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GLOSSARY
169THE RESPIRATORY SYSTEM
Reid Index – the proportion of the total airway thickness
that is made up of mucous glands. It is normally less
than 40%.
residual volume – the volume of gas that is left in the
lungs at the end of maximum expiration, around 1 L.
respiratory airway – airways from which alveoli branch
directly.
respiratory exchange ratio – ratio of carbon dioxide out-
put to oxygen input (also called respiratory quotient).
shunt – deoxygenated blood which passes from the right
hand (venous) side of the circulation to the left, with-
out becoming oxygenated in the alveoli. By doing so, it
reduces the oxygen content of arterial blood.
shunt equation – equation used to calculate the shunt
fraction or venous admixture.
shunt fraction – the amount of blood passing through
the lungs that does not meet ventilated areas of the lung,
expressed as a fraction of total blood flow through the lungs.
sickle cell disease – inherited abnormality of haemoglo-
bin characterised by a change in the shape of red blood
corpuscles (sickling) in response to hypoxia. So called
because the shape of the deformed blood corpuscles is
thought to resemble a sickle.
smooth muscle – involuntary muscle such as that found
in the bronchial walls, digestive system, etc.
spirometer – instrument for measuring and recording
lung volumes.
standard bicarbonate – the theoretical concentration of
bicarbonate in the plasma at a normal carbon dioxide
partial pressure, calculated from the pH and the meas-
ured (actual) carbon dioxide partial pressure.
sternum – the ‘breastbone’ situated in the front of the
ribcage, in the midline, and to which the costal cartilages
attach.
strong acid – in physiological terms, an acid which dis-
sociates almost completely at body pH, making it a poor
buffer.
surface tension – surface tension results from greater
than normal attraction between molecules on the surface
of a liquid. This force tends to cause droplets of liquid to
assume a spherical shape and also tends to cause alveoli,
which are lined by a thin film of liquid, to collapse.
surfactant – phospholipid secreted by type II alveolar
cells which reduces the surface tension of the alveoli
and increases lung compliance and stability; dipalmitoyl
phosphotidylcholine.
sympathetic nervous system – part of the involuntary
nervous system. Fibres from the sympathetic nervous
system innervate organs which are not under voluntary
control, such as the heart, airways, digestive organs, etc.
systemic circulation – blood vessel system carrying oxy-
genated blood from the left ventricle to the body and deox-
ygenated blood from the body back to the right atrium.
tension – blood gas tension refers to the partial pressure
of gases in blood.
thalassaemia – inherited group of diseases characterised
by reduced production of one or more of the molecules
making up haemoglobin. This can lead to severe anaemia
in badly affected individuals.
thebesian veins – veins of the myocardium which drain
blood into the underlying atrium or ventricle.
tidal volume – that volume of air passing into the respir-
atory system during each breath.
tidal breathing – inhalation and exhalation of the tidal
volume, only (around 500 mL). This is quiet breathing
and is also sometimes referred to as ‘normal’ breathing.
time constant – this term describes the rate at which the
functional units of the lungs inflate and deflate. One time
constant is the time taken for a lung unit to complete
63% of its maximal inflation.
total cross- sectional area – the sum of the cross- sectional
areas of all the airways at a given distance into the lung.
total lung capacity – the sum of the residual volume,
the expiratory reserve volume, the tidal volume, and the
inspiratory reserve volume, that is, the volume of gas
that is in the lungs at maximum inspiration.
trachea – the ‘windpipe’; the tube which connects the lar-
ynx to the two main bronchi.
transfer factor – in respiratory physiology, the transfer
factor for a gas is the rate of movement of the gas across
the alveolar membrane divided by the difference in the
partial pressures of the gas across that membrane.
transmural pressure – in respiratory physiology, this
usually refers to the difference between the alveolar gas
pressure and the intrapleural pressure.
turbinates – bony, mucosa- covered projections into the
nasal cavity. There are three on each side. Sometimes also
called conchae.
turbulent – flow of a fluid through a vessel whereby the
particles making up the fluid move in lines that are not
parallel.
upper motor neurons – nerves that convey information
from the cerebral cortex to the spine.
