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The Respiratory System
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Caroline Thomas BSc, MBChB, FRCA
Consultant in Anaesthesia, Leeds Teaching Hospitals NHS Trust
Honorary Senior Clinical Lecturer, University of Leeds
Leeds, UK
Gunchu Randhawa BSc, MBChB, FRCA, FFICM
Consultant in Intensive Care Medicine and Anaesthesia
Faculty Tutor in Intensive Care Medicine
Leeds Teaching Hospitals NHS Trust
Honorary Senior Lecturer, University of Leeds
Leeds, UK
Series Editor
Stephen Hughes BSc, MSc, MBBS, FRCSEd, FRCEM, FHEA
Consultant in Emergency Medicine, Broomfield Hospital
Senior Lecturer in Medicine, School of Medicine, Anglia Ruskin University
Chelmsford, UK
For additional online content visit ExpertConsult.com
SYSTEMS OF THE BODY
THIRD EDITION
The Respiratory System
THIRD EDITION
BASIC SCIENCE AND CLINICAL CONDITIONS
© 2023, Elsevier Limited. All rights reserved.
First edition 2003
Second edition 2010
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher’s permissions poli-
cies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing
Agency, can be found at our website: www.elsevier.com/permissions
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verication of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contribu-
tors for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
ISBN: 978-0-7020-8284-9
Copyedited by Editage, a unit of Cactus Communications Services Pte. Ltd.
Typeset by TNQ Technologies Pvt. Ltd.
Printed in Poland
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Publisher: Jeremy Bowes
Content Project Manager: Fariha Nadeem
Design: Margaret Reid
Illustration Manager: Anitha Rajarathnam
Marketing Manager: Deborah Watkins
For my parents, Dilbag and Gurbans (G.R.)
For my parents, Andrew and Shirley (C.T.)
SERIES EDITOR FOREWORD
Most students now study medicine through a form of inte-
grated curriculum. These courses blend basic science with
exposure to clinical medicine from an early stage. These
students have the good fortune to be left in no doubt, from
the outset, why they are studying medicine. I teach in a
medical school that delivers a fully integrated curriculum
and I can compare it with the traditional model according
to which I received my early medical education. That com-
parison is very favourable.
Unlike many other texts, the Systems of the Body
series has been designed very specifically to sup-
port an integrated approach to learning medicine. Our
carefully selected panel of authors drawn from across
the English- speaking world have combined basic sci-
ence with clinical application. Links to clinical skills,
clinical investigation and therapeutics are made clear
throughout.
The aim is to offer highly accessible guidance for all
student types and stages. It will be invaluable to those
who are approaching the subject for the first time or who
may have found a topic challenging when using other
more traditionally configured resources – as well as
greatly assist all students wishing to excel as their course
progresses. The clear layout and writing style, together
with detail that informs without overwhelming, go a
long way to supporting students. It may also provide
welcome reminders to postgraduates facing their own
examinations.
Whatever curriculum you follow, wherever you are in
the world, and whichever stage you are at, we know that
the Systems of the Body volumes will serve as great places
to start when learning something new and enable you
to effectively piece together the essential components of
each major body system, in a modern clinical context.
Good luck!
Stephen Hughes, MSc MBBS FRCSEd FRCEM FHEA
Senior Lecturer in Medicine
Anglia Ruskin University
Chelmsford, UK
and
Consultant, Emergency Medicine
Broomfield Hospital
Chelmsford, UK
PREFACE
In the digital era, one may wonder whether there remains
a need for the traditional textbook. Undergraduate medi-
cal and health science students are confronted with a
mass of information on the basic science of the respira-
tory system. This text distils and contextualises this
information, approaching complex concepts in an under-
standable way to enable the development of a solid
knowledge base. Each chapter begins with clearly defined
objectives and addresses a discrete aspect of respiratory
physiology. Summaries of each subsection include a recap
of the key points. Normal structure and function are
explained to allow the understanding of the disruptive
effects of respiratory system diseases.
An integrated approach is adopted throughout the
Systems of the Body series. This third edition of The
Respiratory System has been updated to reflect the inte-
grated nature of modern science courses. Pathology and
pharmacology are woven into the information on basic
science to illustrate their relevance and to aid under-
standing. Updated clinical cases are included throughout
the book to illustrate important concepts and new clini-
cal skills sections have been added, in relevant chapters,
to ease the transition from theory to practice. Efforts have
been made to ensure this edition is written in accessible
language and updated references have been included to
reflect current knowledge and practice. Suggestions for
further reading include recent review and educational
journal articles to enhance understanding of respiratory
physiology. New self- assessment materials have been
produced to accompany the print information in the
eBook.
The authors wrote this book while working clinically
in critical care and anaesthesia during the COVID-19
pandemic. The medical management of patients with a
new disease entity, such as SARS- COV- 2, clearly illus-
trates the value of a sound understanding of normal
respiratory physiology and the processes which may dis-
rupt it. This appreciation of basic principles is the foun-
dation upon which patient and population management
strategies are based.
ACKNOWLEDGEMENTS
The authors would like to thank Drs. Andrew Davies
and Carl Moores for their work on the previous edi-
tion, and Dr Andrew Lumb (Department of Anaesthesia,
St James University Hospital and Honorary Clinical
Associate Professor at the University of Leeds) for help-
ful comments during the preparation of this manuscript.