5.

Work of Breathing
Compliance Work: force to expand lung against its elastic properties Force to overcome viscosity of lung & chest wall Airway Resistance Work: force to move air through airways

6. Compliance Work: Compliance of lung & chest wall

The ability of the lung to stretch is measured as the COMPLIANCE, C
lung volume (% TLC)

C = V/P
io n p ir at

where V is lung volume and P is pressure

io n in s p ir
TLC

ex

at

2 Translung pressure (cm H2O)

1. Curves are not linear 2. Difference between inspiratory & expiratory curves called hysteresis
FRC

V = 1.8 L

RV MV

P = 6.5 cm H2O

V/P = 1.8 L/6.5 cm H2O = 0.28 L/cm H2O

For comparison: vein = 0.04 and artery = 0.002 L/cm H2O

Volume, liters

Volume, liters 2 0 Volume, % of Tot. Lung Cap. 4 6

C = V/P

Emphysema

Asthma Normal

Lung volume

Fibrosis

Translung pressure
Deflation pressure volume curves of normal adult and three common chronic lung diseases

Question: How would the compliance change if the lung were lled with water instead of air??

Question: Would the compliance of a lung lled with

air be less than one lled with water??

Experiment:
saline inflation

Volume - ml

air inflation

What are the differences between these two conditions??

Pressure - cm water

7. Alveolar surface tension?

What is surface
air

tension?
air air

How do we deal with surface tension??

What is relationship between surface tension & lung properties??

(dynes/cm2) (dynes/cm) (cm)

Collapse of alveoli

T
P

(dynes/cm2)

(dynes/cm2)

A major component of lung surfactant is dipalmitoylphosphatidylcholine (DPPC). DPPC has typical phospholipid structure: two fatty acid residues are water insoluble, hydrophobic; phosphocholine at other end is charged and water soluble, hydrophilic.

What is the origin and composition of Lung Surfactant?

Approximate composition of surfactant

Component Other phospholipids Neutral lipids Proteins Carbohydrates percent composition 62 15 13 8 2 Dipalmitoylphosphatidylcholine

HOW DOES SURFACTANT KEEP YOUR LUNGS STABLE ??

Importance of Surfactant:
1. Reduces surface tension, therefore increases compliance 2. Stability of alveoli; LaPlace 3. Helps keep alveoli dry; helps prevent pulmonary edema 4. Expansion of lungs at birth

8. Resistance Work: work required to move air in & out Conductive Airway Resistance.
Remember: P = Raw x Flow Raw = (Palv - Patm)/ Flow Like Poiseuille flow in blood vessels, i.e., inversely to r4 (F = P x 1/Raw )

8l R= r4
Agents that constrict vessels (bronchioles) or accumulate debris (e.g., mucus) increase resistance (makes airflow difficult).
One might think that because the terminal bronchioles are very narrow they would represent very high resistance. However, because there are so many (>106) and because they are in parallel they represent a relatively small portion of the total Raw. Bronchiolar smooth muscle is under neurohumoral control Sympathetic stimulation (adrenaline): bronchiole dilation Parasympathetic stimulation (Ach): bronchiole constriction Histamine release from mast cells -- allergic/asthmatic response bronchiole constriction

9. Dynamic Compression of Airways

Very simply means that some conductive vessels are very collapsible. Since they are also enclosed within the thoracic cage, increased pleural pressure can sometimes lead to restrictive outflow (due to vessel collapse). Flow = P/Raw
should be linear function of P but it is not if airways are collapsible

10. Dead Space

How do we measure Dead Space?

Know how to distinguish between what is called Anatomical dead space and Physiological dead space
Bohr equation - uses PCO2 of expired air (PECO2) and alveolar air (PACO2), and tidal volume (VT). We can dene the tidal volume (VT) as being a composite of functional alveolar volume (VA) and dead space volume (VA), i.e.,

VT = VA + VD
by denition

Amount CO2 EXPIRED = Amount CO2 from alveoli + Amount CO2 from dead space
since Amount = concentration x volume, we can combine the two equations

PECO2 x VT = [PACO2 x (VT - VD)] + [PICO2 x VD]

and since PICO2 = atmospheric air = 0.04% CO2 , which is very low 0, we can simplify

PECO2 x VT = PACO2 x (VT - VD) VD = VT (PACO2 - PECO2) / PACO2 Bohr Equation

Conc. of CO2 in alveolar air

Conc. of CO2 in expired air

VD = VT
Conc. of CO2 in alveolar air

(PACO2 - PECO2) PACO2

Bohr Eqn.

Lets say we have a subject who is breathing with a VT of 0.5 L, with a PECO2 = 28 mm Hg and a PACO2 = 40 mm Hg. Why is PECO2 less than PACO2 ? What is VD ?

VD = 0.5 L x

40 - 28 40

= 0.5 x (0.3) = 0.15 L

Does Dead Space Matter? How?

