1

CHAPTER II
LITERATURE REVIEW

2.1 Respiratory System
Respiratory system is the system which brings about inspiration,
expiration, exchange oI gases in lungs and transport oI gases between the lungs
and tissues. The human respiratory system consists oI a pair oI nostrils, nasal
cavity, nasopharynx, larynx, trachea, bronchi, bronchiolesan d alveoli (air sacs)
Iorming the lungs.
The nostrils lead into nasal cavity, which opens into the upper part oI the
pharynx called nasopharynx. It continues into larynx or voice box or adam`s apple
that connects the pharynx to the trachea. The opening oI larynx; glottis is guardred
by a leaI like epiglottis. The trachea or wind pipe is connected to the larynx at the
posterior and is 11 cm long. It is guarded by 16-20 C-shaped incomplete ring oI
hyaline cartilages which prevent it Irom collapsing. The trachea divides into two
bronchi at the lower end. The right bronchus is wider. The bronchi are divided at
the posterior into bronchioles which enter into the lungs. The respiratory tract
Irom the nose to the bronchioles is lined by ciliated epithelium. The bronchioles
divide into many alveolar ducts each oI which terminates in an alveolus or air
chamber, the two lungs contain about 300 million alveoli. The lungs oI man is
spongy. The two lungs are enclosed in a double layered membrane, the pleura.
The right lung is divided into 3 lobes and the leIt lung into two lobes. Inside the
lungs the bronchioles divide into alveolar ducts, which Iinally open into alveoli or
which is called air spaces. The lungs occupy most oI the chest cavity. This cavity
is lined with a serous membrane, the pleura.
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There is a small amount oI serous Iluid between the lungs and the pleura.
The Iluid lessens the Iriction between the membrane and the lung. Internally, the
cavity oI the lung has very small, microscopic air spaces, the alveoli. Each
alveolus is lined by a layer oI Ilattened polygonal squamous cells. The human
lungs contain about 700 million alveoli, with a total surIace area available 100
times that oI the body. This makes a large surIace area available to the lungs so
that suIIicient oxygen taken up by haemoglobin oI the blood and CO
2
is given oII.

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2.2 Mechanism of Respiration
The main purpose oI respiration is to provide oxygen to the tissues and to
remove CO
2
Irom them. The entire process is accomplished in three steps :
O reathing or pulmonary ventilation.
O Exchange oI oxygen and carbon dioxide.
O Transport oI gases in blood.
2.2.1 Breathing and Pulmonary Ventilation
reathing is a mechanical process and is completed in two phases,
inspiration and expiration. In inspiration the ribs are elevated and the diaphragm
contracted and Ilattened, the chest cavity is enlarged. This increase in the volume
oI the chest cavity and lungs causes the air pressure in the lungs to Iall below the
atmospheric pressure and air passes through the air passage ways to the lungs to
equalize the pressure. In inspiration, expansion oI the thorax, aided by descent oI
the diaphragm, decreases into thoracic pressure Irom 4 to 10 mm Hg, and air
pushes into the lungs. Thus, in inspiration the lungs are extending passively in
response to the various mechanisms that result in an increase in thoracic volume.
In expiration the ribs and diaphragm return to their original position so the
volume oI chest cavity decreases. The distended elastic lungs then contract and
the air is Iorced out. Changes in the intrapleural pressure also responsible Ior air
entering and leaving the lungs.In expiration, the size oI the thorax is decreased,
the intrathoracic pressure is raised to-2mm Hg. and air is Iorced out oI the lungs.
The diaphragm is the main muscle oI inspiration. II the diaphragm
descends 10 mm, it will increase the thoracic cavity volume by 250 ml. Passive
expiration results when it relaxes. The contraction and relaxation oI the diaphragm
is controlled by the phrenic nerves arising in the neck Irom the 3rd, 4th and 5th
cervical nerves and passing down through the thorax to the diaphragm.
esides diaphragm, the external intercostals are the muscles mainly
responsible Ior the elevation oI the ribs in inspiration. They are inserted between
two neighboring ribs, sloping Iorward and downward and their relaxation brings
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about passive expiration. The internal intercostals Iorm a deeper layer oI muscle
between the ribs with the Iibers running in the opposite direction, Irom above
downward and backward. On contraction, these muscle depress the ribs aiding in
expiration during very deep breathing or which is known as active expiration.
O Eupnea Normal respiration
O Hypernea Increase in respiratory rate and depth.
O yspnea Irregularities oI respiration.
O pnea Cessation oI respiration
The normal rate oI respiration in the adult is 14 breaths/minute, but in
children it may be up to 30/minute. In exercise it is Iurther increased. Each
inspiration admits about 350 ml oI new air to mix with the 2500 ml oI old air
present in the lungs. The quantity oI new air that enters the lungs per minute is
known as the minute volume, which in the average adult is about 4900 ml (350
14). uring exercise, the rate oI breathing increases due to the increased demand
Ior oxygen. The demand oI extra oxygen is IulIilled by the expansion oI rib cage.
O Tidal Volume : (TV) The volume oI air inspired and expired by the lungs
during normal eIIortless breathing, is called tidal volume. (TV is about
500 ml oI air)
O Inspiratory Reserve volume (IRV) : The extra volume oI air that can be
inspired beyond the normal tidal volume is called inspiratory reserve
volume. (1RV, is about 2500 - 3000 ml oI air)
O Expiratory reserve volume (ERV) : The extra volume oI air that can be
expired beyond the normal tidal volume is called expiratory reserve
volume (ERV, is about 1000 ml oI air).
O Residual Volume (RV) : The volume oI air that remains in the lungs even
aIter maximum IorceIul expiration is called residual volume (RV is about
1500 ml oI air)
O Pulmonary Capacities : When any two or more oI the above mentioned
pulmonary volumes are considered together, such combinations are called
pulmonary capacities.
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O Inspiratory Capacity : is the total amount oI air a person can inspire by
maximum distension oI his lung. It is equal to tidal volume and inspiratory
reserve volume. It is about 3500 ml oI air.
O unctional residual capacity (RV ERV) : is the amount oI air that
remains in lungs aIter normal expiration. It is about 2500 ml oI air.
O Vital capacity (IRV TV ERV) is the maximum amount oI air which
can be expelled IorceIully Irom lungs aIter Iirst Iilling with a maximum
deep inspiration. It is about 4600 ml.

