Breathing cycle

Introduction to Total Lung Capacity

This includes residual volume ,expiratory reserve volume ,Tidal volume and inspiratory reserve volume.vital capacity together with residual volume constitute total lung capacity.It is about 6litre in human.

Total Lung Capacity

When we are at rest, the amount of air that moves in and out per breath is called the tidal volume(about 500 ml for an average human adult). We can breathe much more deeply and inhale more air than our resting tidal volume; the additional volume of air we can take in above normal tidal volume is our inspiratory reserve volume. Conversely,we can forcefully exhale more air than we normally do during a resting exhalation. This additional amount of air is the expiratory reserve volume. The combined tidal volume,inspiratory reserve volume, and expiratory reserve volume is the vital capacity. The vital capacity of an athlete is generally greater than that of a non athlete, and vital capacity decreases with age.Vital capacity is not the entire lung volume. Even after the most extreme exhalation possible, some air remains in the lungs. The lungs and airways cannot be collapsed completely;they always contain a residual volume. The total lung capacity is the sum of the residual volume and the vital capacity.

EXPLAINATION:

Respiratory rate: is the rate of breaths per minute. Normal respiratory rate is 12 breaths / minute. Tidal Volume: (TV) is quantity of air that moves in or moves out with each inspiration or expiration. Minute volume of respiration (MVR): is the total amount of air taken in during one minute. Inspiratory preserve volume (IRV): is the excess amount of air that can be breathed over the normal tidal value. The normal value of IRV is 3000ml. Expiratory reserve volume (ERV) is the surplus volume of air that can be blow out over the normal tidal value. The average value of ERV is 1400 ml.

Vital Capacity
Vital Capacity (Vt) is the maximum amount of air that can be inhaled and exhaled during a single breath is called vital capacity. So vital capacity is the amount of tidal, inspiratory reserve, and expiratory reserve volumes. This is called vital capacity since the life depends on breathing and the more air one can move, the better off one is. This is roughly 4800 ml in males and 3100 ml in females. Alveolar ventilation rate (AVR) is the amount of air that attains alveoli per minute (350 x 12 = 4200 ml). Total lung capacity (TLC) is the sum of imperative capacity and the residual volume (6000 ml in males & 4700 ml in females) Calculation of total lung capacity Total lung capacity = vital capacity + residual volume

How to Calculate Total Lung Capacity

Total lung capacity=vital capacity + residual volume.Vital Capacity is the maximum volume of air a person can breathe in after a forced expiration. This includes Expiratory reserve volume ,tidal volume and inspiratory reserve volume.It is the maximum volume of air a person can breathe out after a forced inspiration.It is 3800 to 4800ml.Residual Volume is the volume of air remaining in the lungs even after aforcible expiration. This averages 1100 mL to 1200 mL.There for total lung capacity is 4900 -6000ml.Total lung capacity includes residual volume ,expiratory reserve volume ,Tidal volume and inspiratory reserve volume.A spirometer is a device that has been replaced used to visualize how we use our lung capacity in breathing

The physical movements associated with the gaseous exchange are called breathing. The various structures that are involved in the breathing mechanism are the respiratory passage, the lungs, the outer and inner intercostal muscles, the diaphragm and the muscles attached to the diaphragm. The breathing movements are controlled by the three respiratory centres of the medulla oblongata and pons Varolli in the human brain. The three respiratory centres are the inspiratory, expiratory (in medulla oblongata) and pneumotaxic centres (in pons Varolli). The respiratory centres are stimulated by the carbon dioxide concentration of the blood. Thus, the breathing movements are involuntary, to a large extent. However, we can control the rate of breathing and extent of breathing but not for long.

Breathing Movements
There are two types of physical movements associated with the gaseous exchange. They are inspiration and expiration. During inspiration, air is drawn in and during expiration, air is exhaled out.

Inspiration or inhalation
During inspiration the outer intercostal muscles contract which raises the chest cavity or the ribs. This is accompanied by the lowering of the diaphragm. Together these movements serve to increase the area of the thoracic cavity that reduces the pressure. The air from outside rushes into the lungs.

Breathing Movement - Inspiration

After the internal respiration in the lungs, the impure air is expelled in the following manner:

Expiration or exhalation
The inner intercostal muscles contract bringing the ribs back to the original position and the diaphragm is also raised back by the action of the abdominal muscles. This reduces the space in the chest cavity and increases the pressure. This expels the air out of the lungs.

Breathing Movement - Expiration

One respiratory cycle consisting of expiration and inspiration takes five seconds - two seconds for inspiration and three seconds for expiration.

Demonstration of breathing mechanism

Take a bell jar. Towards its rounded end, fix a 'Y' shaped glass tube and on the open ends of the two branches tie a balloon each. On its open end, tie a thin rubber sheet. The cavity of the bell jar acts as the thoracic cavity, the "Y" shaped tube as the trachea that branches into bronchi and the rubber sheet as the diaphragm.

