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THE LUNG VOLUMES AND

CAPACITIES

@
CBU SCHOOL OF MEDICINE
THE LUNG VOLUMES

A lung volume is a subdivision of the total capacity of the lungs.

They are measured when the lungs are in the midthoracic


position (at the end of a normal resting expiration)

Their values normally vary with age and sex, being 20 -25 %
less in females, and even more in old age except the residual
volume

The various lung volumes and their average normal values in


young adult males include the following
1- TIDAL VOLUME (TV)

This is the volume of air that moves into the respiratory


passages (i.e. inspired or expired) in a single breath cycle during
eupnea (= normal resting quiet breathing). The average TV is 500
ml.

2- INSPIRATION RESER VE VOLUME (IRV)

This is the volume of air that can be inspired by a maximal


inspiratory effort (i.e. by the deepest possible inspiration) after the
end of a normal resting inspiration (i.e. in excess of the TV). The
average IRV is 3000 ml.
3- EXPIRATORY RESERVE VOLUME (ERV)

This is the volume of air that can be expired by a maximal


expiratory effort (i.e. by the deepest possible expiration) after the
end of a normal resting expiration (i.e. in excess of the TV). The
average ER V is 1000 ml.

4- RESIDUAL VOLUME (IRV)

This is the volume of air that remains in the lungs after the end
of a maximal expiration . Its average value is 1200 ml, and it can
be expelled out of the lungs only after their collapse (e.g. after
opening of the chest)
The minimal air (or volume) and its clinical importance

After opening of the chest, however, about 150 ml of air still


remain in the lungs.

This is called minimal air or volume, and it is used medicolegally


in detecting whether a newly born dead baby had died before or
after delivery.

This is known by placing a piece of the baby's lung in water. lf it


floats, it indicates presence of the minimal air (i.e. the baby was
born alive and breathed then died).

On the other hand, if it sinks, it indicates absence of the minimal


air (i.e. the baby was born dead and had never breathed)
THE LUNG CAPACITIES

A lung capacity comprises 2 or more lung volumes·. The various


lung capacities and their average normal values in young adult
males include :

1-INSPIRATORY CAPACITY

The IC is the volume of air that can be inspired by a maximal


inspiratory effort after the end of a normal resting expiration. It
equals the T V+ IR V = about 3500 ml.
2-EXPIRATORY CAPACITY

The EC is the volume of air that can be expired by a maximal


expiratory effort after the end of a normal resting inspiration. It
equals the TV+ ERV = about 1500 ml

3. FUNCTIONAL RESIDUAL CAPACITY

This is the volume of air that remains in the lungs after the end
of a normal resting expiration. lt equals the ERV + R V = about
2200 ml.
4. VITAL CAPACITY

This is the volume of air that can be expelled out by a maximal


expiration after a maximal inspiration. It equals the TV+ JRV +
ERV = about 4500 ml.

However, it normally varies with the size of the body.


Accordingly, its measured value must be predicted relative to the
body surface area.

Normally it averages 2500 ml and 2000 ml per square meter of


body surface area in young adult males and females respectively.
5. TOTAL LUNG CAPACITY

This is the volume of air that the lungs contain after a maximal
inspiration. lt includes all lung volumes (TV + 1RV + ERV + RV) or,
in other words, it equals the VC + RV= about 5700 ml.
FACTORS THAT AFFECT THE VITAL CAPACITY (VC)

1- Posture : The VC is greater in the standing or sitting positions


than in the recumbent position, because in the latter position the
lung capacity is decreased due to 2 factors
(a) The viscera press on the diaphragm (which limits its descent).
(b) The blood volume in the lungs increases (because
the venous return increases as a result of loss of the effect of
gravity)

2- Movement of the diaphragm : Conditions that limit the


diaphragmatic descent (e.g. pregnancy and ascites) decrease the
VC specially in the recumbent position
3- Pulmonary blood volume : Pulmonary congestion (= increased
blood volume in the lungs) e.g. in left ventricular failure ,
decreases the VC specially in the recumbent position

4- Strength of the respiratory muscles : The VC is greater in


athletes than in sedentary people, and is decreased in all muscle
diseases, myasthenia gravis, and diseases associated with
paralysis (e.g. poliomyelitis).

