Anatomy and Physiology

To better understand pneumonia, it is important to be familiar with the basic

anatomic features of the respiratory system. The anatomy will direct your assessment
process. Visualizing the anatomical landmarks and underlying structures will enable you
to perform the assessment accurately, and understanding the physiology will allow you
to interpret your findings.

The human respiratory system begins at the nose and mouth, where air is
breathed in (inspired) and out (expired). The air tube extending from the nose is the
nasopharynx. The tube carrying air breathed in through the mouth is the oropharynx. The
nasopharynx and the oropharynx merge into the larynx. The oropharynx also carries
swallowed substances, including food, water, and salivary secretion, which must pass
into the esophagus and then the stomach. The larynx is protected by a trap door called
the epiglottis, which prevents substances that have been swallowed, as well as
substances that have been regurgitated (thrown up), from heading down into the larynx
and toward the lungs. The larynx flows into the trachea, which is the broadest part of the
respiratory tree. The trachea divides into two tree limbs, the right and left bronchi. Each
one of these branches off into multiple smaller bronchi, which penetrate the lung tissue.
Each bronchus divides into tubes of smaller and smaller diameter, finally ending in the
terminal bronchioles. The air sacs of the lung, in which oxygen-carbon dioxide exchange
actually takes place, are clustered at the ends of the bronchioles like the leaves of a tree.
They are called alveoli. The tissue of the lung, which serves only in a supportive role for
the bronchi, bronchioles, and alveoli, is known as lung parenchyma.

The main function of the respiratory system is to provide oxygen, the most
important energy source for the body’s cells. Inspired air (the air that is breathed in)
contains oxygen and travels down the respiratory tree to the alveoli. The oxygen moves
out of the alveoli and is sent into circulation throughout the body as part of the red blood
cells. The oxygen in the inspired air is exchanged within the alveoli for carbon dioxide,
the waste product of the human metabolic process. The air that is breathed out contains
the gas carbon dioxide. During expiration, carbon dioxide leaves the alveoli. As one
breathes in oxygen, one breathes out carbon dioxide.

Bacteria and viruses do not normally reside in significant numbers inside the
lung, part of the upper respiratory system. This absence is in contrast to parts of the
gastrointestinal system, where bacteria dwell even in a healthy state. There are multiple
safeguards along the path of the respiratory system. These are designed to keep
organisms from invading and leading to infection. The first line of defense against
infection includes the hairs in the nostrils, which serve as a filter for larger particles. The
epiglottis is a “trap door,” designed to prevent food and other swallowed substances
from entering the larynx and the trachea. Sneezing and coughing, both provoked by the
presence of irritants within the respiratory system, help to clear such irritants from the
respiratory tract. Mucus, produced through the respiratory system, also serves to trap
dust and infectious organisms. Tiny hair-like projections (cilia) from cells line the
respiratory tract and beat constantly, moving debris trapped by mucus upwards and out
of the respiratory tract. This mechanism of protection is called the “mucociliary
escalator.”

The cells that line the respiratory tract produce several types of immune
substances that protect against various organisms. Other cells (macrophages) along the
respiratory tract actually ingest and kill invading organisms. Thus, the organisms that
cause pneumonia are usually carefully kept from entering the lungs by virtue of these
host defenses. However, when an individual encounters a large number of organisms at
once, the usual defenses may be overwhelmed and infection may occur. This may occur
either when contaminated air droplets are inhaled, or when aspiration of organisms that
inhabit the upper airways takes place.