vagus nerve – parasympathetic nerve which arises from
the brainstem and which innervates many of the internal
organs, including those of the respiratory system.
vapour pressure – the gas pressure exerted by a vapour.
vasoconstriction – the reduction in diameter of a blood
vessel as a result of the action of smooth muscle in its
walls.
vasodilation – the increase in diameter of a blood vessel
as a result of the relaxation of the smooth muscle in its
walls.
venous admixture – the theoretical volume of mixed
venous blood that would need to be added to blood leav-
ing the alveoli per unit time in order to produce an oxygen
content equal to that actually seen in aortic arterial blood.
ventilation – the volume of air leaving the respiratory
system.
ventilation/perfusion ratio – for any given part of the
respiratory system, the ratio of gas leaving the region per
unit time divided by the blood flow through that region.
vasoactive intestinal polypeptide – A neurotransmitter
found in the respiratory system.
visceral pleura – the innermost of the two layers of
pleura, that is, the one lying directly over the lung.
vital capacity – the maximum volume of air that can be
passed into or out of the respiratory system in one breath.
GLOSSARY
170 SYSTEMS OF THE BODY
vocal folds – also called vocal cords. Paired folds of tissue
in the larynx which vibrate when air passes between them,
producing a sound from which the voice is generated.
volatile acid – acid that is formed by the solution of a gas
in water. The most important volatile acid in respiratory
physiology is carbonic acid, formed when carbon dioxide
dissolves in water.
voluntary control – the ability to control an organ at will.
Skeletal muscles are under voluntary control, smooth
muscles of the respiratory tract are not.
weak acid – an acid that only partially dissociates in
solution.
West zones – physiological concept dividing the lungs
into areas dependent on the interplay between alveolar
pressure, arterial pressure, and venous pressure.
work of breathing – the energy exerted by the respira-
tory system on its surroundings per unit time. It is not
equal to the total energy used by the respiratory sys-
tem because not all of that energy is transferred to its
surroundings.
Young’s modulus – a measure of the ability of a material
to withstand changes in length when under lengthwise
tension or compression. Also referred to as the modulus
of elasticity.
Index
Note: Page numbers followed by ‘f’ indicate figures, ‘t’ indicate tables and ‘b’ indicate
boxes.
A
Abducted, 128
Acidaemia, 112
Acid- base balance, 111–114
acidaemia, 112
acidosis, 115
alkalaemia, 112
alkalosis, 115
arterial blood gases, interpretation of,
117b–119b
bicarbonate as a buffer, 113–114
blood, 116b–117b
blood buffering, 112–113
buffers, 112
calculation, 115
clinical measurements, 115–119
Davenport diagram, 115
fixed/nonvolatile acids, 112
Henderson–Hasselbalch
equation, 114
illustration of, 115
little chemistry, 111–112
normal plasma hydrogen ion
concentration, 112
phosphates as buffers, 113
pK of a buffer, 113
proteins as buffers, 113
strong acid, 112–113
volatile acids, 112
weak acid, 112–113
Acidosis, 115
Acute respiratory distress syndrome, 31
Adducted, 128
Afferent, 122
Age, 31
Airflow
asthma, 44
bringing about, 44–45
Airflow (Continued)
factors affecting flow, 45–46, 46f
impedance, 44
laminar flow, 45, 45f
respiratory system, 59b–60b
