung dynamic
o Is the amount of air that you can get out of your lungs after you take a deep breath and then breathing
as quickly as you can the measurement is taken within the first second
o The point of the test is how much air can you get out in the first second

▪ How much you should get out in the first second should be at least 80% with healthy lungs
• FEV1.0/FVC = at least 80%

▪ Less than 80% means that air is having a hard time to get out
• Most likely caused by a lung obstructive airway such as asthma or COPD (emphysema
and chronic bronchitis)

Minute ventilation
• The amount of air coming out of your lungs per minute
o This will be a low number at rest

▪ Healthy is about 7-8L/min of air

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• During exercise may exceed 200 L/min of air

• The lungs ability to ventilate will usually never be the limiting factor
o Usually heart and muscle
• Minute ventilation = tidal volume x how many breaths per minute
o This could also be referred to a RR – respiratory rate
• Some of the air doesn’t make it to the lungs but some air is left over in the upper airways (conductive airways)
and don’t engage in gas exchange
o The air that first comes out of the lungs is conducting zone air = dead space air- maybe humidified
o As you breath out longer there will be more alveoli gas exchange air
• If we want to know how much air makes it to the alveoli to take part in gas exchange = effective ventilation
o Then we need to adjust the amount of dead space (the amount of air that never made it to the alveoli
o If we can measure the dead space air and take that away from the amount air breathed out (tidal
volume) then we can know how much air made it to the alveoli for gas exchange
o When we multiply that by breathing frequency then we can figure out how much air actively took part in
alveoli ventilation
o Dead space in the lungs is the function of two things:

▪ Anatomical dead space – air left in the airways in conducting zone

▪ Alveoli dead space

• Some of the alveoli in the lungs are getting ventilated with air but not receiving blood
flow – not perfused with blood = no gas exchange occuring
• Pressure in the pulmonary circulatory system is lower than in the systemic circulatory
and blood gets pushed down by gravity to the bottom of the lungs

▪ Physiological dead space = alveoli and anatomical dead space

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Ventilation perfusion
• What you want to do in the lungs is send air to the alveoli at the base of the lungs and you want to be able to
ventilate the alveolus effectively and you want a nice blood flow (pulmonary capillary blood flow) = gas exchange
o When the air leaves the lungs the partial pressure of O2 and CO2 is the same as the pressure in the
alveolus
• Sometimes we have conditions that block the air way and it is hard to get air down in the alveoli
o Alveoli can get blood circulation but no air flow = called shunt

▪ E.g. choking, diseases (asthma…)

▪ The composition of O2 and CO2 stay the same = ineffective gas exchange

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• Ventilation and perfusion ratio = VA (ventilation alveoli) = very low and the perfusion is
normal
o Ventilation without perfusion = alveolar dead space – proper ventilation but no blood flow

▪ This occurs in normal healthy lungs or can be caused by a lung embolism

• What we want is matching ventilation and blood perfusion to allow for gas exchange to occur
Heart
• To measure pressures in the heart = If can place a catheter through the brachial (swans dan catheter)
o The right atria of the heart is weak – weak atrial contraction P wave in ECG
o The right ventricle during systole – 25 mmHg
o The right ventricle during diastole = 0 mmHg
o Pulmonary artery = systolic 25 mmHg and diastolic 10 mmHg
o And if you keep threading the catheter into the pulmonary circulation that you can measure pulmonary
capillary wedge pressures
Blood flow in the lung

• Now talking about the pulmonary circulation not the bronchiole circulation
o The difference between pulmonary and bronchial are

▪ Pulmonary circulation is where we get oxygenation of the blood

▪ Bronchiole circulation is the blood flow that the lungs need to survive and to function
• Pulmonary pressures are much lower than systemic pressures
o Systemic is usually 120/80 mmHg
o Pulmonary circulation 25/8 mmHg

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• Two reasons why the pulmonary circulation has less pressure is because:
o Pulmonary circulation is much smaller compared to the systemic circulation – don’t need to pump as far
o Blood vessels in the pulmonary circulation are more compliant and low vascular resistance – stretcher

▪ Very little ability to constrict or dilate like the systemic circulation

• The ventilation and perfusion ratio are very important concept that describes lung function and determines the
effectiveness of gas exchange at the lung
• At rest in a human at the top of a lung is poor perfusion because most of the blood is at the base of the lungs,
but we have good ventilation
o If you lay down, then this changes
• Base of the lungs because there is much more blood flow and better ventilation at the base of the lungs = we get
better matching ventilation and perfusion which is closer 0.6 or 1 which is adequate gas exchange
• During exercise when systolic systemic blood pressure increases and pulmonary pressures also rise (not to the
same degree)
• When pressures increase due to exercise we get more of the lung perfused with blood = more ventilation and
perfusion occurring
Partial pressure in the lungs
Two things to calculate partial pressure
• Fractional of concentration of the gas
o E.g. in the atmosphere