2.2.2 Exchange of Gases
In both external as well as internal respiration, exchange oI respiratory
gases occurs. In external respiration, there is exchange oI CO
2
oI blood and O
2
oI
air or water while in internal respiration, there is exchange oI O
2
oI blood and CO
2

oI the body cells. These gas exchanges are physical process and depends upon the
principle oI diIIusion. The kinetic motion oI the molecules provides the energy
required Ior this diIIusion oI gaseous molecule itselI. iIIusion oI any molecule
takes place Irom high to low concentration.
The process oI diIIusion is directly proportional to the pressure oI a used
by the gas alone. The pressure exerted by an individual gas is called partial
pressure. It is is represented as PO
2
, PCO
2
, PN
2
Ior oxygen, carbon dioxide and
nitrogen respectively. Partial Pressure oI a gas is the pressure exerted by the gas
individually. Which is calculated as Iollows :
Partial pressure oI gas Total pressure oI the mixture oI gases
Percentage oI a gas in the mixture
The partial pressure oI a gas is directly proportional to its concentration in
the mixture. Total pressure oI the air at the sea level 760 mm Hg. The inspired
air ultimately reaches the alveoli oI the lung which in turn receives the blood
supply oI the pulmonary circulation. t this place, the oxygen oI the inspired air is
taken in by the blood, and carbon dioxide is released into the alveoli Ior
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expiration. or eIIicient gaseous exchange, the organ must have the Iollowing
characteristics :
O It should have a large surIace area
O It must be highly vascular, thin, moist, direct or indirect contact with
source oI oxygen (air or water), permeable to the respiratory gases (O
2
&
CO
2
).
The respiratory membrane has a limit oI gaseous exchange between
alveoli and pulmonary blood. It is called diIIusing capacity and is deIined as the
volume oI gas, that diIIuse through the membrane per minute Ior a pressure
diIIerence oI 1mm Hg. t a particular pressure diIIerence, the diIIusion oI carbon
dioxide is 20 times Iaster than oxygen, and that oI oxygen is two times Iaster that
nitrogen. ue to the existing pressure diIIerence oI oxygen and carbon dioxide
between the alveoli & the blood capillary, oxygen diIIuses Irom alveolar air to the
capillary blood, whereas carbon dioxide diIIuses Irom capillary blood to the
alveolar air.