turbulent flow, 45, 45f
Air pollution, 23
Airway resistance, 31, 46–48
sites, 46–48
Airways, 10
histological structure of, 14–16, 15f
Alkalaemia, 112
Alkalosis, 115
Allergic rhinitis, 12
Alpha motor neurons, 127
Alveolar- arterial PO
2
gradient, 95
Alveolar gas equation, 67
Alveolar membrane, 81
Alveolar ventilation, 66
Alveoli liquid lining, surfactant in, 36–37,
36f–37f
Aminophylline/theophylline, 57
Anatomical/alveolar dead space, 64–65, 64f
Anatomical shunt, 94
Anticholinergic drugs, 57
Aorta, 8b
Aortic bodies, 140
Arterial blood gases, interpretation of,
117b–119b
Asphyxia, 143–145
Asthma, 31, 44, 54–57
bronchitis, 57
bronchoconstriction relief, 56–57
aminophylline/theophylline, 57
anticholinergic drugs, 57
corticosteroids, 57
leukotriene receptor antagonists, 57
chronic obstructive pulmonary disease
(COPD), 57
Asthma (Continued)
diagnosis, 54–55
emphysema, 57–60
factors affecting bronchomotor tone, 55–56
carbon dioxide, 56
circulating catecholamines, 55
eosinophils, 56
mast cell degranulation, 56
neutrophils, 56
nonadrenergic noncholinergic systems
(NANC), 56
parasympathetic nerves, 55
rapidly adapting pulmonary
receptors, 56
slowly adapting pulmonary
receptors, 56
sympathetic nerves, 55
pathophysiology, 54–55
principles of treatment of, 56–57
radial traction, 57–58
sodium cromoglicate, 57
Atmosphere to alveoli, 67–68
Auscultation, 6b
B
Baroreceptor, 140
Basic science
bubbles, 162–163
compliance, 160
elastance, 160
elasticity, 160
flow of gases, 161–162
gas laws, 160–161
gas volumes, 163
states of matter
gases, 159–160
liquids, 159, 159f
INDEX
172
Basic science (Continued)
solids, 159
surface tension, 162–163
Young’s Modulus, 160
Bicarbonate, carbon dioxide in, 109
Biologically active substances, 24
Blood, 83b
buffering, 112–113
capacity, 25
filtration, 24
Blood flow distribution, lungs, 89–92
cor pulmonale, 91
dead space, 90
gravity, 89–90
hypoxic pulmonary vasoconstriction
(HPV), 90–91
pulmonary hypertension, 91
pulmonary vessels innervation, 91–92, 91f
regional differences in ventilation, 92, 92f
vasoconstrict, 90
vasodilate, 90
Blood fluidity, 24–25
Blood gas analysis, 152
Blood plasma, 81
Blood transport gases, 102
Bohr equation, 65–66
Breathing
abducted, 128
adduct, 128
afferent, 122
alpha motor neurons, 127
asphyxia, 143–145
central chemoreceptors, 138–140
anatomy, 139, 139f
function, 139–140, 139f
central control of, 123
central pattern generator (CPG), 123
chemical control anaesthesia, 143, 143f
Cheyne–Stokes breathing, 142
apnoeic threshold, 142
chronic obstructive pulmonary disease
(COPD), 126f, 126–127, 144b–145b
causes, 144b–145b
clinical features of, 144b–145b
oxygen therapy, 144b–145b
conscious control, 125–126
economy of energy, 122–123
expiratory muscles, 128
extrafusal motor fibres, 127
hypercapnia, 138–139
hypocapnia, 138
hypoxia, 140
larynx, 128
long- term hypoxic stimulation, 142–143
lower motor neurons, 127
mechanics of, 20–21
medullary respiratory centres, 124–125
dorsal respiratory group (DRG), 124
pontine respiratory group (PRG), 125f,
125
ventral respiratory group (VRG), 124–125
minute ventilation, 122, 138
motor unit, 127
muscle- spindle reflexes, 128
musculoskeletal afferents, 133
Breathing (Continued)
cardiovascular afferents, 133
coning, 134b
somatic and visceral reflexes, 133
neuromuscular disorders, 128–130
central nervous system disorders,
128–129
disuse atrophy, 129
Duchenne muscular dystrophy, 129
