1. PULMONARY FUNCTION & RESPIRATORY ANATOMY KAAP310

2. Respiratory Anatomy ◦Larynx ◦Hyoid bone ◦Thyroid cartilage ◦Lateral cricothyroid ligaments ◦Cricoid cartilage http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam%203/larynx%20figure.jpg

3. Anatomy of the Lung ◦Trachea ◦Bronchi ◦Upper lobe ◦Middle lobe ◦Lower lobe ◦Diaphragm http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=270740&version=Patient&language=English

4. Anatomy of the Lung ◦Terminal bronchiole ◦Respiratory bronchiole ◦Pulmonary vein ◦Pulmonary artery ◦Alveoli ◦Capillary bed http://cnx.org/content/m46548/latest/2309_The_Respiratory_Zone.jpg

5. Surfactant ◦A detergent-like complex of lipids and proteins produced by alveolar cells. ◦Decreases the surface tension of the fluid that lines the walls of the alveoli. ◦Less energy is required for breathing. ◦Prevents alveoli from collapsing. http://hyperphysics.phy-astr.gsu.edu/hbase/fluids/imgflu/alveolicut.gif

6. Blood Circulation ◦The heart pumps deoxygenated blood to the pulmonary capillaries for gas exchange to occur between blood and alveoli – air sacs in the lungs. ◦This is known as the pulmonary circulation. ◦Oxygenated blood returns to the heart, where it is pumped out through the aorta by the left ventricle to the rest of the body (systemic circulation). ◦Red blood cells (erythrocytes) transport oxygen in the body. ◦RBC concentration is higher in those living at high altitudes. http://www.lenoircc.edu/disted/med/medgif/med12111c.gif

7. Inspiration and Expiration ◦During inspiration, the diaphragm and external intercostals contract to make the thoracic cavity larger. ◦Active process – requires muscle action. ◦During expiration, the diaphragm and external intercostals relax and the thoracic cavity becomes smaller. ◦Passive process at rest ◦Active process during exercise http://3.bp.blogspot.com/-oBzLa5UeiQM/TZyfGjrEHpI/AAAAAAAAAAQ/_IrQb_OSNSc/s1600/inspirationexpiration.jpg

8. Respiratory Volumes ◦Tidal Volume (V T ) – the amount of air that moves into and out of the lungs during normal, quiet breathing (~500 ml). ◦Inspiratory Reserve Volume (IRV) – the amount of air that can be inspired forcibly beyond the tidal volume (2100-3200 ml). ◦Expiratory Reserve Volume (ERV) – the amount of air that can be expelled from the lungs after a normal tidal volume expiration (1000-1200 ml). ◦Residual Volume (RV) – the amount of air that remains in the lungs even after the most strenuous expiration (1200 ml).

9. Respiratory Capacities ◦Inspiratory Capacity (IC) – the amount of air that can be inspired after a normal tidal volume expiration. ◦IC = V T + IRV ◦Functional Residual Capacity (FRC) – the amount of air remaining in the lungs after a normal tidal volume expiration. ◦FRC = RV + ERV ◦Vital Capacity (VC, also called FVC, forced vital capacity) – the total amount of exchangeable air (~4800 ml). ◦VC = V T + IRV + ERV ◦Total Lung Capacity (TLC) – the sum of all lung volumes (~6000 ml). ◦TLC = V T + IRV + ERV + RV

10. Spirogram http://www.austincc.edu/apreview/NursingPics/RespiratoryPics/Picture16.jpg Rate of breathing and tidal volume increase during exercise.

11. Dead Space ◦Dead Space – some of the inspired air fills the conducting respiratory passageways and never contribute to gas exchange in the alveoli. ◦Anatomical Dead Space (V D )– volume in conducting zone (~150 ml). ◦Alveolar Dead Space – volume of air in alveoli that have ceased to act in gas exchange (due to alveolar collapse or obstruction by mucus, for example). ◦Total Dead Space = anatomical dead space plus alveolar dead space. http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/anesthesia/site/content/figures/2015f21.gif

12. Additional Terms

13. Spirometry ◦Measurement of pulmonary function that is common in clinical medicine ◦Involves measurement of the volume and rate of expired airflow ◦FVC – forced vital capacity – amount of gas expelled when a person takes a deep breath and then forcefully exhales maximally and as rapidly as possible. ◦FEV 1 (forced expired volume in one second) – the amount of air exhaled in the first second of a maximal exhalation. ◦Normally 75-85% of VC ◦FEV 1 /FVC ratio – used to assess and diagnose airway disorders ◦Clinically significant when <75% https://www.nhlbi.nih.gov/health/health-topics/images/spirometry.jpg

14. ◦It is used to diagnose airway disorders. ◦Obstructive airway diseases – asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), etc. ◦Reduced FEV 1 ◦Normal FVC ◦Reduced FEV 1 /FVC ratio http://www.rationalprescribing.com/images/illustrations/obstructive_vs_restrictive_lung_disease.gif ◦Restrictive airway diseases – kyphoscoliosis, neuromuscular disease, pulmonary fibrosis, etc. ◦Reduced FVC ◦Reduced FEV 1 ◦FEV 1 /FVC ratio may be normal, or not Why do spirometry?

15. Experiment 1 ◦Using the handheld spirometers, ONE person from each group will be the subject, who will wear a nose piece to prevent air from escaping through the nasal passages. ◦Subject will take a maximal inspiration, then quickly place their mouth around the mouthpiece creating a tight seal, and then exhale AS QUICKLY AND AS FORCEFULLY AS POSSIBLE until he/she cannot exhale anymore. ◦The subject will perform 3 trials, allowing rest time between trials. ◦Record your FVC and FEV 1 values in the data sheet. ◦Calculate your FEV 1 /FVC ratio

16. Spirometry Reference Value Calculator ◦Go to the following website: http://www.cdc.gov/niosh/topics/spirometry/RefCalculator.html ◦Select “Hankinson 1999” as your reference source. ◦Enter your gender, race, age, and height and the highest numbers you recorded for FVC and FEV 1 (leave the other boxes blank). ◦Click calculate. ◦Fill in the table in the lab packet. ◦Answer and turn in the lab questions – either before the end of lab or next week.

17. Equations to Remember

18. Sample Calculations with the Equations to Remember