Ikhlas Muhammad Jenie

Physiology Department
FKIK UMY
Trachea has cartilago ring (5/6 of its
diameter) to prevent it from collapse

However, starting from bronchus, the
cartilago becomes less

Nevertheless, bronchiolus have no cartilago
(have smooth muscles only)


It creates the airway resistance
1. Respiratory movement (passive or active)
2. The secretion from the bronchial glands
3. The ciliary activity of the epithelium lining
the trachea and bronchi
4. The cough reflex
Normal values
measured by the body plethysmograph
Airway resistance = 0.05-1.5 cm H
2
0/L/sec (adults)

Sources of airway resistance
Nasal passage
Mouth
Glottis
Branching tubes


1. Constriction of bronchial smooth muscle
2. Mucosal congestion or inflammation
3. Edema of bronchiolar tissues
4. Plugging of the lumen by mucus, edema fluid,
exudate or foreign bodies
5. Cohesion of mucosal surfaces by surface tension
forces
6. Infiltration, compression or fibrosis of bronchioles
7. Collapse or kinking of bronchioles due to loss of
the pull of alveolar elastic fibers of bronchiolar
walls or to loss of structural, supporting tissues of
the bronchial walls
Physical factors
Nervous regulation
Chemical factors
Airway resistance becomes less as the lung
volume is increased
1 = FVC
R
Coughing

Sympathetic nerve impulses relax smooth
muscle of the airways

Parasympathetic impulses constrict airway
smooth muscle

Lungs have a few of sympathetic nerve fiber
but contain much of parasympathetic ones
(vagus nerves)


It secretes neurotransmitter Ach
(acetylcholine)


Contriction of bronchiolus
Secretion of Ach from parasympathetic nerves
in the airway resistance was stimulated by:

iritation of airway tract (infection, dust, smoke,
gases)

microemboli (Pulmonary artery)
Some drugs & chemicals affect bronchiolar
smooth muscle by stimulating autonomic
ganglia but some have direct action

Isopropylarterenol, epinephrine, norepinephrine
stimulate receptor sites of sympathetic
postganglionic fibers bronchodilation

Acetylcholine parasympathetic receptor sites
bronchoconstriction
Medulla adrenal gland


Epinephrine (adrenaline)


adrenergic receptor


Smooth muscle of bronchiolus


Dilatation of bronchiolus
Alergy, iritation, infection

Mast cells

Histamine, SRSA

Constriction of bronchiolus
Receptor
Afferent fibers
Central nervous
system
Efferent fibers
Effector
Reflex arc
Histology
The airway epithelium contains sensory nerve
fibers, which can be seen under the electron
microscope and studied by
immunofluorescent techniques.
Most of these nerves lie in the basal region of
the epithelium, deep to the tight junction
between the epithelial cells.
Histology (2)
The nerves branch to mucus secreting glands,
blood vessels, airway smooth muscle, and
autonomic ganglia.
The nerves also send process up towards the
lumen and mucosa, often with splayed
terminals.
The extensive plexus stained for substance P
(SP) and calcitonin gene-related peptide
(CGRP).
Slowly adapting pulmonary stretch receptors
(SAR-PSR)
Rapidly adapting pulmonary stretch receptors
(RAR-PSR)
Pulmonary & bronchial C-fibers receptors
Slowly adapting pulmonary stretch receptors
Within the tracheobronchial tree there are
mechanoreceptors that respond to stretch of
the airway walls; thus, it detects lung volumes
The firing, once it develops, decays very
slowly over time.
Rapidly adapting pulmonary stretch receptors
A second type of PSR are very sensitive to a
variety of chemical stimuli (irritant receptors)
The firing, after it increased, decreases within
1 sec.
High density in larynx & carina
C-fibers receptors
A rich network of small, unmyelinated axons
(C fibers) innervate receptors in either the
conducting airways or the alveoli (J receptors
or juxtacapillary receptors)
These receptors are sensitive to chemical
stimuli.