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2.2.3 Transport Of Gases In Blood :
lood is the medium Ior the transport oI oxygen Irom the respiratory
organ to the diIIerent tissues, and carbon dioxide Irom tissue to the respiratory
organ.
Transport oI Oxygen :
The solubility oI O
2
in water is rather low, but this shortcoming is
overcome by the Iact that the O
2
is bound to carrier substances in the blood. In
human blood, the O
2
carrier respiratory pigment is haemoglobin which is a
conjugated protein made up oI haem, a prosthetic group containing iron, and
globin the protein portion. The maximum amount oI O
2
which the normal human
blood can absorb is 20 ml per 100 ml oI blood. When O
2
passes Irom the lung
alveoli into the lung capillaries, it diIIuses into the blood and unite with
haemoglobin to Iorm oxyhaemoglobin.
Hb
4
4O
2
~ Hb4O
8
or Hb
4
(O
2
)4 (oxyhaemoglobin)
Under the normal conditions the arterial blood which has been exposed to
the alveoli oI the lungs is not quite completely oxygenated. With an O
2
tension oI
100 mm oI Hg, it is usually 98 saturated and thereIore, contains 19.6 ml oI O
2

(combined to haemoglobin) per 100 ml oI blood. In addition to this there is about
0.2 to 0.3 ml oI O
2
which is dissolved in the plasma. The arterial blood and the
alveoli have the same O
2
pressure (100 mm oI Hg). ut the cells and the tissues oI
the body the O
2
tension is considerably low (1 to 40 mm oI Hg). The O
2
is
accordingly liberated Irom the oxyhaemoglobin and diIIuses out Irom the blood
through the thin capillary walls into the cells. This is made possible by the
important Iact that the combination between O
2
and haemoglobin in the red blood
cells to Iorm oxyhaemoglobin is a reversible one. The liberation oI O
2
Irom the
blood to the tissue is just as important as its rapid absorption by the blood during
its passage through the lungs.
Hb
4
----~ 4Hb 4O
2

Oxyhaemoglobin Reduced haemoglobin
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The reduced haemoglobin is Iurther transported via blood to the lungs and
the cycle is repeated while the O
2
that has diIIused into the cells is utilized in the
oxidation oI carbohydrates, resulting in the release oI CO
2
and energy.
Oxygen-Haemoglobin issociation Curve
t high O
2
pressure, the haemoglobin combines with O
2
to Iorm
oxyhaemoglobin. Each iron atom can bind one O
2
molecule, and when all sites are
occupied, the haemoglobin cannot take on anymore, since it is Iully loaded or
saturated. t low O
2
pressure, O
2
dissociate Irom its binding, and the
haemoglobin will eventually give up all its O
2
. t any given O
2
concentration
there is a deIinite proportion between the amount oI haemoglobin and
oxyhaemoglobin. In this way the actual relationship between the partial pressure
oI O
2
and the degree oI saturation oI the haemoglobin with O
2
is shown by the
remarkable oxygen haemoglobin dissociation curve.


Note : Increased CO
2
concentration shiIts the curve to the right.
O The curve shows that the haemoglobin is almost completely oxygenated
(saturated) with O
2
, at the O
2
partial pressure oI about 100 mm Hg.
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O t higher O
2
pressure, no more O
2
is taken up by the haemoglobin.
O t lower O
2
pressure, O
2
is given oII and at 30 mm Hg, O
2
pressure, halI
the haemoglobin is present as oxyhaemoglobin.
O s the O
2
pressure decreases Iurther, more oxygen is given oII, and all is
given up when the O
2
pressure reaches zero.
Thus, the degree oI haemoglobin saturation is lowered with the Iall in the
partial pressure oI O
2
. In the passage oI blood through the tissue where the O
2

tension is low, rapid dissociation oI oxyhaemoglobin occurs, yielding a
comparatively large quantity oI O
2
to the surrounding tissues and cells where it is
most needed.
lungs (PO
2
100 mm Hg)
Hb O
2
HbO
2
( Oxyhaemoglobin)
Tissues (PO
2
30 to 40 mm Hg )
HbO
2
Hb O
2

uring Exercise : There is a Iall in tissue PO
2
, an increase in PCO
2
and an
increase in pH, local temperature and 2,3- diphosploglycerate concentration. ll
these Iactors promote the release oI oxygen Irom oxyhaemoglobin (shiIting the
oxygen-haemoglobin dissociation curve to the right) and thus increasing the
eIIiciency oI oxygen delivery to the active tissues.
actors IIecting Oxygen issociation Curve oI haemoglobin
ollowing Iour Iactors inIluence the dissociation curve.
O H

concentration
O Carbon dioxide tension
O Temperature
O Erythrocyte concentration oI 2,3 diphosphoglycerate (PG). Increase in
these Iactors bring right word shiIt oI the curve thereby decreasing the
aIIinity oI haemoglobin Ior oxygen.