dyspnoea, 129–130
peripheral nervous system disorders, 129
respiratory centre, afferent inputs to, 130
respiratory muscle disorders, 129
peripheral chemoreceptors, 138, 140–142
anatomy, 140–141
aortic bodies, 140
baroreceptor, 140
carotid bodies, 140
eupnoea, 141
function, 141–142
glomus tissue, 140
histology, 140–141
hypercapnic stimulation, 142
hypoxic stimulation, 141–142
total blood oxygen content, 141
peripheral mechanoreceptors, 126
pulmonary afferents, 130–132
C- fibre receptors (J receptors), 132
rapidly adapting (irritant) receptors
(RARs), 131–132
slowly adapting pulmonary stretch
receptors (PSRs), 130–131
respiratory muscle innervation, 127–128
upper airway afferents, 132–133
coughing, 133
laryngospasm, 133
larynx, 132–133
nose, 132–133
pharynx, 132–133
sneezing, 132
swallowing, 133
upper motor neurons, 127
Bronchial challenge tests, 155–157
Bronchial circulation, 86, 86f, 94
Bronchitis, 57
Bronchoconstriction relief, 56–57
aminophylline/theophylline, 57
anticholinergic drugs, 57
corticosteroids, 57
leukotriene receptor antagonists, 57
Bronchomotor, 19–20
Bubbles, 162–163
Buffers, 112
Phosphates, 113
pK of, 113
proteins as, 113
C
Carbamino Hb, 106
Carbon dioxide, 56, 83–84
combined with proteins, 109–110
dissociation curve for, 111
transport, 109–111
Carboxyhaemoglobin (HbCO), 108
Cardiopulmonary exercise testing (CPET), 155
Cardiovascular afferents, 133
Carotid bodies, 140
Carriage of gases
acid–base balance, 111–114
acidaemia, 112
acidosis, 115
alkalaemia, 112
alkalosis, 115
arterial blood gases, interpretation of,
117b–119b
bicarbonate as a buffer, 113–114
blood, 116b–117b
blood buffering, 112–113
buffers, 112
calculation, 115
clinical measurements, 115–119
Davenport diagram, 115
fixed/nonvolatile acids, 112
Henderson–Hasselbalch equation, 114
illustration of, 115
little chemistry, 111–112
normal plasma hydrogen ion concentra-
tion, 112
phosphates as buffers, 113
pK of a buffer, 113
proteins as buffers, 113
strong acid, 112–113
volatile acids, 112
weak acid, 112–113
bicarbonate, carbon dioxide in, 109
blood transport gases, 102
carbamino Hb, 106
carbon dioxide
combined with proteins, 109–110
dissociation curve for, 111
transport, 109–111
carboxyhaemoglobin (HbCO), 108
cyanosis, 105
dissolved carbon dioxide, 109
double Bohr shift, 107–108
DPG, 106–107
foetal haemoglobin (HbF), 107–108, 108f
gas exchange in the lungs, 110
haemoglobin, 103–107
oxygen combination with, 103–104
haemoglobin variants, 107–109
Hb content, 104–105
Hb saturation, 105
hydrogen ion concentration, 106
methaemoglobin (Met- Hb), 108
myoglobin, 107, 108f
oxygen transport, 102–103
oxyhaemoglobin dissociation curve, 104–106
displacement, 106–107
partial pressure, 104–105
sickle cell disease (HbS), 108–109
temperature, 106
thalassaemia, 109
transported carbon dioxide quantities,
110–111
Central chemoreceptors, 138–140
anatomy, 139, 139f
function, 139–140, 139f
INDEX
173
Central nervous system disorders, 128–129
overdose, 128
poliomyelitis, 128–129
spinal cord injury, 129
trauma, 128
Central pattern generator (CPG), 123
C- fibre receptors (J receptors), 132
Chemical control anaesthesia, 143, 143f
Chest inspection, 6b
Cheyne–Stokes breathing, 142
apnoeic threshold, 142
Chronic obstructive pulmonary disease
(COPD), 126f, 57, 126–127, 144b–145b
causes, 144b–145b
clinical features of, 144b–145b
oxygen therapy, 144b–145b
Ciliated epithelium, 15
Compliance, 150, 160