Demonstration of Breathing Mechanism

Respiratory Volumes
There are totally about 700 million alveoli in the two lungs of an adult human being. This increases the surface area enormously. The total surface area of the lungs is 70 square metres - that is almost the size of the tennis court. It is nearly 100 times the surface of the human body (skin).

Thus, the lungs can hold a lot of air, about 6000 ml. This lung capacity is defined as the maximum air that can be held in the two lungs at any time.
However, during one breath in and out, the volume of gas exchanged is called the tidal volume. It is about 450ml during quiet breathing.

The volume of air that can be drawn in after normal inspiration is about 1500 ml and is called the inspiratory reserve volume (IRV) or complemental air.
The volume of air that can be expelled out after a normal expiration is about 1500ml and is called the expiratory reserve volume (ERV) or supplemental air.

Even after forced expiration, some amount of air remains in the lungs. This is called residual air that is about 1500ml.

Some amount of air remains behind in the various parts of the respiratory tract also. The air in the trachea and bronchi (where no diffusion occurs) is called dead space air (350ml). The air remaining in the alveoli or air sacs is alveolar air (150ml).

The maximum volume of air that can be exchanged in one breath in and out is called the vital capacity. It is about 5000ml.
The above figures are represented in the given graph

The instrument that is used to measure the lung volume is called spirometer.

Respiration and breathing

In most cases, glucose is oxidised in the presence of oxygen to give carbon dioxide. Thus, for respiration, an organism has to take in oxygen and give out carbon dioxide. This is called gaseous exchange. The oxygen taken in is used to break down the respiratory substrate (e.g., glucose) and energy is released along with carbon dioxide. This whole process is called respiration.

Gaseous exchange involves movements of some specialised structures. The mechanism of taking in oxygen and giving out carbon dioxide is called breathing. Thus breathing and respiration are not synonymous. Respiration involves the mechanical and the bio-chemical processes whereas breathing is only the mechanical or physical process of exchange of gases.

Breathing training with the Breathing Trainer for COPD needs to be put in perspective, and the following diagram briefly summarizes some of the major physiologic components. Breathing training and the Breathing Trainer is only part of the equation in breathing control, though certainly a very important part. It can show you very effectively how to breathe, but no breathing is possible without an effective chest and diaphragm so-called "Bellows" mechanism to make the lungs actually move. All active lung movement is totally dependant on an effective Bellows mechanism to enable more efficient breathing pattern training. It is therefore important you have some understanding of the bellows mechanism. In another module we will describe how the COPD chest becomes deformed into the so-called "Barrel Chest" deformity, the physiologic consequences of this, and how to deal with that problem with chest physiotherapy techniques.

The Bellows mechanism is composed of the "Chest Wall" as noted in the center of the diagram. The Chest Wall in turn has two distinct components, the "Ribs" of the chest, and the "Diaphragm," which is a thin curved muscle between the chest and the abdomen, attached to the lower ribs. The diaphragm is the major driving force of breathing, and in COPD it's function is typically severely compromised, by lung overinflation that pushes the diaphragm downwards into the abdomen, putting it into a position of mechanical inefficiency. It is critically important that diaphragm function be restored as much as possible, in order that you can then effectively use breathing training to learn more efficient breathing patterns. The breathing pattern parameters are defined in the center of the diagram, by adjusting:
y y y y

Tidal Volume (i.e. the breath volume of air) Respiratory Rate (i.e. the number of breaths per minute) Inspiration : Expiration Time Ratio (i.e. the relative time of the Inspiration and Expiration components) End-Inspiration and End-Expiration Pauses (i.e. slight breath hold times at the end of inspiration and expiration)

Inspiration and Expiration Waveforms (i.e. the shape of the inspiration and expiration breathing pattern. NOTE: The complexity of waveform considerations has been omitted from the Breathing Trainer.)

As noted in the small diagram on the right, it is critical the breathing pattern achieve a minimal adequate degree of "Alveolar Ventilation," i.e. the ventilation breath that actually gets down to lung alveoli (air sacks) where gas exchange takes place. However, as noted in the small diagram on the left, it is also critical that the breathing pattern produce the minimal degree of "Work of Breathing" i.e. a measure of the effort and energy to breathe, as dyspnea is most closely related to the increased Work of Breathing. It should be apparent that there are conflicting needs involved in developing an optimal breathing pattern, and that balancing these different breathing parameters of adequate Alveolar Ventilation versus minimal Work of Breathing is a delicate task, and one that requires compromises. Considerable experimental adjustment may be needed to achieve the optimal compromise. I am impressed as to how small adjustments may make substantial differences in patient comfort. The Breathing Trainer is designed to permit very subtle adjustments to permit you to seek out the breathing pattern that is best for you. Another module will go into detail as to how to adjust your Breathing Trainer to make a "Breathing Prescription" individualized for your particular needs. Be aware there are many therapists who strongly advocate for one or another type of breathing pattern. I would suggest that frequently a strong advocacy position does not take into account the fact that most every breathing parameter adjustment has both positive benefits, and also undesirable negative factors. The trick is to find the optimal balance between these conflicting parameters.