▪ 20.93% O2
• Barometric pressure
o At sea level is 760
• E.g. calculate 21.3% x 760 = 159 mmHg
• Most of the air around us consist of oxygen 20.93% and nitrogen 79%
• Very little CO2
• The barometric pressures change in high altitude

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• Fick’s law of diffusion (different than the fick’s equation that describes cardiovascular diffusion)
o As air travels down into the alveolus then it has to get across the alveoli capillary membrane in order for
O2 to diffuse into the blood and CO2 to diffuse out
o What you can see

▪ A red blood cell comes into contact with the alveoli wall, and the alveoli basement membrane is
very thin and allows gas diffusion to occur – O2 one direction and CO2 the other way = diffusion
gradients
• The rate in which these gases diffuse across the alveoli capillary membrane = 4 things
• Fick’s law of diffusion (4 things that determine how well CO2 and O2 to pass)
o Rate of gas diffusion across the membrane is dependent on

▪ Tissue surface area available

• Greater the surface area the greater the diffusion

▪ Tissue thickness
• Tissue thickness is inversely related to the rate of gas diffusion
• If anything causes the alveoli capillary tissue to thicken = harder for CO2 and O2 to get
across
• Pulmonary edema effects the tissue thickness – this is seen in mountaineer

▪ Gas diffusion coefficient

• Some gases diffuse better than others
• Based on their solubility – ability go in and out of solutions

▪ Partial pressure difference

• The difference pressures on one side of the barrier compared to the other side

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• The rate of gas diffusion

Remember the normal partial pressures under normal resting

• Two gases most concerned about in normal exercise physiology are partial pressures of O2 and CO2
• Two things that you need to calculate partial pressure of a gas
o The total of barometric pressure

▪ At sea level 760 mmHg

o What is the percentage of the mixture of gas

▪ 20.93% is O2
• E.g. 0.2093 x 760 =159 mmHg
• The partial pressure of O2 that is inhaled is about 160 mmHg
• When the O2 gets down into the alveoli the partial pressure decreases to about 100
(105)
o Why the is the partial pressure lower in the alveolus than the air?

▪ This occurs is because when the air enters the nasal passage, we get
water vapor
• Water vapor exerts its own partial pressure
• When we get the air down into the alveolus we have four gases to consider
o Oxygen
o Nitrogen
o CO2
o Water vapor

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▪ When these gases are added together = 760 mmHg

• At the alveolus the partial pressures
o O2 100 mmHg
o CO2 40 mmHg
• Partial pressure in venous blood at rest moving towards the lungs
o O2 40 mmHg

▪ Lower levels of O2 in venous blood compared to alveolus = driving pressure for O2 to move
into the blood
o CO 46 mmHg

▪ Is higher in venous blood compared to alveolus = net driving force for CO2 to leave the blood
• KNOW THE PARTIAL PRESSURES
• At altitude there is less driving pressures to drive O2 into the blood and why it is harder to breath
• NOTE: There is going to be a small partial pressure difference in the alveoli arterial compared to arteriole
blood - not all the tissues in the lungs are perfused with blood = slightly lower partial pressure of O2 in the
arteriole blood
o This concept is called the alveoli and arteriole difference
o There is a reason why that O2 is different

▪ Ventilation ratio
• Only two ways you are going to get oxygenated blood
o ventilation
o Perfused alveolus – perfused with blood

▪ Need matching ventilation and perfusion to get efficient gas

exchange

▪ In normal lung there are areas that will not be perfused with blood during rest
• The part of the lung that is not perfused with blood is the upper lung when in an
upright position (this change when laying down)

▪ In the base of the lungs the gravity pushes blood down where most perfusion occurs
• The upper lungs are being ventilated, but not perfused
• At rest in the muscle tissue and venous blood at rest have very similar partial pressures of O2 and CO2
o Full equilibration of gas exchange

▪ Oxygen moves into the tissues and CO2 moves out of the tissues
• Capillary blood flow slows everything down to ensure proper blood flow occurs at the tissue and to allow for
gas exchange
• During exercise Muscle tissue partial pressure

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o O2 decreases
o CO2 increases

▪ This will mirror what we seen in the venous blood

Hemoglobin
• Hemoglobin major carrier of O2 in the blood
• Hemoglobin can change its infinity for oxygen according to the conditions
• Hemoglobin can shift Bohr effect which will help the O2 to unload into the tissues
o Decreased affinity- shift down to the right in gas diffusion = better delivery of O2 into the muscles

