Breathing includes several components, including flow-resistive and elastic work; surfactant production; and lung resistance and compliance.
Explain the roles played by surfactant, flow-resistive and elastic work, and lung resistance and compliance in breathing
- Both flow-resistive and elastic work are conducted during the act of respiration; flow-resistive work involves the alveoli and tissues, while elastic work involves the intercostal muscles, chest wall, and diaphragm.
- These types of work function in an inverse relationship; for example, increasing the rate of respiration results in an increase in the flow-resistive work and a decrease in the elastic work.
- Surfactant is a phospholipid and lipoprotein substance produced in the lungs that functions similarly to a detergent: it reduces the surface tension between alveoli tissue and air within the alveoli, thereby reducing the work needed for airway inflation.
- Lung resistance plays a key role in the ability to efficiently exchange gases; if there is obstruction (resistance) within the airways, the result will be decreased gas exchange.
- Lung compliance plays a key role in the ability to efficiently exchange gases; if there is too much of an increase or decrease in elasticity of the lung, the result will be disruption of gas exchange, which will cause obstructive or restrictive diseases.
- surfactant: a lipoprotein in the tissues of the lung that reduces surface tension and permits more efficient gas transport
- tidal volume: the amount of air breathed in or out during normal respiration
The Work of Breathing
The number of breaths per minute is the respiratory rate; under non-exertion conditions, the human respiratory rate averages around 12–15 breaths/minute. The respiratory rate contributes to the alveolar ventilation, or how much air moves into and out of the alveoli, which prevents carbon dioxide buildup in the alveoli. There are two ways to keep the alveolar ventilation constant: increase the respiratory rate while decreasing the tidal volume of air per breath (shallow breathing), or decrease the respiratory rate while increasing the tidal volume per breath. In either case, the ventilation remains the same, but the work done and type of work needed are quite different. Both tidal volume and respiratory rate are closely regulated when oxygen demand increases.
There are two types of work conducted during respiration: flow-resistive and elastic work. Flow-resistive work refers to the work of the alveoli and tissues in the lung, whereas elastic work refers to the work of the intercostal muscles, chest wall, and diaphragm. When the respiratory rate is increased, the flow-resistive work of the airways is increased and the elastic work of the muscles is decreased. When the respiratory rate is decreased, the flow-resistive work is decreased and the elastic work is increased.
The air-tissue/water interface of the alveoli has a high surface tension, which is similar to the surface tension of water at the liquid-air interface of a water droplet that results in the bonding of the water molecules together. Surfactant is a complex mixture of phospholipids and lipoproteins that works to reduce the surface tension that exists between the alveoli tissue and the air found within the alveoli. By lowering the surface tension of the alveolar fluid, it reduces the tendency of alveoli to collapse.
Surfactant works like a detergent to reduce the surface tension, allowing for easier inflation of the airways. When a balloon is first inflated, it takes a large amount of effort to stretch the plastic and start to inflate the balloon. If a little bit of detergent were applied to the interior of the balloon, then the amount of effort or work needed to begin to inflate the balloon would decrease; it would become much easier. This same principle applies to the airways. A small amount of surfactant on the airway tissues reduces the effort or work needed to inflate those airways and is also important for preventing collapse of small alveoli relative to large alveoli. Sometimes, in babies that are born prematurely, there is lack of surfactant production; as a result, they suffer from respiratory distress syndrome and require more effort to inflate the lungs.
Lung Resistance and Compliance
In pulmonary diseases, the rate of gas exchange into and out of the lungs is reduced. Two main causes of decreased gas exchange are compliance (how elastic the lung is) and resistance (how much obstruction exists in the airways). A change in either can dramatically alter breathing and the ability to take in oxygen and release carbon dioxide.
Examples of restrictive diseases are respiratory distress syndrome and pulmonary fibrosis. In both diseases, the airways are less compliant and stiff or fibrotic, resulting in a decrease in compliance because the lung tissue cannot bend and move. In these types of restrictive diseases, the intrapleural pressure is more positive and the airways collapse upon exhalation, which traps air in the lungs. Forced or functional vital capacity (FVC), which is the amount of air that can be forcibly exhaled after taking the deepest breath possible, is much lower than in normal patients; the time it takes to exhale most of the air is greatly prolonged. A patient suffering from these diseases cannot exhale the normal amount of air.
FEV1/FVC ratio: The ratio of FEV1 (the amount of air that can be forcibly exhaled in one second after taking a deep breath) to FVC (the total amount of air that can be forcibly exhaled) can be used to diagnose whether a person has restrictive or obstructive lung disease.
Obstructive diseases and conditions include emphysema, asthma, and pulmonary edema. In emphysema, which mostly arises from smoking tobacco, the walls of the alveoli are destroyed, decreasing the surface area for gas exchange. The overall compliance of the lungs is increased, because as the alveolar walls are damaged, lung elastic recoil decreases due to a loss of elastic fibers; more air is trapped in the lungs at the end of exhalation. Asthma is a disease in which inflammation is triggered by environmental factors, obstructing the airways. The obstruction may be due to edema, smooth muscle spasms in the walls of the bronchioles, increased mucus secretion, damage to the epithelia of the airways, or a combination of these events. Those with asthma or edema experience increased occlusion from increased inflammation of the airways. This tends to block the airways, preventing the proper movement of gases. Those with obstructive diseases have large volumes of air trapped after exhalation. They breathe at a very high lung volume to compensate for the lack of airway recruitment.