ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM

The respiratory system consists of the nose, the nasal cavity, the pharynx, the larynx,
the trachea, the bronchi, and the lungs. The upper respiratory tract refers to the nose, nasal
cavity, pharynx, and associated structures; and the lower respiratory tract includes the larynx,
trachea, bronchi, and lungs. These terms are not official anatomical terms, however, and there
are several alternative definitions. For example, one alternative places the larynx in the upper
respiratory tract. Although air frequently passes through the oral cavity, it is considered to be
part of the digestive system instead of the respiratory system.

NOSE AND NASAL CAVITY

The term nose refers to the visible structure that forms a prominent feature of the face.
Most of the nose is composed of cartilage, although the bridge of the nose consists of bone.
The bone and cartilage are covered by connective tissue and skin.
 The nasal cavity extends from the nares to the choane. The nares, or nostrils, are the
external openings of the nose and the choane are the openings to the pharynx. The nasal
septum is a partition dividing the nasal cavity into the right and left sides. The hard palate forms
the floor of the nasal cavity, separating the nasal cavity from the oral cavity. Air can flow
through the nasal cavity when the mouth is closed or when the oral cavity is full of food.

Three prominent bony ridges called conchae resembling a conch shell, are present on
the lateral walls on each side of the nasal cavity. The conchae increase the surface area of the
nasal cavity.

Paranasal sinuses are air-filled spaces within the bone. The maxillary, frontal,
ethmoidal, and sphenoidal sinuses are named after the bones in which they are located. The
paranasal sinuses open into the nasal cavity and are lined with a mucous membrane. They
reduce the weight of the skull, produce mucus, and influence the quality of the voice by acting
as resonating chambers.

Mucus produced by the epithelium of the paranasal sinuses, drains through small
passageways into the nasal cavity. When the mucous membranes become swollen because of
nasal infections, sinus infections, or allergies, these passages can become blocked. The mucus
then accumulates within the sinuses, and the increasing pressure can produce a painful sinus
headache.

The nasolacrimal ducts, which carry the tears from the eyes, also open into the nasal
cavity. Sensory receptors for the sense of smell are found in the superior part of the nasal
cavity.

Air enters the nasal cavity through the nares. Just inside the nares the epithelial lining is
composed of stratified squamous epithelium containing coarse hairs. The hairs trap some of
the large particles of dust suspended in the air. The rest of the nasal cavity is lined with
pseudostratified columnar epithelial cells containing cilia and many mucus-producing goblet
cells. Mucus produced by the goblet cells also traps debris in the air. The cilia sweep the
mucus posteriorly to the pharynx, where it is swallowed. As air flows through the nasal cavities,
it is humidified by moisture from the mucus epithelium and is warmed by blood flowing through
the superficial capillary networks underlying the mucous epithelium.
PHARYNX

The pharynx is the common passageway of both the respiratory and digestive systems.
It receives air from the nasal cavity and air, food, and water from the mouth. Inferiorly, the
pharynx leads to the rest of the respiratory system through the esophagus. The pharynx can be
divided into three regions; the nasopharynx, the oropharynx, and the laryngopharynx.

The nasopharynx is the superior part of the pharynx and extends from the choane of the
nasal cavity to the level of the uvula, a soft process that extends from the posterior edge of the
soft palate. The soft palate forms the floor of the nasopharynx. The nasopharynx is lined with
pseudostratified ciliated columnar epithelium that is continous with the nasal cavity. The
auditory tubes extend from the middle ears and open into the nasopharynx. The posterior part
of the nasopharynx contains the pharyngeal tonsil, which aids in defending the body against
infections. The soft palate and the uvula are elevated during swallowing; this movement results
in the closure of the nasopharynx, which prevents food from passing from the oral cavity into the
nasopharynx.

The oropharynx extends from the uvula to the epiglottis, and the oral cavity opens into
the oropharynx. Thus food, drink, and air all pass through the oropharynx. The oropharynx is
lined with stratified squamous epithelium, which protects against abrasion. Two sets of tonsils,
the palatine tonsil and lingual tonsil, are located near the opening between the mouth and the
oropharynx. The palatine tonsils are located in the lateral walls near the border of the oral
cavity and the oropharynx. The lingual tonsil is located on the surface of the posterior of the
tonque.

The laryngopharynx passes posterior to the larynx and extends from the tip of the
epiglottis to the esophagus. The laryngopharynx is lined with stratified squamous epithelium
and ciliated columnar epithelium.