▪ = decrease pH

▪ = increased body temperature- e.g. working muscle

▪ =Increased DPG

▪ =Increase PCO2
Myoglobin
• In the tissue’s myoglobin will hold onto O2 well (high infinity for O2)
• There is a different shape to the curve than hemoglobin
• Myoglobin is a simpler molecule than hemoglobin – but is related to hemoglobin
• Myoglobin grabs onto oxygen very quickly – even with very low partial pressures of O2
o With hemoglobin there needs to significant higher amounts of O2 partial pressure until it force to 100%
saturation
• Oxygen can be stored in muscle fibers and tissues

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Know this for the final and read this in the text book

Major controlling systems at rest and during exercise – table above need to know for exam
• What causes breathing rates to change during rest and exercise
o Chemical signals

▪ The brain is constantly monitoring what levels of partial pressures of O2 an CO2 within the
bloodstream and if it senses difference particularly in CO2 = rapid increase in ventilation
• CO2 is monitored in the blood more closely than O2
o CO2 is an immediate danger to the blood because it causes respiratory acidosis
= dangerous
o The lungs are important for controlling pH in the blood stream

▪ Hyperventilation = decrease CO2 = increase pH = respiratory alkalosis

o Mechanical signals in the body can influence breathing

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▪ When you start moving the information from the joints sends afferent signal to the brain
informing the brain that there is movement = will need blood flow to exchange gases
• = mechanoreceptor feedback
o The brain (central Command) can influence breathing

▪ Anxious

▪ Anticipate – fight or flight

o Brain directly translates information to the body to increase breathing

Regulation of blood pH: acid-base balance

• The lungs help control blood pH
• High-intensity exercise metabolism has the ability of producing H+ ions and creating more acidic environment in
the muscle and blood stream – called metabolic acidosis
• In the blood stream when H+ increase in the blood stream will bind to bicarbonate and then will become CO2
• Certain disease processes can cause pH acidosis
o E.g. diabetes
• What happens in the blood stream when there is an increase of H+ accumulation the H+ ions bind to a normal
blood buffer bicarbonate
o Bicarbonate drives the reaction to the right which results in more CO2 being produced
o This is important because the lungs can expel CO2 which helps buffer H+

▪ Increase ventilation through increase alveoli ventilation will help to drive CO2 back down and
increase blood pH
• If you start to breath faster and ventilate the alveoli at a greater rate then you will see blood pH will increase

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o Blood will become more alkaline – blowing off more CO2

• If the breathing rate decreases, then blood pH will also decrease – less CO2 is being blown off
o Failing to adequately ventilate the alveoli

▪ Respiratory acidosis
• Normal blood pH at rest is a little alkaline it is about 7.4
o One of the reasons why normal blood pH is at 7.4 is because there is a significant amount of buffer
reserve – bicarbonate
• Buffer reserve – bicarbonate which are important in the bloodstream
o Kidneys are the regulators of bicarbonate – get rid of or hold onto

▪ Kidneys can excrete bicarbonate if necessary

o Bicarbonate to CO2 is a 20:1 = more bicarbonate then CO2

▪ When we start to lose the buffer reserve then pH levels will start to creep to the left = more
acidic
• Bicarbonate levels are very important

Lactate threshold
• 2 mmols = lactate threshold 1
• 4 mmols = lactate threshold 2
Can look at the lactate thresholds using ventilatory thresholds
• LT1 = VDAT (VT1) (ventilatory derived anaerobic threshold

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• LT2 = RCP (VT2) (respiratory compensation point)

• The measures are called Ventilatory equivalent for oxygen and how much you are breathing out CO2
• If you take someone from light to heavy exercise and you see how the variables of CO2 and O2 change then
there will be a specific shape of change

▪ Blue line VE/CO2

▪ Redline VE/O2
o The VDAT is broken down into VT1

▪ you will notice is that the lines start to demonstrate a sustained increase

▪ The ratio of VE/VCO2 is starting to increase at a faster proportional rate compared to VE/VO2
• Between the two thresholds there is a period of time called the isocapnic buffering period
o Is between the two thresholds VT1 and VT2
o The body can handle the H+ ions that are being produced
o Blue and redline are the same
o Can sustain exercise for a longer period of time
o The lungs are able to increase breathing to maintain steady levels of CO2
• Respiratory compensation point
o Harder to control the H+ ions in the blood
o Breathing will be stimulated at a higher rate
o The ratio between VeO2 and VeCO2 change and VECO2 starts to climb
o This is called hypercapnic hyperventilation
o People can breathe so aggressively during exercise that they maybe able to decrease the CO2 levels
• Take home for an athlete is the later you can push these thresholds the better
o The higher the level of exercise a person can sustain before running into the thresholds = the fitter the
individual
V-Slope
• Slightly different way of measuring the first VT1
• What is done is VCO2 is plotted against VO2
o S1 to S2
• Which is another way to find the first threshold
• Caused by the buffering that is occurring to buffer the H+ ions
Dyspnea, stitches and smoking
• Dyspnea = SOB
• Dyspnea can be due to a bunch of different things