5- Lung compliance (stretchability) : A decrease in the lung


compliance reduces the VC. This commonly occurs in (
a) Lung fibrosis [e.g. after a severe TB (tuberculosis) infection].
b) Pneumothorax (collection of air in the pleural sac
c) Hydrothorax (collection of fluid in the pleural sac).
6- Lung elasticity : Reduction of the elastic property of the lungs
decreases the VC e.g. in emphysema, in which the lungs are well
inflated and their compliance increases, but expiration becomes
difficult.

7- Resistance to air flow : An increase in the resistance to air flow


reduces the VC. This occurs in obstructive lung diseases e.g.
asthma, in which the resistance to air flow occurs mainly during
expiration
8- Expansibility of the thoracic wall : A decrease in the expansion
of the thorax reduces the VC. This commonly occurs due to
deformities in either the thoracic cage or the vertebral column
(e.g. kyphosis and scoliosis)

7- Resistance to air flow : An increase in the resistance to air flow


reduces the VC. This occurs in obstructive lung diseases e.g.
asthma, in which the resistance to air flow occurs mainly during
expiration
*** The diseases that limit the lung or thoracic wall expansibility
are called restrictive lung diseases. In these diseases, as well as
in cases of pulmonary congestion and limited diaphragmatic
movement both the TLC as well as the VC are reduced.

*** In diseases characterized by difficult expiration (e.g.


emphysema and asthma), the TLC is almost normal while the VC
is decreased and the RV is increased
*** The lung volumes already described are called static volumes,
because they are measured while the subject is in the resting
midthoracic position. All can be measured by an apparatus called
the spirometer except the residual volume.

Therefore, the capacities that include the residual volume (i.e.


FRC and TLC) cannot be measured by this apparatus.
Measurement of the Residual Volume

The R V can be measured by application of the dilution principle


as follows. The subject expires maximally (so only the RV remains
in the lungs) then he breathes deeply 3 - 4 times in a spirometer
that contains a known concentration of helium in air.

In this way, helium is diluted by the RV and its concentration


becomes equal in both the spirometer air and the RV.
The amount of helium remains constant during the test because
(a) It is present in a closed circuit
(b) It is an inert gas that is not produced or utilized by the
body
(c) It is almost insoluble in the blood.

After equilibration, the RV is calculated as follows


Clinical importance of measuring the RV

Normally, the RV is less than 30 % of the TLC. Such ratio is


exceeded in diseases that cause inefficient expiration, particularly
asthma & emphysema and ratios more than 35 % indicate that the
condition is serious .
Importance of the FRC and its measurement

The FRC maintains an adequate gas exchange in the lungs in


the intervals between breaths, and its large volume (about 5 times
the TV) prevents acute changes in the 02 and C02 concentrations
in the blood.

lt can also be measured by using the dilution principle but in this
case the subject starts breathing in the spirometer after a normal
expiration.
DIFFERENCES BETWEEN ALVEOLAR AND EXPIRED AIR

The alveolar air is that air that undergoes gas exchange with
blood in the pulmonary capillaries. Its volume is about 2000 ml
after a quiet expiration.

It continuously loses O2 and gains CO2, so its O2 content is


less and its CO2 content is more than the amounts of these gases
in both the inspired and the expired air
During inspiration, the air conducting part of the respiratory
passages (which is called the anatomical dead space) contains
atmospheric air.

However during the next expiration, this air is exhaled first and
is followed by alveolar air (which fills the anatomical dead space
after expiration).