Conditioning air, 21
Conductance, 49–50
Coning, 134b
Conscious control, 125–126
Corticosteroids, 57
Coughing, 5, 133
Cyanosis, 6b, 105
D
Davenport diagram, 115
Dead space, 14, 64, 93–94
alveolar gas equation, 67
alveolar ventilation, 66
anatomical/alveolar dead space, 64–65, 64f
atmosphere to alveoli, 67–68
Bohr equation, 65–66
factors affecting, 66–69
Fowler’s method, 65
regional differences, 68–69, 69f
respiratory exchange, 66
ventilation regional variation, 69–75
airway smooth muscle tone, 70
pathological changes, 70–75
pneumonia, 73b–74b
pneumothorax, 71b–73b
posture, 70
Diaphragm, 8b, 17–18, 17f–18f
Dichotomous branching, 13–14
Diffusion, 3, 21–22
alveolar membrane, 81
blood plasma, 81
capacity, 150–152
carbon dioxide, 83–84
factors affecting, 78–79
surface area available for, 79–81
haemoglobin, 81
idiopathic pulmonary fibrosis
clinical features of, 84b
diagnosis, 84b
treatment of, 84b
inadequate diffusion, 82–83
measuring capacity, 81–82
partial pressure, 78
Dissolved carbon dioxide, 109
Disuse atrophy, 129
Double Bohr shift, 107–108
DPG, 106–107
Driving pressure, 88–89
Drugs, 5
Duchenne muscular dystrophy, 129
Dynamic lung compliance, 39, 39f
Dyspnoea, 129–130
E
Economy of energy, 122–123
Elastance, 30, 160
Elasticity, 160
Embryology, 10
Emphysema, 31, 57–60
Empyema, 17
Environment, defences against, 21
Eosinophils, 56
Eupnoea, 141
Expiratory flow limitation, 48–49
Expiratory muscles, 128
Expiratory reserve volume (ERV), 63
Extrafusal motor fibres, 127
Exudates, 17
F
Finger clubbing, 6b
Fixed/nonvolatile acids, 112
Flow of gases, 161–162
Flow- related airway collapse, 48–49
Folds/cords, 12
Forced vital capacity (FVC), 148
Fowler’s method, 65
Functional residual capacity (FRC),
50, 148
Functional testing, 154–157
bronchial challenge tests, 155–157
cardiopulmonary exercise testing (CPET),
155
G
Gas exchange, 83b
surface area available for, 79–81
Gas laws, 160–161
Gas transport, 3
Gas volumes, 163
Glomus tissue, 140
H
Haemoglobin, 81
Haemoptysis, 5
Haemothorax, 17
Heart, 8b
Helium dilution, 148–149
Henderson–Hasselbalch equation, 114
Homeostasis, 2
Hypercapnia, 138–139
Hypercapnic stimulation, 142
Hypocapnia, 138
Hypoxia, 140
Hypoxic stimulation, 141–142
I
Idiopathic pulmonary fibrosis
clinical features of, 84b
diagnosis, 84b
treatment of, 84b
Impaction, 21–22
Impedance, 44
Inadequate diffusion, 82–83
Inert gas washout, 153
Inertia, 46
Infective rhinitis, 12
Inhaled particles, 21–23
Inspiratory reserve volume (IRV), 63
Interrupter technique, 52–53
Intrathoracic airways, 13–14
L
Laminar flow, 45, 45f
Laryngospasm, 12, 133
Laryngotracheal bud, 10
Larynx, 12, 46–48, 128, 132–133
Leukotriene receptor antagonists, 57
Liquid lining, 34–35, 35f
Little chemistry, 111–112
Long- term hypoxic stimulation, 142–143
Lower motor neurons, 127
Lung compliance, 30
acute respiratory distress syndrome, 31
age, 31
airway resistance, 31
asthma, 31
disease effects, 31
elastance, 30
emphysema, 31
factors affecting, 30
lung volume, 31
measuring compliance, 38–39
dynamic lung compliance, 39, 39f
static compliance, 39–42
static lung compliance, 38–39, 38f
new- born, respiratory distress syndrome
of, 31
physical basis of, 33–38
alveoli liquid lining, surfactant in,
36–37, 36f–37f
liquid lining of, 34–35, 35f
lung tissue elasticity, 34
nature of bubbles, 35–36
opening and closing, 37–38
surface of liquids, 35, 35f
pneumonia, 31
posture, 31
pulmonary blood volume, 31
