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Learningobjectives
Basicelementsoftherespiratorycontrolsystem (sensor,centralcontroller,effectors) Central C t lcontroller t ll (brain (b i stem, t cortex, t other th parts t of fthe th brain) b i ) Effectors Sensors:Centralchemoreceptors :Peripheralchemoreceptors :Lungreceptors :otherreceptors IntegratedresponsestoCO2,O2,pHandexercise Abnormalpatternsofbreathing

Control of ventilation Centralcontroller

Input Pons,medulla Otherpartsofbrain Output

Sensors
Chemoreceptors Lung&other receptors

negativefeedback

Effectors
Respiratorymuscles

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Central controller
1.Medullaryrespiratorycenter 1.1Dorsalrespiratorygroup(DRG) mainlyforinspiration intrinsicperiodicfiring basicrhythmofventilation 1.2Ventralrespiratorygroup(VRG) quiescentduringnormalquietbreathing forcedbreathing(exercise),expirationbecomes activeasaresultofactivityofexpiratorycells 2.Apneusticcenter excitatory i effect ff oninspiratory i i areaof fDRG prolongedinspiration(promotinginspiration) receiveinhibitoryimpulsefrompneumotaxic centerorrostralpontinegroup(RPG)&pulmonary stretchreceptor(PSR)

3.Pneumotaxiccenterorrostralpontinegroup switchofforinhibitinspiration(byinhibitingapneusticcentre) regulateinspirationvolume&respiratoryrate finetuning tuning ofrespiratoryrhythm fine

Ventralrespiratory group(VRG)

Dorsal respiratory group(DRG)

Respiratory rhythmcentre

Cortex Voluntaryventilation (hyperventilation,breathholding) Otherpartsofbrain Limbicsystem(emotionalstate) Hypothalamus(hyperthermia/fever)

Modified from http://www.elrinajouberthuebner.online.de/assets/images/Medulla_Respiratory_Center.gif

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Arterialchemoreceptor
1. Centralchemoreceptor
majorhypercapnic detector ventral lsurface f of fmedulla d ll

VentilatoryresponsetoincreasedPCO2

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PO2
severe hypoxaemia

anaerobicmetabolism + LacticacidinCSF(H)
+

2.Peripheralchemoreceptor

Centralchemoreceptor Respiratorycenter Increasedventilation

PaO2 , PaCO2 , pH
(main 80%) +

Carotid bodies, Aortic bodies

CNIX CNX

Respiratory center

Increased ventilation

1 = Pons, 2 = Ventral respiratory group, 3 = Central chemoreceptor, 4 = Sensory neuron, 5 = Carotid body, 6 = Somatic motor neuron, 7 = Aortic body, 8 = Internal intercostal muscles, 9 = Abdominal muscles, 10 = Diaphragm, 11 = External intercostal muscles, 12 = Scalene and sternocleidomastoid muscles, 13 = Somatic motor neuron, 14 = Dorsal respiratory group, 15 = limbic system, 16 = higher brain centers (emotions and voluntary control)

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Lungreceptors
1. Pulmonary or lung stretch receptors (PSR/LSR) (slowly adapting pulmonary stretch receptors) : airway i smooth th muscle l + Inspiration pulmonary stretch receptors - CNX Apneustic center Inspiratory cells of DRG

2.Pulmonaryorlungirritantreceptors (PIR/LIR)(rapidlyadaptingpulmonary stretchreceptors) :Airwayepithelium Stimuli:mechanicalorchemicalirritant (noxiousgas,cigarettesmoke, inhaleddusts,coldair) CNX Sneeze,cough,bronchoconstriction

Hering-Breuer inflation reflex

3.Jreceptors(juxtapulmonarycapillaryreceptors) :ending of nonmyelinated C fibers Stimuli:edema,pulmonarycongestion, airemboli,etc. CNX Respiratorycenter Dyspnea 4.BronchialCfibers Chemicalinjectedintobronchialcirculation Rapidshallowbreathing, bronchoconstriction,mucoussecretion

Other receptors
1.Noseandupperairwayreceptors
Mechanicalorchemicalstimulation Sneeze,cough,bronchoconstriction

2.Jointandmusclereceptors
Proprioceptors Respiratorycenter VE intheinitialstageofexercise

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3.Gammasystem
Elongationofintercostalm.anddiaphragm Musclespindles p Controlthestrength ofcontraction Sensationofdyspnoea

5.PainandTemperature Visceralpain Somaticpain BT

Apnea Hyperpnea

Thermalreceptor (hypothalamus) Respiratorycenter

4.Arterialbaroreceptors Arterialbloodpressure
aorticandcarotidsinusbaroreceptors

Hypoventilationorapnoea

VE

Response to CO2

ResponsetoO2
Onlytheperipheralchemoreceptors areinvolved Thereisnegligiblecontrolduring normoxiccontrol Thecontrolbecomesimportant athighaltitude,andinlongterm hypoxaemiacausedbychronic l lung disease di