LARYNX

The larynx is located in the anterior throat, and it connects superiorly to the pharynx and
inferiorly to the trachea. The larynx consists of an outer casing of nine cartilages that are
connected to one another by muscles and ligaments. Three of the nine cartilages are unpaired,
and six of them form three pairs. The largest cartilage is the unpaired thyroid cartilage, or
Adam’s apple. The thyroid cartilage is attached superiorly to the hyoid bone. The most inferior
cartilage of the larynx is the unpaired cricoid cartilage, which forms the base of the larynx on
which the other cartilages rest. The thyroid and cricoid cartilages maintain an open
passageway for air movement.

The third unpaired cartilage is the epiglottis. It differs from the other cartilages in that it
consists of elastic cartilage rather than hyaline cartilage. Its inferior margin is attached to the
thyroid cartilage anteriorly, and the superior part of the eipiglottis projects as a free flap toward
the tonque. The epiglottis helps prevent swallowed materials from entering the larynx. As the
larynx elevates during swallowing, the epiglottis tips posteriorly to cover the opening of the
larynx.

The six paired cartilages consists of three cartilages on either side of the posterior part
of the larynx. The top cartilage on each side is the cuneiform cartilage, the middle cartilage is
the corniculate cartilage, and the bottom cartilage is the arytenoid cartilage. The arytenoids
cartilages articulate with the cricoid cartilage inferiorly. The paired cartilages form and
attachment site for the vocal folds.

Two pairs of ligaments extend from the posterior surface of the thyroid cartilage to the
paired cartilages. The superior pair forms the vestibular folds or false vocal cords, and the
inferior pair composes the vocal cords, or true vocal cords. When the vestibular folds come
together, they prevent air from leaving the lungs, such as when a person holds his breath.
Along with the epiglottis, the vestibular folds also prevent food and liquids from entering the
larynx.

The vocal folds are the primary source of voice production. Air moving past the vocal
cords causes them to vibrate, producing sound. Muscles control the length and tension of the
vocal folds. The force of air moving past the vocal folds controls the loudness, and the tension
of the vocal folds controls the pitch of the voice. An inflammation of the mucous epithelium of
the vocal folds is called laryngitis. Swelling of the vocal folds during laryngitis inhibits voice
production.

TRACHEA
 The trachea or windpipe is a membraneous tube that consists of connective tissue and
smooth muscle, reinforced with 16 – 20 C-shaped pieces of cartilage. The adult trachea is
about 1.4 – 1.6 centimeters in diameter and about 10 – 11 cm. long. It begins immediately
inferior to the cricoid cartilage, which is the most inferior cartilage of the larynx. The trachea
projects through the mediastinum, and divides into the right and left primary bronchi at the level
of the fifth thoracic vertebra. The esophagus lies immediately posterior to the trachea.

C-shaped cartilages form the anterior and lateral sides of the trachea. The cartilages
protect the trachea and maintain an open passageway for air. The posterior wall of the trachea
has not cartilage and consists of a ligamentous membrane and smooth muscle. The smooth
muscle can alter the diameter of the trachea.

The trachea is lined with pseudostratified columnar epithelium, which contains numerous
cilia and goblet cells. The cilia propel mucous produced by the goblet cells, as well as foreign
particles embedded in the mucus, out of the trachea, through the larynx, and into the pharynx,
from which they are swallowed.

Constant irritation of the trachea by cigarette smoke can cause the tracheal epithelium to
change to stratified squamous epithelium. The stratified squamous epithelium has no cilia and
therefore lacks the ability to clear the airway of mucus and debris. The accumulations of mucus
provide a place for microorganisms to grow, resulting in respiratory infections. Constant
irritation and inflammation of the respiratory passages stimulate the cough reflex, resulting in
“smoker’s cough”.

BRONCHI

The trachea divides into the left and right main (primary)
bronchi, each of which connects to a lung. The left main bronchus is
more horizontal than the right main bronchus because it is displaced
by the heart. Foreign objects that enter the trachea usually lodge in
the right main bronchus, because it is more vertical than the left main
bronchus and therefore more in direct line with the trachea. The main
bronchi extend from the trachea to the lungs. Like the trachea, the main bronchi are lined with
pseudostratified ciliated columnar epithelium and are supported by C-shaped pieces of
cartilage.
LUNGS

The lungs are the principal organs of respiration. Each lung is cone-shaped, with its
base resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm above
the clavicle. The right lung has three lobes called the superior, middle, and inferior lobes. The
left lung has two lobes called the superior and inferior lobes. The lobes of the lungs are
separated by deep, prominent fissures on the surface of the lung. Each lobe is divided into
bronchopulmonary segments separated from one another by connective tissue septa, but these
separations are not visible as surface fissures. Individual diseased bronchopulmonary segment
can be surgically removed leaving the rest of the lung relatively intact, because major blood
vessels and bronchi do not cross the septa. There are nine bronchopulmonary segments in the
left lung and 10 in the right lung.