pulmonary fibrosis, 31
static compliance, 30
thoracic cage, 31–32
INDEX
174
Lung compliance (Continued)
total compliance, 32–33
intrapleural pressure, 32–33, 32f
vital capacity, 31
Lung function tests
blood gas analysis, 152
diffusing capacity, 150–152
functional testing, 154–157
bronchial challenge tests, 155–157
cardiopulmonary exercise testing
(CPET), 155
inert gas washout, 153
lung mechanics
compliance, 150
resistance, 150
static compliance, 150
major surgery, referral and assessment for,
156b–157b
measuring flow, 149
peak expiratory flow, 149
multiple- breath washout curves, 153–154
multiple inert gas washout, 154, 154f
oxygen levels, measuring, 152
PEFR measurement, clinical
skill–performing, 150
perfusion, 152–153
single- breath method, 151–152
single- breath washout curves, 152–153
steady- state method, 151
ventilation, 152–153
volumes and capacities
forced vital capacity (FVC), 148
functional residual capacity (FRC), 148
helium dilution, 148–149
nitrogen washout, 148–149
nitrogen wash- out technique, 149
plethysmograph, 149
plethysmography, 148–149
spirometry, 148
Lungs, 8b
mechanics
compliance, 150
resistance, 150
static compliance, 150
non- respiratory functions of, 24–25
blood capacity, 25
blood filtration, 24
blood fluidity, 24–25
cooling, 25
structure of, 25b
voluntary control of breathing, 25
tissue elasticity, 34
volume, 31
volumes, 62–63
Lymphatics, 19
M
Massive pulmonary embolism, 96b–98b
Mast cell degranulation, 56
Medullary respiratory centres, 124–125
dorsal respiratory group (DRG), 124
pontine respiratory group (PRG), 125f, 125
ventral respiratory group (VRG), 124–125
Metabolic activity, 23–24
Microcirculation, 18–19
Minute ventilation, 62, 122, 138
Mixed venous blood, 88
Motor unit, 127
Mouth and nose, 11–12, 11f
Multiple- breath washout curves, 153–154
Multiple inert gas washout, 154, 154f
Muscle- spindle reflexes, 128
Musculoskeletal afferents, 133
cardiovascular afferents, 133
coning, 134b
somatic and visceral reflexes, 133
N
Nature of bubbles, 35–36
Nerves, 19–20
bronchomotor, 19–20
parasympathetic nerves, 19–20
sympathetic nerves, 19
visceral afferents, 19–20
Neuromuscular disorders, 128–130
central nervous system disorders,
128–129
disuse atrophy, 129
Duchenne muscular dystrophy, 129
dyspnoea, 129–130
peripheral nervous system
disorders, 129
respiratory centre, afferent
inputs to, 130
respiratory muscle disorders, 129
Neutrophils, 56
New- born, respiratory distress syndrome
of, 31
Nitrogen washout, 148–149
Nonadrenergic noncholinergic systems
(NANC), 56
Normal plasma hydrogen ion concentration,
112
Nose, 46–48, 132–133
O
Ohm’s law, 46
Oxygen
carbon dioxide diagram, 93–94
levels, measuring, 152
therapy, 144b–145b
P
Parasympathetic nerves, 19–20, 55
Parenchyma, 16–17
Partial pressure, 78
Pathophysiology, 54–55
Peak expiratory flow, 149
PEFR measurement, clinical
skill–performing, 150
Percussion, 6b
Perfusion, 86, 89–92, 152–153
Peripheral chemoreceptors, 138, 140–142
anatomy, 140–141
aortic bodies, 140
baroreceptor, 140
carotid bodies, 140
eupnoea, 141
function, 141–142
glomus tissue, 140
histology, 140–141
hypercapnic stimulation, 142
hypoxic stimulation, 141–142
total blood oxygen content, 141
Peripheral mechanoreceptors, 126
Peripheral nervous system disorders, 129
botulism, 129
diphtheria, 129
Guillain- Barré, 129
myasthenia gravis, 129
Pharynx, 46–48, 132–133
Plethysmograph, 149
Plethysmography, 148–149
Pleura, 16–17
