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The Lower Airways

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The Lower Airways CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORThe SALE Lower OR DISTRIBUTION AirwaysNOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Golatckii Nikolai/Shutterstock. © Golatckii © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE KEY TERMS The Lower Airway © Jones & Bartlett Learning, LLCacute respiratory distress ©lobar Jones bronchi & Bartlett Learning, LLC The Trachea NOT FOR SALE OR DISTRIBUTIONsyndrome (ARDS) NOTlower FOR airway SALE OR DISTRIBUTION Conditions of the Trachea alveolar sac main stem bronchi Main Stem Bronchi alveoli noncartilaginous airways Lobar, Segmental, and Subsegmental Bronchi asthma pneumonia The Bronchioles bronchiectasis pores of Kohn The Terminal Bronchioles bronchioles pulmonary edema The© Respiratory Jones Bronchioles, & Bartlett the Acinus, Learning, the Alveolar LLC Ducts, bronchiolitis© Jones & Bartlettpulmonary Learning, interstitium LLC NOTand the FOR Alveoli SALE OR DISTRIBUTION bronchoalveolarNOT FOR SALEpulmonary OR DISTRIBUTION parenchyma Conditions of the Lower Airway and Alveolus lavage (BAL) segmental bronchi The Cranial Nerves canals of Lambert sputum cartilaginous airways subsegmental bronchi CHAPTER OBJECTIVES chronic bronchitis surfactant club cells terminal bronchioles © Jones & AfterBartlett completing Learning, this chapter, you LLC will be able to: © Jonescranial & nerves Bartlett Learning,trachea LLC 1. Identify the structures of the lower airway. dyspnea tracheal agenesis NOT FOR SALE2. Describe OR DISTRIBUTIONthe histology of the lower respiratory airways. NOTemphysema FOR SALE OR DISTRIBUTIONtracheal stenosis 3. Identify the cartilaginous and noncartilaginous airways. endotracheal intubation tracheobronchial tree 4. Explain the rationale behind endotracheal intubation to fibroblast cells tracheoesophageal facilitate ventilation and the clearance of secretions. isothermic saturation fistula (TEF) 5. Identify the markings on an endotracheal tube. boundary tracheomalacia 6. List the structures© through Jones which & air Bartlett travels from Learning,the nose to LLC © Jones & Bartlett Learning, LLC the alveoli. 7. Provide examples NOTof abnormal FOR physiologic SALE processes OR DISTRIBUTION of the NOT FOR SALE OR DISTRIBUTION lower airway. 8. Identify the cranial nerves that affect ventilation. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 19 © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284430240_CH02_019_032.indd 19 23/06/20 7:46 AM 20 CHAPTER 2 The Lower Airways © Jones &The Bartlett Lower Learning, Airway LLC © Jonescontains & Bartlett16 to 20 C-shaped Learning, hyaline LLC cartilage rings, with the open portion of the rings facing the back, or Thelower airway includes those airways that are below NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION posterior, of the neck. The tracheal rings are completed the larynx. These airways bifurcate, or split, branching in by a membrane that contains a smooth muscle called an inverted treelike fashion as they move deeper into the the trachealis. This muscle constricts the trachea, al- airway toward the alveoli. Because of this inverted tree- lowing air to be expelled with more force, for example, like structure, the lower airway is often referred to as the when an individual coughs. Directly posterior to this tracheobronchial tree©. LikeJones the upper & Bartlett airway, aLearning, portion LLC © Jones & Bartlett Learning, LLC membrane is the esophagus. The trachea is lined with of the lower airway isNOT classified FOR as SALEthe conducting OR DISTRIBUTION airway. NOT FOR SALE OR DISTRIBUTION pseudostratified ciliated columnar epithelium and The conducting airway, or conducting zone, of the lower goblet cells (Figure 2-3). Along with the submucosal airway begins at the larynx and extends to the end of the glands, the goblet cells secrete high-molecular-weight terminal bronchioles. This portion of the lower airway is lined with epithelium, mucous-producing cells, and cilia© that Jones help to & remove Bartlett particles Learning, and debris LLC from the © Jones & Bartlett Learning, LLC airway.NOT Gas FOR exchange SALE does OR not DISTRIBUTIONoccur in this portion of NOT FOR SALE OR DISTRIBUTION the airway. Gas exchange occurs in the small grapelike