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o Poor cardiorespiratory fitness,

o Poor cardiorespiratory diseases

▪ CHF

▪ Bronchitis

▪ COPD

▪ Asthma….
Stitches
• Probably related to transient diaphragmatic spasm
• Hypoxic spasm
o This is not fully understood
Issues with Smoking
• Increase O2 cost of breathing = decrease blood and O2 supply to working muscle = decrease capacity
o Higher oxygen cost of breathing

▪ Need more oxygen to breath at the same rate

o And if you smoke just prior to exercise within 1 hour of exercise will increase your oxygen cost

▪ = drive down your exercise capacity and increase the oxygen cost of ventilation
• Increase risk of COPD and lung cancer
o Two big COPD issues

▪ Chronic bronchitis

▪ Emphysema
• Decrease O2 carrying capacity in blood (CO Carbon monoxide poisoning)
o CO has an affinity for the heme groups in hemoglobin = poison hemoglobin molecule
Effect of training on pulmonary system
• Detrained, disease and aging can deteriorate the lung-heart-muscle axis via:
o Decrease compliance of chest wall

▪ Chest wall becomes stiffer – cannot get to the same level of expansion = increases the work of
breathing within the lungs
o Decrease respiratory muscle strength and endurance
o Decrease elastic recoil
o Decrease surface area for gas exchange = decrease lung diffusion capacity
o Decrease capillaries in lungs
• Breathing reserve (VEmax:MVV note: MVV in a normal healthy person is higher than VEmax – even during
heaving exercise) can be maintained in healthy active aging

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• The lungs are minimally “ untrainable”

o Cannot change the ability of the lungs to load oxygen in the blood

▪ Oxygen diffuse capacity – cannot change

▪ Cannot change the amount of gas diffused into and out of the blood
• What can change are:
o increase respiratory muscle strength/endurance to increase ventilatory efficiency
o Another thing that does change with training is that ventilation goes up fairly linearly and will increase
when training gets harder
o You will see trained athletes will have a better there is a slight better breathing pattern at the same level
of oxygen consumption

▪ Slight less breathing at the same oxygen consumption

Illness and the lungs

Flow volume loop

• A test
o Using a metabolic cart, you can ask someone to take a deep breath in all the way to full lung capacity
(inflation)
o Get the person to breath out all the air out of their lungs

▪ = What you get is a flow volume loop

▪ The peak flow rate of expired air is the initially very high

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▪ But as a person keeps squeezing the flow rate will start to decline
• In a healthy lung you will see a
o Initial high expiratory rate
o Then a gradual declining rate
• Then you ask a person to take a big breath in which then plots the inspired air flow rate
• Looking at the shape of the curve a person can diagnose what is wrong with someone’s lungs
o The air flow FEF25% and FEF 75% gives pulmonologist how air is flowing through the narrow airways
• The flow loop can diagnose respiratory illnesses
o Restrictive
o Obstructive

▪ Reduced peak

▪ Fast reduction in air flow

▪ Ext…..
• Asthma
o Can occur from exercise induced bronchiospasm = airways restrict
o Acute asthma attacks due to bronchial restriction

▪ Bronchodilator puffer opens up the air ways

▪ Blue = immediate relief

o Can be caused by inflammation – allergies, pollutants…. (hyperirritable airways)

▪ Inflammatory base asthma person may need to use an inhale corticosteroid which has an anti-
inflammatory reaction – stops the release of histamine within the mast cells
• COPD
o More severe form of obstructive lung disease

▪ Chronic bronchitis

▪ Emphysema
o Force vital capacity maybe normal

▪ Big thing that changes is FEV1 – the ability to get air out of the lung quickly

▪ Compromise gas exchange

• Even at rest a person may of saturations lower than 90 at sea level which is bad
• At exercise saturation can become worst
• Restrictive vs Obstructive
o Restrictive – total lung capacity is reduced

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▪ The ability to expand the rib cage

• Extra pulmonary – not involving the lungs
o Structural problems that prevent the thoracic from exanding

▪ Spinal problems – kyphosis

▪ Severely scooped chest – pectus excavatum

o Severe obesity

▪ Pressed down on the lungs and make it harder to breath

▪ Will feel breathless

• Intrinsic to lung – causes at the lungs
o Fibrosis
o Radiation induced damage of the lung
o Asbestosis
o Sarcoidosis