Receptors Site Fiber
Slowly adapting
PSR

Smooth
muscle
airway
A-
myelinate
d
Rapidly adapting
PSR

Airway
epithelium
A
myelinate
d
Pulmonary &
bronchial C-
fibers
Airway wall C
unmyelin-
ated





Pharynx -- > the afferent fibers of the
glossopharyngeal nerve (the IX
th
cranial
nerve)
Larynx, trachea, and larger bronch -- >
afferent fibers of the vagus (the x
th
cranial
nerve) [and also through n.laryngeus
superior]

The nucleus of tractus solitarius (NTS)
Medulla oblongata (brain stem) near the
respiratory center
Receptors in MO:
Opioid receptors
5-hydroxytryptamine receptors (5HT
1A
)
GABA receptors
NMDA antagonist
(N-methyl-D-asparate)
The descending fibers arising from NTS to the
spinal primary motor neurons and
n.laryngeus recurrence.
Laryngeal muscles
Diaphragm
The intercostal muscles
The abdominal muscles

The air is inspired (2.5 L)
The epiglottis is closed, and the vocal cords
shut tightly to entrap the air within the lungs
The abdominal muscle contract forcefully,
pushing against the diaphragm, while other
expiratory muscle contract forcefully the
pressure in the lungs > 100 mmHg
The vocal cords and epiglottis suddenly
opened widely, so that the air under pressure
in the lungs explodes outward (velocity 75
100 miles/ hour)
The rapidly moving air usually carries with it
any foreign matter that is present in the
bronchi or trachea
Deep inspiration
Glottis is closed
Forced expiratory effort against
the closed glottis
Raised intrathoracic & intraabdominal
pressure
Glottis is suddenly opened
A drop in intralaryngeal pressure
Increased air flow (axial & radial)
Brief violent rush of air out of trachea
(800 km/h)
The origins of cough are part of respiratory
tract:
Pharynx
Larynx (the endings of n.laryngeal superior)
Trachea (at the bifurcation or carina)
Segmental bronchi
Others:
External ear
Pleura
Esophagus
Abdominal organs
Abnormal secretion within respiratory tract
Edema or ulceration of respiratory mucous
membrane
Irritation produced by foreign bodies
Pressure from outside of respiratory tract
(mediastinal tumor, aortic aneurysms,
Hodgkins disease)
Pressure upon the recurrent laryngeal nerve
Irritation of the pleural surface (pleurisy,
effusion)
The axon reflex set up by irritation of the
nerve terminals in the epithelium and
mucosa.
Their activation will release sensory
neuropeptides (tachykinins). Such as SP,
neurokinin A (NKA), and CGRP neurogenic
inflammation
Vasodilatation
Plasma exudation
Edema
Epithelial damage
Submucosal gland secretion
Smooth muscle contraction
COUGH
Watery viscoelastic secretion in the bronchi of
respiratory tract (tracheobronchial secretion)
Depth 5um
Produced by:
Submucosal glands
Goblet cells
Stimulated by:
Neural -- > Parasympathetic nerves (acetylcholine)
Local -- > Irritant (cigarette smoking, ammonia)
Structural representation of the tracheobronchial wall
Two phases:
Gel
semisolid, sticky
outer most layer
Sol
thin
Inner most layer
Composition
Gel
95% water
1% ash
1% CH
1% protein
Glycoprotein:
Threonine, serine
Cyctein
0,025% DNA
Electrolytes: sodium (211 mEq/L), potassium (17), calcium
(3), chloride (157)
Sol
Salivary amylase, lysozyme, lactoferrin, albumin,
sialoglycoprotein, salivary alpha, beta and gamma globulin

Acute and chronic non-asthmathic cough
Postnasal drip syndrome
Asthma (cough variant asthma)
Gastro-esophageal reflux
Chronic bronchitis
Angiotensin-converting enzyme inhibitors
(ACE inhibitors)
Others:
Pharyngitis
Pulmonary congestion
Pulmonary tuberculosis
Intrathoracal malignancies
Pleural effusion
Pleurisy