CLINICAL FOCUS: Cartilaginous alveoli clusters at the end of the airway known as . Some and Noncartilaginous Airways gas exchange also occurs in the terminal bronchioles. For this reason, the alveoli and the terminal bronchioles At the top of the tracheobronchial tree, the out- © Jones & areBartlett called the Learning, respiratory zoneLLC (Figure 2-1). © Jonesermost & Bartlett layer of the Learning, airway is made LLC up of cartilage. NOT FOR SALEThe lowerOR DISTRIBUTION airway is divided into generations. The NOT FORThis layer SALE of cartilage OR DISTRIBUTION decreases in thickness mov- main generations of the airway and some of their char- ing down the airway until it completely disappears acteristics are provided in Figure 2-2. at the level of the bronchioles. The cartilaginous airways are the trachea, main stem bronchi, lobar The Trachea © Jones & Bartlett Learning, LLCbronchi, segmental bronchi,© and Jones the subsegmental & Bartlett Learning, LLC The large airway descendingNOT FOR immediately SALE OR below DISTRIBUTION the bronchi. The noncartilaginousNOT airways FOR are SALE the bron- OR DISTRIBUTION larynx and beginning approximately at the level of chioles and alveolar ducts. the sixth cervical vertebra is the trachea. The trachea © Jones & Bartlett Learning, LLC Nasopharynx© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NasalNOT cavity FOR SALE OR DISTRIBUTION Oropharynx Pharynx Upper Mouth airway Epiglottis © Jones & Bartlett Learning, LLC © Jones & LaryngopharynxBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONTrachea NOT FOR SALELarynx OR DISTRIBUTION Apex of the lung Artery Alveolus Lower Alveoli airway Bronchiole Bronchioles © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Main bronchi NOT FOR SALE OR DISTRIBUTION Vein NOT FOR SALE OR DISTRIBUTION Base of the lung © Jones & BartlettDiaphragm Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORCapillary SALE OR DISTRIBUTION (A)A Carina B(B) network FIGURE 2-1 The lower airway includes the conducting zone and the respiratory zone. (A) The conducting zone of the lower airway extends from the larynx to the end of the terminal bronchioles. The change between the terminal bronchioles and respiratory bronchioles is sometimes referred to as the transitional zone of the lungs. (B) The respiratory zone is © Jones & Bartlettmade Learning, up of the respiratory LLC bronchioles, the alveolar ducts,© andJones alveoli. Gas& Bartlett exchange occurs Learning, in the respiratory LLC zone. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284430240_CH02_019_032.indd 20 23/06/20 7:46 AM Conditions of the Trachea 21 © Jones & Bartlett Learning, LLC Conducting Zone© Jones & Bartlett Learning, LLCRespiratory Zone NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ansitional Zone Tr © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Main Lobar Segmental Subsegmental Terminal Respiratory Alveolar Alveolar Structure Larynx Trachea Stem Bronchioles Bronchi Bronchi Bronchi Bronchioles Bronchioles Ducts Sacs Bronchi Tracheo- © Jones & Bartlett Learning,bronchial LLC © Jones & Bartlett Learning, LLC Generation tree begins 0123 4–9 10–1516–19 20–23 24–27 28 NOT FOR SALE OR DISTRIBUTIONbeneath NOT FOR SALE OR DISTRIBUTION the larynx Division Ten segmental of the bronchi on the 6th Cervical main stem right and eight Anatomic vertebrae bronchi on the left. T5 Note/ Approx. into left 4 mm The pulmonary 1 mm 0.5 mm 0.4 mm 0.3 mm 0.2 mm © Jones &12 mmBartlett Learning, LLC © Jones & Bartlett Learning, LLC Diameter 18 mm and right parenchyma NOTin diameter FOR SALEsides OR at DISTRIBUTIONbegins below NOT FOR SALE OR DISTRIBUTION the carina this level. 8–5 mm 3–1 mm Disappears Cartilaginous Ye sYes Ye sYes Ye sYes Ye sNNo o No No at this level Gas No No No No No No No No No Ye s Ye sYes ©Ex chanJonesge & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 2-2 The main generations of the lower airway and their characteristics. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC mucus glycoproteins (mucins) into the lining of the vertebrae (T3–T5), usually around the fourth thoracic NOT FOR SALEairway. TheseOR DISTRIBUTION mucins, along with water, comprise theNOT vertebra FOR SALE (T4). OR DISTRIBUTION airway mucus. The mucins provide the gel-forming properties of mucus and also promote viscosity. Goblet cells
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