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The Respiratory System
A. Review of structure and function
1. Nasal cavity
a. Mucous membrane
b. Turbinate bones
c.
Blood supply
d. Functions
i.
Warm, moisten, filter inspired air
ii.
Olfaction
The Respiratory System
A. Review of structure and function
2. Pharynx
3. Larynx
4. Trachea
a. Ciliated mucous membrane
b. Cartilages
The Respiratory System
A. Review of structure and function
5. Bronchi and bronchial tree
a. Primary, secondary, tertiary
b. Bronchioles
i.
Terminal
ii.
Respiratory
6. Alveoli
a. Respiratory membrane
b. Surfactant vs. surface tension
c.
What is compliance?
The Respiratory System
A. Review of structure and function
7. Lungs
a. Apex vs. base
b. Lobes
c.
Bronchopulmonary segment
d. Pleura
i.
Visceral layer
ii.
Parietal layer
iii.
Pleural space
iv.
Pleural fluid
The Respiratory System
A. Review of structure and function
8. Pulmonary ventilation
a. Inspiratory cycle
i.
Active process at rest
ii.
Inspiratory muscles
iii.
Forced inspiration
b. Expiratory cycle
i.
Passive process at rest
ii.
Forced expiration and expiratory muscles
The Respiratory System
A. Review of structure and function
9. Pulmonary volumes and capacities
a. Tidal volume
b. Inspiratory reserve volume
maximum inspiration
6000 ml
5000 ml
IRV
c.
Expiratory reserve volume
VC
TLC
4000 ml
d. Residual volume
3000 ml
e. Vital capacity
f.
Total lung capacity
TV
2000 ml
ERV
1000 ml
maximum
expiration
SPIROGRAM
RV
The Respiratory System
A. Review of structure and function
9. Pulmonary volumes and capacities
g. Clinical values of importance
i.
Maximum breathing capacity
ii.
Minute respiratory volume
iii.
Forced vital capacity
iv.
Forced vital capacity per second (FEV1)
The Respiratory System
B. Age-related changes
1. Trachea and bronchi
a. Calcification of cartilages
b. Smooth muscle in bronchioles replaced by collagen
c.
Loss of elasticity of lungs and thoracic wall (decreased
compliance)  decreased maximum breathing capacity and
vital capacity
i.
Age 25, MBC = 165L/min; age 85, MBC = 75L/min
ii.
Age 25, VC = 100%; age 70, VC = 60%
d. Mucosal degeneration, decreased ciliary action,
decreased phagocytic activity
The Respiratory System
B. Age-related changes
2. Alveoli
a. Fusion between adjacent alveolar walls = decreased
respiratory membrane surface area
b. Increased collagen + decreased elastin = decreased
compliance and diminished ventilation
c.
Interstitial fluid changes hamper oxygen transport across
respiratory membrane
d. Altogether, these changes cause declining blood oxygen
levels with aging
The Respiratory System
B. Age-related changes
3. Lungs
a. Lose some elastic recoil, thus less resistance to expansion,
due to changes in elastin
b. Lower lung regions to be poorly ventilated, causing decreased
blood saturation with oxygen
c.
Alveolar air isn’t exchanged as well with tidal air
d. Respiratory rates do not increase as well with decreased blood
oxygen or increased blood carbon dioxide
e. Decreased forced vital capacity and FEV1
The Respiratory System
B. Age-related changes
4. Structural changes in the thorax
a. Rounding of thoracic vertebrae  kyphosis
b. Rib cartilages calcify
c.
Decreased muscle tone in diaphragm and intercostals
d. Breathing while lying down may be more difficult due to
increases in intrabdominal pressure (fat) and because older
folks tend to be diaphragmatic breathers
The Respiratory System
C. Age-related dysfunctions
1. Chronic obstructive pulmonary disease (COPD)
a. Obstructive disease limits expiration
b. Decreased ratio of FEV1:FVC
c.
Symptoms
d. Causes
i.
Emphysema
ii.
Chronic bronchitis
The Respiratory System
C. Age-related dysfunctions
2. Pneumonia
a. Bacterial, viral, fungal infections lead to exudate-filled
air sacs, causing decreased gas exchange with blood
b. Community- vs. hospital-acquired
c.
Aspiration pneumonia
3. Tuberculosis
a. Bacterial infection leading to nodule formation
b. Nodules replace functional lung tissue
The Respiratory System
C. Age-related dysfunctions
4. Pulmonary embolism
a. What is an embolus?
b. How does it affect respiratory function?
The Respiratory System
D. Take home messages
1. Decreased lung elasticity, increased rigidity of thorax
and bronchial tree, and changes in spinal curvatures
lead to:
a. Increased breathing effort
b. Decreased maximum breathing capacity and vital capacity
2. Gradual loss of respiratory membrane surface area
and poor exchange between alveolar air and tidal air
lead to:
a. Decreased oxygen saturation of blood
b. Increased carbon dioxide in blood
end