1 INTRODUCTION Introduction What is respiration? The need for respiration Diffusion in respiration and the circulation Timing in the circulation and respiration Basic science of respiration Drugs 2 STRUCTURE OF THE RESPIRATORY SYSTEM,RELATED TOFUNCTION Introduction The upper airways The intrathoracic airways Blood vessels Pulmonary hypertension The lymphatics The nerves Gross structure of the respiratory system Pleurisy The diaphragm and chest wall How breathing is brought about Embryology Air-conditioning Metabolic activity Metabolism of circulating biologically activesubstances Non-respiratory functions 3 ELASTIC PROPERTIES OF THE RESPIRATORY SYSTEM Introduction Intrapleural pressure (Ppl) Static lung compliance (CL) The effect of disease The physical basis of lung compliance 4 AIRFLOW IN THE RESPIRATORY SYSTEM Introduction How airflow is brought about The nature of airflow The major determinant of flow - radius Airways resistance and obstructive pulmonary disease The clinical situation Sites of airways resistance Asthma and airways smooth muscle Bronchomotor tone Pharmacological treatment of asthma Clinical definitions Bronchitis and mucus Emphysema and radial traction Intrapleural pressure and cough Clinical tests for changes in resistance Work of breathing 5 VENTILATION OF THE RESPIRATORY SYSTEM: THE IMPORTANCE OFITS LACK OF UNIFORMITY IN DISEASE Introduction Spirometric abnormalities in disease Uneven distribution Dead space. Alveolar dead space in disease The Bohr equation Factors affecting physiological dead space Alveolar ventilation and respiratory exchange The alveolar gas equation Distribution of inspired gas Other factors influencing distribution 6 GAS EXCHANGE BETWEEN AIR AND BLOOD:DIFFUSION The path from air to tissue Lung disease and diffusion Fick's Law of Diffusion Measuring transfer factor Treating diffusion difficulties Carbon dioxide and other gases 7 THE PULMONARY CIRCULATION: BRINGING BLOOD AND GASTOGETHER The functions of the pulmonary circulation The anatomy of the pulmonary circulation Matching ventilation and perfusion Distribution of blood flow through the lungs Regional differences in ventilation in the lungs Ventilation/perfusion matching and its effect on blood O and CO content Shunt 8 CARRIAGE OF GASES BY THE BLOOD AND ACID/BASE BALANCE Introduction Oxygen transport Dissolved oxygen: do we really need Hb and why keep it in red cells? Carbon dioxide transport Acid-base balance 9 CHEMICAL CONTROL OF BREATHING Introduction Oxygen lack Carbon dioxide excess 10 NERVOUS CONTROL OF BREATHING Introduction The rhythm generator Pattern of breathing in COPD The respiratory 'centres' The medullary groups Conscious control of breathing Respiratory muscle innervation Neuromuscular disorders Vagal reflexes Dyspnoea Other reflexes 11 LUNG FUNCTION TESTS: MEASURING DISABILITY Introduction Spirometry Flow measurements Plethysmography Lung mechanics Transfer factor (diffusing capacity) Blood gases Gas washouts Exercise testing Challenge tests Appendix: some basic science Glossary Index
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