There fore, the expired air is a mixture of alveolar air and


atmospheric air from the anatomical dead space.
The following table shows the composition of the inspired,
expired and alveolar air, all fully saturated with water vapour (PP =
partial pressure in mmHg).
THE RESPIRATORY DEAD SPACE (DS)

This is the space in the respiratory system occupied by gas that


does not exchange with blood. lt is subdivided into the following
types :

1. Anatomical DS : This is the area in which gas exchange does


not normally occur. It extends from the nose down till the
respiratory bronchioles, and its volume is normally about 150 ml.

2. Alveolar DS : This includes the alveoli in which no gas


exchange occurs due to blockage of their blood supply. It is
normally absent(= zero).
3. Physiological DS : This is the area of wasted ventilation in the
respiratory system (i.e. the area in which no gas exchange
occurs). It equals the sum of the anatomical and alveolar dead
spaces. Since normally no alveolar dead space exists, the
physiological DS should be normally equal to the anatomical DS.
FUNCTIONS AND SIGNIFICANCE OF THE ANATOMlCAL DS

(1) The DS constitutes the conducting part of the respiratory tract,


which performs the following functions:
a- Conduction of air to and from the alveoli.
b- Regulation of the body temperature (by helping heat loss).
c- Control of airflow resistance (by adjusting the bronchial tone).
d- Providing several protective mechanisms.

The protective mechanisms are:


- Conditioning of the inspired air.
- Filtration of the inspired air from harmful foreign particles.
- Elimination of the foreign particles by the ciliary escalator.
- Formation of immunoglobulins (antibodies).
- Initiation of the sneeze and cough reflexes.
(2) The nasal olfactory mucosa perceives the sensation of smell.
(3) The larynx is concerned with phonation (sound production).
(4) The anatomical DS is the cause of the difference between the
total and effective ventilation, and is used as a pulmonary function
test
ASSESSMENT OF PULMONARY FUNCTION

The efficiency of the respiratory system can be assessed by


determining one or more of the following parameters :

I . The pulmonary ventilation.


2. The dead space : The presence of non-functioning alveoli is
indicated by a greater physiological DS than the anatomical DS.
3. The lung compliance.
4. The ventilation perfusion ratio.
5. The static lung volumes and capacities.
6. The timed vital capacity.
7. The maximal breathing capacity and the breathing reserve
8. The peak expiratory flow.
9. The levels of both O2 and CO2 in the blood (in cases or severe
pulmonary insufficiency. the blood O2 level decreases while the
blood C02 level increa5es and is associated with acidosis)
PUL MONARY VENTILATION (PV)

The term PV means lung aeration with atmospheric air, and it is


tested by measuring one or both of the following volumes

(1) The total PV or respiratory minute volume (RMV)

This is the total volume of air that is inspired per minute It is


calculated by multiplying the (TV) x breathing rate per minute
Since normally the former is about 500 ml and the latter about 12
per minute, then the normal
total PV (or RMV) = 500 x I2 = 6000 ml (6 litres) per minute
(2) The alveolar PV (or effective PV)

This is the volume of air that actually ventilates the alveoli per
minute Since about 150 ml of the inspired TV normally remain in
the anatomical dead space, then during rest only about 350 ml of
the TV reach the alveoli each breath and the resting alveolar
ventilation = 350 x 12 =4200 ml (4. 2 litres) per minute.

The alveolar PV is more significant than the total PV. It is


frequently altered in disease while the total PV remains constant
e.g. :
1- In a case of tachypnea ( rapid shallow breathing due to any
cause), if the breathing rate increases to 30 I minute, the TV may
decrease down to 200 ml, and in this case. the total PV remains
constant at 6000 ml (200 x 30) while the alveolar PV is markedly
decreased, becoming only I500 ml (200-150 X 30).

2- In a case of slow deep breathing due to any cause. if the


breathing rate decreases to 6 I minute, the TV may increase up to
I000 ml and in this case, the to al PV remains constant at 6000 ml
( I000 x 6) while the alveolar PV is markedly increased, becoming
5100 ml (I 000- 150 x 6).

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