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Transport OI Carbon ioxide :
Carbondioxide is evolved in the body as a result oI various metabolic
activities oI the cells & diIIuses into blood. The total amount oI CO
2
in the
various blood is about 60 ml per 100 ml blood, and the arterial blood contains
about 50 ml total CO
2
per 100 ml. Thus, a relatively small amount oI CO
2
is given
oII in the lungs. Carbon dioxide that diIIuses into the blood is transported in the
Iollowing three ways :
(i) Transport oI CO
2
in physical solution :
s CO
2
enters the blood Irom the tissues, it combines with water oI the plasma to
Iorm carbonic acid (H
2
CO
3
). Thus, about 7 oI CO
2
is carried in solution in the
plasma as carbonic acid.
CO
2
H
2
O ~ H
2
CO
3
~ HCO
-
3
H

These ions then combine with the buIIers oI the blood.
(ii) Transport oI CO
2
as carbamino compounds :
bout 20 to 25 oI CO
2
is transported as carbamino compounds. In the red blood
cells it combines directly. With the amino groups (NH
2
) oI the haemoglobin to
Iorm the So-called carbaminohaemoglobin.
CO
2
Hb.NH
2
~ Hb.NH.COOH (carbaminohaemoglobin)
(iii) Transport oI CO
2
as bicarbonates :
The rest, or about 70 oI the total CO
2
is carried in the Iorm oI
bicarbonates in both the plasma and red blood cells. s CO
2
enters the blood cells
Irom the tissues, it combine with water to Iorm carbonic acid (H
2
CO
3
), which
dissociates to hydrogen ions (H

) and bicarbonat ions (HCO

3
). The latter diIIuse
into the plasma and with sodium or potassium ions is the plasma Iorm sodium or
potassium bicarbonate.
Carbonic (Zn - containing enzyme)
~
anhydrage
CO2 H2O ~ H

HCO
-
3
Hydrogen Ion icarbonate ions
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Na

HCO

3
~ Na. HCO
3
(sodium bicarbonate)
K

HCO
-
3
~ KHCO
3
(Potassium bicarbonate)
small amount oI bicarbonate ions is transported in the RC. Whereas most oI
them diIIuse into the plasma to be carried by it. The majority oI bicarbonate ions
(HCO
-
3
) Iormed within the erythrocytes diIIuse out into the plasma along a
concentration gradient. Hydrogen ions combine with haemoglobin to Iorm the
haemoglobinic acid (H.Hb)
Carbonic anlydrase
CO
2
H
2
O ~ H
2
CO
3

H
2
CO
3
~ H

HCO
-
3

KHbO
2
~ KHb O
2

Haemoglobinic acid
H

HCO
-
3
KHb ~ H.Hb KHCO
3

2.3 Regulation of Respiration
The respiratory rhythm is controlled by the nervous system. The rate oI
respiration can be enhanced as per demand oI the body during strenuous physical
exercises. number oI groups oI neurons located bilaterally in the medulla
oblongata control bilaterally in the medulla oblongata control the respiration.
These are called respiratory centres. Three groups oI respiratory centres have been
identiIied namely : dorsal respiratory group, ventral respiratory group and
pneumotaxic centre.
O The dorsal respiratory group is present in the dorsal portion oI medulla
oblongata. The signals Irom these neurons generate the basic respiratory
rhythm. The nervous signals released Irom this group is transmitted to the
diaphragm, which is the primary inspiratory muscle.
O The ventral respiratory group oI neurons are located anterolateral to the
dorsal respiratory group. uring normal respiration, this remains inactive
and even does not play any role in the basic respiratory drive, the
respiratory signal oI this group contributes to IulIil the demand by
regulating both inspiration and expiration.
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O The pneumotaxic centre is located dorsally in the upper pons. It transmits
signals to the inspiratory area. Primarily, it controls the switch oII point oI
inspiration. When this signal is strong, the inspiration lasts only Ior 0.5
seconds or more, resulting into complete Iilling oI lungs. The strong signal
causes increased rate oI breathing because inspiration, as well as
expiration, is shortened.
O The concentration oI CO
2
and H

cause increased strength oI inspiratory,

as well as expiratory signal. However, oxygen has no such direct eIIect.