The main bronchi branch many times to form the tracheobronchial tree. Each main
bronchus divides into lobar bronchi as they enter their respective lungs. The lobar (secondary)
bronchi, two in the left lung and three in the right lung, conduct air to each lobe. The lobar
bronchi in turn give rise to segmental (tertiary) bronchi, which extend to the bronchopulmonary
segments of the lungs. The bronchi continue to branch many times finally giving rise to
bronchioles. The bronchioles also subdivide numerous times to give rise to terminal
bronchioles, which then subdivide into respiratory bronchioles. Each respiratory bronchiole
subdivides to form alveolar ducts, which are like long, branching hallways with many open
doorways. The doorways open into alveoli, which are small air sacs. The alveoli becomes so
numerous that the alveolar duct wall is little more than a succession of alveoli. The alveolar
ducts end as two or three alveolar sacs, which are chambers connected to two or more alveoli.
There are about 300 million alveoli in the lungs.

As the air passageways in the lungs become smaller, the structure of their walls
changes. The amount of cartilage decreases and the amount of smooth muscle increases, until
at the terminal bronchioles the walls have a prominent smooth muscle layer, but no cartilage.
Relaxation and contraction of the smooth muscle within the bronchi and bronchioles can change
the diameter of the air passageways. For example, during exercise, the diameter can increase,
thus increasing the volume of air moved. During an asthma attack, however, contraction of the
smooth muscle in the terminal bronchioles can result in greatly reduced airflow. In severe
cases, air movement can be so restricted that death results.
 As the air passageways of the lungs becomes smaller, the lining of their walls also
changes. The trachea and bronchi have pseudostratified ciliated columnar epithelium, the
bronchioles have ciliated simple columnar epithelium, and the terminal bronchioles have ciliated
simple cuboidal epithelium. The ciliated epithelium of the air passageways functions as a
mucus cilia escalator, which traps debris in the air and removes it from the respiratory system.

As the air passageways beyond the terminal bronchioles become smaller, their walls
become thinner. The walls of the respiratory bronchioles are cuboidal epithelium and those of
the alveolar ducts and alveoli are simple squamous epithelium. The respiratory membrane of
the lungs is where gas exchange between the air and blood takes place. It is mainly formed by
the walls of the alveoli and the surrounding capillaries, but there’s some contribution by the
alveolar ducts and respiratory bronchioles. The respiratory membrane is very thin to facilitate
the diffusion of gases. It consists of:

1. A thin layer of fluid lining the alveolus.

2. The alveolar epithelium composed of simple squamous epithelium.
3. The basement membrane of the alveolar epithelium.
4. A thin interstitial space.
5. The basement membrane of the capillary endothelium.
6. The capillary endothelium composed of simple squamous epithelium.
The elastic fibers surrounding the alveoli allow them to expand during inspiration and recoil
during expiration. The lungs are very elastic, and when inflated, they are capable of
expelling the air and returning to their original, uninflated state. Specialized secretory cells
within the walls of the alveoli secrete a chemical called surfactant that reduces the tendency
of the alveoli to recoil.

PLEURAL CAVITIES
 The lungs are contained within the thoracic
cavity. In addition, each lung is surrounded by
a separate pleural cavity. Each pleural cavity is
lined with a serous membrane called the pleura.
The pleura consists of a parietal and visceral
part. The parietal pleura, which lines the walls
of the thorax, diaphragm, and mediastinum, is
continuous with the visceral pleura, which
covers the surface of the lung.

The pleural cavity, between the parietal and

visceral pleurae, is filled with a small volume of
pleural fluid produced by the pleural membranes. The pleural fluid performs two functions: (1) it
acts as a lubricant, allowing the visceral and parietal pleurae to slide past each other as the
lungs and thorax change shape during respiration, and (2) it helps hold the pleural membranes
together. The pleural fluid acts like a thin film of water between two sheets of glass (the visceral
and parietal pleurae); the glass sheets can slide over each other easily, but it is difficult to
separate them.

LYMPHATIC SUPPLY

The lungs have two lymphatic supplies. The

superficial lymphatic vessels are deep to the
visceral pleura and function to drain lymph from the
superficial lung tissue and the visceral pleura. The
deep lymphatic vessels follow the bronchi and
function to drain lymph from the bronchi and
associated connective tissues. No lymphatic
vessels are located in the walls of the alveoli. Both
the superficial and deep lymphatic vessels exit the
lungs at the main bronchi.

Phagocytic cells within the lungs phagocytize carbon particles and other debris from
inspired air and move to the lymphatic vessels. In older people, the surface of the lungs can
appear gray to black because of the accumulation of these particles, especially if the person
smoked or lived most of his life in a city with air pollution. Cancer cells from the lungs can also
spread to other parts of the body through the lymphatic vessels.