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Jesus Mario A. Lopez Jr., RN, RTRP

Upper Airway
Bounderies: From the anterior nares to the
true vocal cords
- Heating/cooling inspired gases @ body
temperature (37C)
- Filtering inspired gases
- Humidifying inspired gases to 100%
relative humidity at body temperature
- Olfaction: act of smelling
- Phonation: production of sound
- Conduction passageway for ventilating

A. Nose
1. Framework of cartilage
2. (2) septum/nostril
Regions of the Nasal Fossa:
- Vestibular
- Olfactory
- Respiratory
B. Paranasal sinuses
1. To give voice resonance (prolongation &
2. To lighten head to some extent (cavities
filled w/ air)
C. Oral Cavity
- serves multiple purposes. It is involved in
digestion, speech, and respiration.

D. Pharynx (Throat)
1. To produce vowel sounds (phonation)
2. To serve as a common passageway (for GI
& RT)
- Nasopharynx
- Orophrynx
- Laryngopharynx (hypopharynx)

Larynx (voice box)

Lower Airway
Boundaries: From the true vocal cords to the terminal air
spaces (alveoli).
- Ventilation: to and fro movement of gas (gas conduction)
- External respiration: actual gas exchange between body
(pulmonary capilliary blood) and external environment
(alveolar gas)
- Sphincter/glottic mechanisms:
*Valsalva maneuver: Forced exp. against closed glottis
*Mller maneuver: Forced insp. against closed glottis
*Cough mechanisms
*Protection of laryngeal inlet
- Phonation

Tracheobronchial Tree (conducting airway)

B. Trachea(Wind pipe)

The Lungs
- An conical-shaped organ whch is situated in the thoracic
cavity separated by a structure (mediastinum) containing the
heart, great vessels, esophagus, and trachea.

The Thorax
- is a bony and cartilaginous frame within which lie the
principal organs of circulation and respiration.

Muscles for Inspiration: (at rest)
1. Diaphragm: dome shaped muscle that separates thoracic
from abdominal cavity.
Origin: Thoracic outlet
Insertion: Central Tendon
Action: Increases vertical diameter of the thorax (piston
2. External intercostals:
Origin: Inferior boarder of superior rib
Insertion: Superior boarder of inferior rib
Action: Elevate ribs, increasing anteroposterior and
transverse diameter of thorax (pump and bucket handle

Accessory muscles for Inspiration:

1. Each tends to perform one of two actions; either raising the
thorax so that other muscles can effectively raise the thorax.
2. It should be noted that the use of accessory muscles for
resting is ABNORMAL!!! It should occur only with deep or
forced inspiration.

Accessory muscles for Expiration:

1. There are NO!!! Muscles for quiet resting expiration. It is
purely a passive process brought by the normal elastic
tendencies of the lung coupled with cessation of inspiratory
muscles. Therefore any muscles used in expiration are
termed accessory muscles for expiration
2. Any usage of these muscles for quiet resting expiration is
3. It is used only for forced expiration, making expiration a
active process
4. The accessory muscles of expiration are either of the back,
thorax, or abdomen and tend to pull the thorax down or to
support the thorax so that other muscle groups can
effectively pull down on the thorax.

- is a heterogeneous disease, usually
characterized by chronic airway
inflammation. It is defined by the history
of respiratory symptoms such as wheeze,
shortness of breath, chest tightness and
cough that vary over time and in intensity,
together with variable expiratory airflow
limitation. [GINA 2014]

Extrinsic or Allergic - is a result of an antigenantibody reaction on mast cells of the
respiratory tract.
Intrinsic or Idiopathic - is a result of imbalance of
the autonomic nervous system, that is, the
response of and adrenergic sites, as well
as cholinergic sites are not properly
Non-specific - implies that the origin is unknown
it may follow from a infection, emotional
changes or exercise.

Normal Resident Antibodies: 5 types

IgG can pass placenta passive
immunity, temporary
IgA body secretions saliva, tears,
IgM acute inflammation
IgE allergic reactions
IgD chronic inflammation


- is a common preventable and treatable
disease, characterized by persistent
airflow limitation that is usually
progressive and associated with enhanced
chronic inflammatory responses in the
airways and the lungs to noxious particles
or gases. Exacerbations and comorbidities
contribute to the overall severity in
individual patients. [GOLD 2014]21

Asthma-COPD Overlap Syndrome


- is characterized by persistent airflow

limitation with several features usually
associated with asthma and several
features usually associated with COPD.
ACOS is therefore identified by the
features that it shares with both asthma
and COPD

- Egans Fundamentals of Respiratory Care by

Kacmarek, Wilkins, Stoller, 10th edition

- Essentials in Respiratory Care by Kacmarek, 3rd

- CardioPulmonary Anatomy and Physiology by Terry
des Jardins, 5th edition
- Principles of Anatomy and Physiology by Tortora,
Derrickson, 12th edition