Pleural effusion, 17
Pleurodesis, 17
Pneumonia, 31, 73b–74b
Pneumothorax, 17, 71b–73b
Poliomyelitis, 128–129
Pores of Kohn, 14
Posture, 31, 70
Pressure, 52
Pulmonary afferents
C- fibre receptors (J receptors), 132
rapidly adapting (irritant) receptors
(RARs), 131–132
slowly adapting pulmonary stretch
receptors (PSRs), 130–131
Pulmonary blood vessels, 87–89, 88f
Pulmonary blood volume, 31
Pulmonary circulation
alveolar- arterial PO
2
gradient, 95
anatomical shunt, 94
blood flow distribution, lungs, 89–92
alveolar gas pressure, 90
cor pulmonale, 91
dead space, 90
gravity, 89–90
hypoxic pulmonary vasoconstriction
(HPV), 90–91
pulmonary hypertension, 91
pulmonary vessels innervation, 91–92,
91f
regional differences in ventilation, 92,
92f
vasoconstrict, 90
vasodilate, 90
bronchial circulation, 86, 86f, 94
dead space, 93–94
function, 86–89
gross structure, 87–89
driving pressure, 88–89
mixed venous blood, 88
pulmonary blood vessels, 87–89, 88f
recruitment, 88
right ventricle, 87, 88f
massive pulmonary embolism, 96b–98b
INDEX
175
Pulmonary circulation (Continued)
oxygen- carbon dioxide diagram, 93–94
perfusion, 86, 89–92
pulmonary emboli, 96b–98b
pulmonary embolus, 96b–98b
respiratory exchange ratio (R), 93
salutary tale, 95–99
shunt, 94–95
equation, 95
structure, 86–89
systemic circulation, 86
tensions, 93
thebesian veins, 94
venous admixture, 95
ventilation, 86, 89–92
Pulmonary emboli, 96b–98b
Pulmonary fibrosis, 31
Pulmonary hypertension, 19
Pulmonary vasculature, 18–19
Pulmonary ventilation
capacities, 62–63
dead space. See Dead space
expiratory reserve volume (ERV), 63
inspiratory reserve volume (IRV), 63
lung volumes, 62–63
minute ventilation, 62
spirometric abnormalities in disease,
63–75, 63f
spirometry, 62–63
total lung capacity (TLC), 63
vital capacity (VC), 63
Pulmonary vessels, 8b
R
Radial traction, 57–58
Rapidly adapting pulmonary receptors, 56
Rapidly adapting (irritant) receptors (RARs),
131–132
Recruitment, 88
Regional differences, 68–69, 69f
Resistance, 150
Respiration
aorta, 8b
basic science of, 3–4, 4f
bones, 8b
breathlessness, 5
centimetre, gram, second (CGS) system,
4–5
chest pain, 5
chest x- ray, clinical skill interpreting, 7b,
7f–8f
clinical skill examination, 6b
auscultation, 6b
chest inspection, 6b
cyanosis, 6b
finger clubbing, 6b
percussion, 6b
trachea, 6b
cough, 5
definition, 2
diaphragm, 8b
diffusion, 3
drugs, 5
Respiration (Continued)
gas transport, 3
haemoptysis, 5
heart, 8b
homeostasis, 2
lungs, 8b
need for, 2–3
pulmonary vessels, 8b
respiratory symbols, 4
sputum, 5
stridor, 5
symbols, 5t
symptoms of, 5
Système International (SI), 4
timing in circulation, 3, 3f
trachea, 8b
ventilation, 2
wheezing, 5
Respiratory centre, afferent inputs to, 130
Respiratory exchange, 66
Respiratory exchange ratio (R), 93
Respiratory muscle
disorders, 129
innervation, 127–128
Respiratory symbols, 4
Respiratory system, 59b–60b
air pollution, 23
airways, 10
histological structure of, 14–16, 15f
allergic rhinitis, 12
biologically active substances, 24
breathing, mechanics of, 20–21
ciliated epithelium, 15
conditioning air, 21
dead space, 14
diaphragm, 17–18, 17f–18f
dichotomous branching, 13–14
diffusion, 21–22
embryology, 10
empyema, 17
environment, defences against, 21
exudates, 17
folds/cords, 12
haemothorax, 17
impaction, 21–22
infective rhinitis, 12
inhaled particles, 21–23
intrathoracic airways, 13–14
laryngospasm, 12
laryngotracheal bud, 10