VT = VA + VT
It is necessary to correct for dead space to effectively measure ventilation rate We have already been introduced to the respiratory minute volume,

V = freq x VT
A more important minute volume is the alveolar ventilation rate Alveolar vent. rate = total volume of "new air" entering alveoli each minute, VA

VA = freq x (VT - VD) Think about and Do homework questions from reader
Calculate some VDs Is it more efcient to change VA by frequency or by VT? What are the consequences of breathing through a long tube? What is an absolute upper limit for the length of the tube?

11. & 12. Factors determining PACO2 and PAO2

the Alveolar Ventilation Equation

Will cover later after we deal with blood ow

(pg. 279-280 reader)

II. PHYSICAL PRINCIPLES OF GAS EXCHANGE (pp 280-79 reader) A. Properties of GASES 1. Partial Pressure 2. Correcting gas volumes 3. Gases in solution 4. Diffusion B. Gas exchange in the lung 1. Composition of alveolar & expired air 2. Pulmonary (Lung) Diffusion Capacity 3. Characteristics of pulmonary circulation 4. Gas exchange at alveolar and systemic capillaries 5. Ventilation-Perfusion ratio 6. Pathological examples of altered gas exchange

II. PHYSICAL PRINCIPLES OF GAS EXCHANGE A. Properties of GASES

General Gas Law: PV = nRT

1. Partial Pressure = pressure exerted by any one gas in a mixture Partial Pressure = total pressure x fraction of total represented by the gas (Daltons law), i. e., Pgas = Ptotal x fgas What is the composition of the room air that we breathe? (in percent & in partial pressure)
Dry atm. air % Partial pressure mm Hg
Accounting for water vapor pressure = 47mmHg

mm Hg

O2 CO2 N2 & other total

20.9 0.04 79 100

(0.21x760) (0.0004x760) (0.79x760)

160 0.3 600 760

149 0.3 564 713

STPD BTPS ATPS

2. How do we deal with gases in solution?

to n r io i ut ar a l so eol a se alv o xp 2in e s al O t Le pic ty

Henrys Law:
Conc. of gas in solution = partial pressure of gas X solubility coefficient e.g., [O2] in moles/L:

[O2] = PO2 x SO2

SCO2 is 20x higher than SO2

Remember, in solution [gas] = Pgas x Sgas

SCO2 = 30 mol/L/mm Hg = 0.03 mmol/L/mm Hg SO2 = 1.37 mol/L / mm Hg

Therefore [Gas] depends on both Pgas and Sgas

4. What is DIFFUSION?

start

intermediate

equilibrium

How fast is DIFFUSION?

Diffusion distance (m) 1 10 100 1,000 (1 mm) 10,000 (1 cm) Time required for diffusion 0.5 msec 50 msec 5 seconds 8.3 minutes 14 hours CONCLUSION?

Fick's 1st Law of Diffusion

dC Rate of diffusion = dm/dt = D A dx A = area available for diffusion C = concentration of the substance x = the distance for the diffusion D = the diffusion coefficient

O2 CO
2

Area

P2 P1

thickness

Rate of Diffusion

Area x Concentration Distance available surface area distance required for diffusion (i.e., thickness)

What is the strategy in the evolution of the respiratory apparatus?

B. Gas exchange in the lung Total AREA available for diffusion of gases is large in human ~50-100 m2

Diffusion PATH LENGTH is very small, <1 m

Pulmonary Epithelium

How long does it take for blood to equilibrate with alveolar gases? for Oxygen:
100 PO2 (mm Hg) 40 0 0.2 0.4 0.6 0.8 equilibration occurs in 0.2-0.25 sec
time in pulmonar y cap (sec)

time in pulmonary capillary (sec)

Therefore, entry of O2 into blood is not limited by diffusion

Evaluating whether the movement of a gas across the lungs is limited by DIFFUSION or limited by PERFUSION

CONCLUSION: As long as there is no abnormal thickening, movement of O2 and CO2 are not limited by DIFFUSION

Therefore: Increasing blood flow (PERFUSION), such as in exercise will increase movement of O2 (into) and CO2 (out of) the system

2. Pulmonary (Lung) Diffusion Capacity Measurement of Pulmonary (Lung) Diffusion Capacity, DL dC geometry terms dm/dt = D A dx dPSgas V dm/dt = gas = D A dx = D'A (P1 - P2)/thickness , where D' = D x Sgas
D' (solubility of Gas x Temp) / M.W.

Lets define the diffusion capacity or a lung Vgas = dm/dt = D'A (P1 - P2) / T = D'A/T (P1 - P2)
Lets define

D' A/T = DL and DL = V gas/(P1 - P2)

V gas = DL (P1 - P2)

(not responsible for bottom half of pg. 285: Section f. Reaction rates of gases in blood.