By:Jesus Mario A. Lopez Jr., RN, RTRP

Upper AirwayBounderies: From the anterior nares to the

true vocal cordsFunctions: - Heating/cooling inspired gases @ body

temperature (37°C)- Filtering inspired gases- Humidifying inspired gases to 100%

relative humidity at body temperature- Olfaction: act of smelling- Phonation: production of sound- Conduction passageway for ventilating

gases

A. Nose1. Framework of cartilage2. (2) septum/nostril

Regions of the Nasal Fossa:- Vestibular- Olfactory- Respiratory

B. Paranasal sinuses1. To give voice resonance (prolongation & intensification). 2. To lighten head to some extent (cavities filled w/ air)

C. Oral Cavity- serves multiple purposes. It is involved in digestion, speech, and respiration.

D. Pharynx (Throat)1. To produce vowel sounds (phonation) 2. To serve as a common passageway (for GI & RT)

Sections:- Nasopharynx- Orophrynx- Laryngopharynx (hypopharynx)

Larynx (voice box)

Lower AirwayBoundaries: From the true vocal cords to the terminal air

spaces (alveoli).Functions: - Ventilation: to and fro movement of gas (gas conduction)- External respiration: actual gas exchange between body

(pulmonary capilliary blood) and external environment (alveolar gas)

- Sphincter/glottic mechanisms:

*Valsalva maneuver: Forced exp. against closed glottis*Müller maneuver: Forced insp. against closed glottis*Cough mechanisms*Protection of laryngeal inlet

- Phonation

Tracheobronchial Tree (conducting airway)

B. Trachea(Wind pipe)

The Lungs- An conical-shaped organ whch is situated in the thoracic

cavity separated by a structure (mediastinum) containing the heart, great vessels, esophagus, and trachea.

The Thorax- is a bony and cartilaginous frame within which lie the

principal organs of circulation and respiration.

MusclesMuscles for Inspiration: (at rest)1. Diaphragm: dome shaped muscle that separates thoracic

from abdominal cavity. Origin: Thoracic outlet

Insertion: Central TendonAction: Increases vertical diameter of the thorax (piston movement)

2. External intercostals: Origin: Inferior boarder of superior ribInsertion: Superior boarder of inferior ribAction: Elevate ribs, increasing anteroposterior and transverse diameter of thorax (pump and bucket handle movement)

Accessory muscles for Inspiration: 1. Each tends to perform one of two actions; either raising the

thorax so that other muscles can effectively raise the thorax.

2. It should be noted that the use of accessory muscles for resting is ABNORMAL!!! It should occur only with deep or forced inspiration.

Accessory muscles for Expiration: 1. There are NO!!! Muscles for quiet resting expiration. It is

purely a passive process brought by the normal elastic tendencies of the lung coupled with cessation of inspiratory muscles. Therefore any muscles used in expiration are termed accessory muscles for expiration

2. Any usage of these muscles for quiet resting expiration is ABNORMAL!!!

3. It is used only for forced expiration, making expiration a active process

4. The accessory muscles of expiration are either of the back, thorax, or abdomen and tend to pull the thorax down or to support the thorax so that other muscle groups can effectively pull down on the thorax.

ASTHMA- is a heterogeneous disease, usually

characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation. [GINA 2014]

Categories: Extrinsic or Allergic - is a result of an antigen-

antibody reaction on mast cells of the respiratory tract.

Intrinsic or Idiopathic - is a result of imbalance of the autonomic nervous system, that is, the response of β and ά adrenergic sites, as well as cholinergic sites are not properly coordinated

Non-specific - implies that the origin is unknown it may follow from a infection, emotional changes or exercise.

Normal Resident Antibodies: 5 types IgG – can pass placenta – passive

immunity, temporary IgA – body secretions – saliva, tears,

colostrum IgM – acute inflammation IgE – allergic reactions IgD – chronic inflammation

CHRONIC OBSTRUCTIVE PULMONARY DISEASE- is a common preventable and treatable

disease, characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory responses in the airways and the lungs to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. [GOLD 2014]21

Asthma-COPD Overlap Syndrome (ACOS)- is characterized by persistent airflow

limitation with several features usually associated with asthma and several features usually associated with COPD. ACOS is therefore identified by the features that it shares with both asthma and COPD

References:

- Egan’s Fundamentals of Respiratory Care by Kacmarek, Wilkins, Stoller, 10th edition

- Essential’s in Respiratory Care by Kacmarek, 3rd edition

- CardioPulmonary Anatomy and Physiology by Terry des Jardins, 5th edition

- Principles of Anatomy and Physiology by Tortora, Derrickson, 12th edition