larynx, 12
lung, non- respiratory functions of, 24–25
blood capacity, 25
blood filtration, 24
blood fluidity, 24–25
cooling, 25
structure of, 25b
voluntary control of breathing, 25
lymphatics, 19
metabolic activity, 23–24
metabolism, 24
microcirculation, 18–19
mouth and nose, 11–12, 11f
nerves, 19–20
bronchomotor, 19–20
Respiratory system (Continued)
parasympathetic nerves, 19–20
sympathetic nerves, 19
visceral afferents, 19–20
parenchyma, 16–17
pleura, 16–17
pleural effusion, 17
pleurodesis, 17
pneumothorax, 17
pores of Kohn, 14
production of, 24
pulmonary hypertension, 19
pulmonary vasculature, 18–19
sedimentation, 21–22
smoking, 23
smooth muscle, 15
structure of, 26b
surfactants, 16
trachea, 13
trachealis muscle, 13
transudates, 17
turbinates, 11
vasomotor rhinitis, 12
Respiratory system, elastic properties of
compliance, 30–42
elastance, 30–42
elastic resistance, 30
intrapleural space, 30
lung compliance. See Lung compliance
new- born
respiratory distress syndrome in,
40b–41b
surface forces, 30
Respiratory system resistance, 46–50
airway resistance, 46–48
airway resistance sites, 46–48
assessing and measuring resistance,
52–54
interrupter technique, 52–53
pressure, 52
whole- body plethysmography, 53–54,
53f
clinical tests for changes, 54, 54f
conductance, 49–50
expiratory flow limitation, 48–49
flow- related airway collapse, 48–49
functional residual capacity
(FRC), 50
inertia, 46
larynx, 46–48
nose, 46–48
Ohm’s law, 46
pharynx, 46–48
tidal breathing, 49–50
tissue resistance, 46
transmural, 48–49
volume- related airway collapse, 49–50
work of breathing, 50–51
Right ventricle, 87, 88f
S
Salutary tale, 95–99
Sedimentation, 21–22
INDEX
176
Shunt, 94–95
equation, 95
Single- breath method, 151–152
Single- breath washout curves, 152–153
Slowly adapting pulmonary
receptors, 56
Slowly adapting pulmonary stretch
receptors (PSRs), 130–131
Smoking, 23
Smooth muscle, 15
Sneezing, 132
Sodium cromoglicate, 57
Somatic and visceral reflexes, 133
Spinal cord injury, 129
Spirometric abnormalities in disease, 63–75,
63f
Spirometry, 62–63, 148
Sputum, 5
States of matter
gases, 159–160
liquids, 159, 159f
solids, 159
Static compliance, 30, 39–42, 150
Static lung compliance, 38–39, 38f
Steady- state method, 151
Stridor, 5
Strong acid, 112–113
Surface of liquids, 35, 35f
Surface tension, 162–163
Surfactants, 16
Swallowing, 133
Sympathetic nerves, 19, 55
Système International (SI), 4
Systemic circulation, 86
T
Tensions, 93
Thalassaemia, 109
Thebesian veins, 94
Thoracic cage, 31–32
Tidal breathing, 49–50
Timing in circulation, 3, 3f
Total blood oxygen content, 141
Total compliance, 32–33
intrapleural pressure, 32–33, 32f
Total lung capacity (TLC), 63
Trachea, 6b, 6b, 13
Trachealis muscle, 13
Transported carbon dioxide quantities,
110–111
Transudates, 17
Trauma, 128
Turbinates, 11
Turbulent flow, 45, 45f
U
Upper airway afferents, 132–133
coughing, 133
laryngospasm, 133
larynx, 132–133
nose, 132–133
pharynx, 132–133
sneezing, 132
swallowing, 133
Upper motor neurons, 127
V
Vasomotor rhinitis, 12
Venous admixture, 95
Ventilation, 2, 86, 89–92, 152–153
Ventilation regional variation, 69–75
airway smooth muscle tone, 70
pathological changes, 70–75
pneumonia, 73b–74b
pneumothorax, 71b–73b
posture, 70
Visceral afferents, 19–20
Vital capacity (VC), 31, 63
Volatile acids, 112
W
Weak acid, 112–113
Wheezing, 5
Whole- body plethysmography, 53–54, 53f
Y
Young’s Modulus, 160