PaCO2 isthemostimportantstimulus toventilationundermostconditions anditisnormallytightlycontrolled Mostofthestimuluscomesfromthe centralchemoreceptorsbutthe peripheralchemoreceptorsalso contributeandtheirresponseis faster The Th responsei ismagnified ifi dif thePaO2 islowered Multiplicativeeffect

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Response to pH

Ventilatory response to exercise

Immediate Response neural component Centralcommand Learnedorconditionedreflex Directconnectionsfrommotorcortex collateralsfrommotorneuronsto muscles Coordinationinhypothalamus Proprioceptorsormechanoreceptorsinlimbs probablynotmusclespindlesorGolgi tendonorgans

H+

Carotidbodychemoreceptors Respiratorycenter

Increasedventilation

SubsequentIncrease Duringmoderateexercise
1. Arterialchemoreceptors PO2:usuallynochangeinmean PCO2:usuallynochangeinmean [H+]usuallynochangeunlesscross anaerobicthreshold [K+]:minorrole OscillationsinarterialPO2 andPCO2 2.Metaboreceptors b 3.Nociceptors:H+,K+,bradykinin, arachidonicacid 4.Temperaturereceptors

During exercise severe enough to exceed anaerobic threshold 1. Arterial chemoreceptors H+, adenosine, ATP, ADP, K+ 2. Increased sensitivity of chemoreceptor responses during exercise

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Patternofbreathing
Apnea:absenceorcessationofbreathingintheresting expiratoryposition Apneusis:respirationceasesininspiratoryposition,because ofsustainedcontractionoftheinspiratorymuscles Biot'sRespiration:sequencesofuniformlydeepgasps,apnea, thendeepgasps Breathholding:voluntaryapnea,eitherbycontinuous contractionoftheinspiratorymuscles, muscles orbyrelaxationagainst glottisclosure

CheyneStokesbreathing:cyclesofgradually
increasingtidalvolumefollowedbygradually decreasingtidalvolume,usuallyseparatedbybrief periodsofapnea cerebrovascular b l accident id t congestiveheartfailure normalpeopleduringsleepathighaltitude

Dyspnea: difficultorlabouredbreathing;anuncomfortable awarenessoftheactofbreathing,"airhunger" Eupnea: normalspontaneousbreathing Hyperpnea: yp p increasedp pulmonary yventilation( (abovethe normalrestingvalue) Hypopnea:ventilationbelowthenormallevel Hyperventilation:increaseinpulmonaryventilation(VE,ml/min) (strictly,alveolarventilationVA,ml/min)relativetometabolic rate,irrespectiveoftheabsolutevalueofventilation Hypoventilation: ventilationlessthanrequiredbymetabolic demands,irrespectiveoftheabsolutevalueofventilation

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Stimuli postulated to produce dyspnoea Panting: breathingpatternbothveryrapidandshallow. Insomeconditions,thispatternisadoptedtodissipate heat(thermalpanting) Orthopnea: dyspneaexperiencedonlyintherecumbent position,usuallysupine,andrelievedbysittingor standing.Itoftenoccursinpatientswithleftventricular insufficiency. Tachypnea: increasedrateofbreathing
Stimulus
- Vascular stimuli : Right arterial p. : Right ventricular p.

Receptors

Example of Clinical Disease

- Congestive heart failure - Congestive heart failure, - Pulmonary stenosis - Primary pulmonary hypertension - Mitral valve disease

- Right atrial stretch receptors - Right ventricular strain receptors - Pulmonary artery stretch receptors - Left atrial stretch receptors

- Pulmonary artery p. - Left atrial p.

- Mechanical stimuli : Respiratory muscle - Muscle spindles Length-tension inappropriateness : Pulmonary - Stretch receptors (vagal) hyperinflation : Deformation of lung - J receptors (vagal) interstitium

- Pleural effusion, - Pneumothorax - Bullous emphysema - Pulmonary edema, - Pneumonia

Stimulus - Humoral stimuli : Hypoxemia : Hypercapnia : Acidosis - Movement of extremities - Psychogenic

Receptors

Example of Clinical Disease - Lung diseases - Chronic obstructive lung disease - Cardiovascular - None reported - Psychoneurosis

- Carotid bodies - Carotid bodies, central chemoreceptors - Carotid bodies, central chemoreceptors - Mechanoreceptors - Metaboreceptors - Cerebral cortex

It tis soften o te what atwe ethink t weknowthatprecludes usfromlearning.