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Basicelementsoftherespiratorycontrolsystem (sensor,centralcontroller,effectors) Central C t lcontroller t ll (brain (b i stem, t cortex, t other th parts t of fthe th brain) b i ) Effectors Sensors:Centralchemoreceptors :Peripheralchemoreceptors :Lungreceptors :otherreceptors IntegratedresponsestoCO2,O2,pHandexercise Abnormalpatternsofbreathing
Sensors
Chemoreceptors Lung&other receptors
negativefeedback
Effectors
Respiratorymuscles
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Central controller
1.Medullaryrespiratorycenter 1.1Dorsalrespiratorygroup(DRG) mainlyforinspiration intrinsicperiodicfiring basicrhythmofventilation 1.2Ventralrespiratorygroup(VRG) quiescentduringnormalquietbreathing forcedbreathing(exercise),expirationbecomes activeasaresultofactivityofexpiratorycells 2.Apneusticcenter excitatory i effect ff oninspiratory i i areaof fDRG prolongedinspiration(promotinginspiration) receiveinhibitoryimpulsefrompneumotaxic centerorrostralpontinegroup(RPG)&pulmonary stretchreceptor(PSR)
Respiratory rhythmcentre
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Arterialchemoreceptor
1. Centralchemoreceptor
majorhypercapnic detector ventral lsurface f of fmedulla d ll
VentilatoryresponsetoincreasedPCO2
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PO2
severe hypoxaemia
anaerobicmetabolism + LacticacidinCSF(H)
+
2.Peripheralchemoreceptor
PaO2 , PaCO2 , pH
(main 80%) +
Respiratory center
Increased ventilation
1 = Pons, 2 = Ventral respiratory group, 3 = Central chemoreceptor, 4 = Sensory neuron, 5 = Carotid body, 6 = Somatic motor neuron, 7 = Aortic body, 8 = Internal intercostal muscles, 9 = Abdominal muscles, 10 = Diaphragm, 11 = External intercostal muscles, 12 = Scalene and sternocleidomastoid muscles, 13 = Somatic motor neuron, 14 = Dorsal respiratory group, 15 = limbic system, 16 = higher brain centers (emotions and voluntary control)
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Lungreceptors
1. Pulmonary or lung stretch receptors (PSR/LSR) (slowly adapting pulmonary stretch receptors) : airway i smooth th muscle l + Inspiration pulmonary stretch receptors - CNX Apneustic center Inspiratory cells of DRG
3.Jreceptors(juxtapulmonarycapillaryreceptors) :ending of nonmyelinated C fibers Stimuli:edema,pulmonarycongestion, airemboli,etc. CNX Respiratorycenter Dyspnea 4.BronchialCfibers Chemicalinjectedintobronchialcirculation Rapidshallowbreathing, bronchoconstriction,mucoussecretion
Other receptors
1.Noseandupperairwayreceptors
Mechanicalorchemicalstimulation Sneeze,cough,bronchoconstriction
2.Jointandmusclereceptors
Proprioceptors Respiratorycenter VE intheinitialstageofexercise
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3.Gammasystem
Elongationofintercostalm.anddiaphragm Musclespindles p Controlthestrength ofcontraction Sensationofdyspnoea
Apnea Hyperpnea
4.Arterialbaroreceptors Arterialbloodpressure
aorticandcarotidsinusbaroreceptors
Hypoventilationorapnoea
VE
Response to CO2
ResponsetoO2
Onlytheperipheralchemoreceptors areinvolved Thereisnegligiblecontrolduring normoxiccontrol Thecontrolbecomesimportant athighaltitude,andinlongterm hypoxaemiacausedbychronic l lung disease di
PaCO2 isthemostimportantstimulus toventilationundermostconditions anditisnormallytightlycontrolled Mostofthestimuluscomesfromthe centralchemoreceptorsbutthe peripheralchemoreceptorsalso contributeandtheirresponseis faster The Th responsei ismagnified ifi dif thePaO2 islowered Multiplicativeeffect
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Response to pH
H+
Carotidbodychemoreceptors Respiratorycenter
Increasedventilation
SubsequentIncrease Duringmoderateexercise
1. Arterialchemoreceptors PO2:usuallynochangeinmean PCO2:usuallynochangeinmean [H+]usuallynochangeunlesscross anaerobicthreshold [K+]:minorrole OscillationsinarterialPO2 andPCO2 2.Metaboreceptors b 3.Nociceptors:H+,K+,bradykinin, arachidonicacid 4.Temperaturereceptors
During exercise severe enough to exceed anaerobic threshold 1. Arterial chemoreceptors H+, adenosine, ATP, ADP, K+ 2. Increased sensitivity of chemoreceptor responses during exercise
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Patternofbreathing
Apnea:absenceorcessationofbreathingintheresting expiratoryposition Apneusis:respirationceasesininspiratoryposition,because ofsustainedcontractionoftheinspiratorymuscles Biot'sRespiration:sequencesofuniformlydeepgasps,apnea, thendeepgasps Breathholding:voluntaryapnea,eitherbycontinuous contractionoftheinspiratorymuscles, muscles orbyrelaxationagainst glottisclosure
CheyneStokesbreathing:cyclesofgradually
increasingtidalvolumefollowedbygradually decreasingtidalvolume,usuallyseparatedbybrief periodsofapnea cerebrovascular b l accident id t congestiveheartfailure normalpeopleduringsleepathighaltitude
Dyspnea: difficultorlabouredbreathing;anuncomfortable awarenessoftheactofbreathing,"airhunger" Eupnea: normalspontaneousbreathing Hyperpnea: yp p increasedp pulmonary yventilation( (abovethe normalrestingvalue) Hypopnea:ventilationbelowthenormallevel Hyperventilation:increaseinpulmonaryventilation(VE,ml/min) (strictly,alveolarventilationVA,ml/min)relativetometabolic rate,irrespectiveoftheabsolutevalueofventilation Hypoventilation: ventilationlessthanrequiredbymetabolic demands,irrespectiveoftheabsolutevalueofventilation
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Stimuli postulated to produce dyspnoea Panting: breathingpatternbothveryrapidandshallow. Insomeconditions,thispatternisadoptedtodissipate heat(thermalpanting) Orthopnea: dyspneaexperiencedonlyintherecumbent position,usuallysupine,andrelievedbysittingor standing.Itoftenoccursinpatientswithleftventricular insufficiency. Tachypnea: increasedrateofbreathing
Stimulus
- Vascular stimuli : Right arterial p. : Right ventricular p.
Receptors
- Right atrial stretch receptors - Right ventricular strain receptors - Pulmonary artery stretch receptors - Left atrial stretch receptors
- Mechanical stimuli : Respiratory muscle - Muscle spindles Length-tension inappropriateness : Pulmonary - Stretch receptors (vagal) hyperinflation : Deformation of lung - J receptors (vagal) interstitium
Receptors
Example of Clinical Disease - Lung diseases - Chronic obstructive lung disease - Cardiovascular - None reported - Psychoneurosis
- Carotid bodies - Carotid bodies, central chemoreceptors - Carotid bodies, central chemoreceptors - Mechanoreceptors - Metaboreceptors - Cerebral cortex