Pulmonary Physiology, 10th Edition
Genres: Physics
Book Preface
The tenth edition of Pulmonary Physiology has been thoroughly updated. New figures and tables have been added and others revised to help students visualize concepts more clearly and learn the material more effectively. New references and clinical correlations have been added to the end of each chapter. It has been more than 40 years since Pulmonary Physiology was first published. The book is now older than most of its readers!
Perhaps the greatest pleasure associated with the first nine editions has been receiving many favorable comments and helpful suggestions from students, readers, and colleagues, and I have used many of these suggestions in the preparation of this new edition.
This book is intended to be used both as an introductory text for beginning students and as a review for residents and fellows in such fields as internal medicine, anesthesiology, pediatrics, and pulmonary medicine. Students who have studied the text should be able to review for licensure and certification examinations by concentrating on the figures, key concepts, tables, and appendices, which summarize nearly all of the material in the book.
My goal in writing this book is to provide first-year medical students (as well as respiratory therapy, nursing, nurse-anesthesia, and other students) with a solid background on the aspects of pulmonary physiology essential for an understanding of clinical medicine. My approach is to encourage self-sufficiency not only in studying pulmonary physiology for the first time, but also in understanding the basic concepts of pulmonary physiology well enough to apply them with confidence to future patients.
I believe that the ways to accomplish this are to inform the reader of the goals of each chapter with clearly stated learning objectives, to give detailed and complete explanations of physiologic mechanisms and demonstrate how they apply to pathologic states, and to give the reader a means of self-testing by providing clinical correlations, problems, and pulmonary function test data to interpret.
The challenge is to write a book that students can read without difficulty in the limited amount of time allocated to pulmonary physiology in the typical curriculum. The material must be presented in a way that discourages memorization without real comprehension, because only those students who understand the basic mechanisms are able to apply them to new situations. The result of this approach should be a book that covers the essentials of the respiratory system as concisely as possible yet raises no questions in students’ minds without answering them. I hope that I have achieved these goals in writing this book.
I would like to thank the many people whose comments have helped me revise the various editions of the book, including my colleagues in respiratory physiology and pulmonary medicine, my colleagues at LSU Health Sciences Center and Tulane University School of Medicine, and my students and readers. I give special thanks to Drs. Andy Pellett and Lisa Harrison-Bernard of Louisiana State University Health Sciences Center and Hershel Raff of the Medical College of Wisconsin. I would also like to thank everyone who has helped me prepare the manuscripts, illustrations, and proofs, including my many editors at McGraw Hill, Betsy Giaimo, and my wife Elizabeth. This book is dedicated in memory of Robert S. Alexander and Jim Miller.
Michael G. Levitzky
Contents
Preface
Chapter 1 Function and Structure of the Respiratory System
Functions of the Respiratory System
Structure of the Respiratory System
Key Concepts
Suggested Readings
Chapter 2 Mechanics of Breathing
Generation of a Pressure Difference Between Atmosphere and Alveoli
Pressure-Volume Relationships in the Respiratory System
Interaction of Lung and Chest Wall: The Static Pressure-Volume Curve
Airways Resistance
The Work of Breathing
Key Concepts
Clinical Problems
Suggested Readings
Chapter 3 Alveolar Ventilation
The Lung Volumes
Measurement of the Lung Volumes
Anatomic Dead Space and Alveolar Ventilation
Measurement of Alveolar Ventilation
Alveolar Ventilation and Alveolar Oxygen and Carbon Dioxide Levels
Regional Distribution of Alveolar Ventilation
The Closing Volume
The Effects of Aging
Key Concepts
Clinical Problems
Suggested Readings
Chapter 4 Blood Flow to the Lung
The Bronchial Circulation
The Functional Anatomy of the Pulmonary Circulation
Pulmonary Vascular Resistance
The Regional Distribution of Pulmonary Blood Flow: The Zones of the Lung
Hypoxic Pulmonary Vasoconstriction
Effects of Mechanical Ventilation on Pulmonary Blood Flow
Pulmonary Edema
Key Concepts
Clinical Problems
Suggested Readings
Chapter 5 Ventilation-Perfusion Relationships
The Concept of Matching Ventilation and Perfusion
Consequences of High and Low 
Testing for Nonuniform Distribution of Inspired Gas and Pulmonary Blood Flow
Regional Differences and Their Consequences in the Lung
Key Concepts
Clinical Problems
Suggested Readings
Chapter 6 Diffusion of Gases and Interpretation of Pulmonary Function Tests
Fick’s Law for Diffusion
Limitations of Gas Transfer
Diffusion of Oxygen
Diffusion of Carbon Dioxide
Measurement of Diffusing Capacity
Interpretation of Pulmonary Function Tests
Key Concepts
Clinical Problems
Suggested Readings
Chapter 7 Transport of Oxygen and Carbon Dioxide in the Blood
Transport of Oxygen by the Blood
Hemoglobin and the Physiologic Implications of the Oxyhemoglobin Dissociation Curve
Influences on the Oxyhemoglobin Dissociation Curve
Transport of Carbon Dioxide by the Blood
The Carbon Dioxide Dissociation Curve
The Bohr and Haldane Effects Explained
Key Concepts
Clinical Problems
Suggested Readings
Chapter 8 Acid-Base Balance
The Chemistry of Acids, Bases, and Buffers
Buffer Systems of the Human Body
Acidosis and Alkalosis
Respiratory and Renal Compensatory Mechanisms
Clinical Interpretation of Blood Gases and Acid-Base Status
The Causes of Hypoxia
Key Concepts
Clinical Problems
Suggested Readings
Chapter 9 Control of Breathing
The Generation of Spontaneous Rhythmicity
The Medullary Respiratory Center
The Pontine Respiratory Groups
Spinal Pathways
Reflex Mechanisms of Respiratory Control
Influences of Higher Centers
The Response to Carbon Dioxide
The Response to Hydrogen Ions
The Response to Hypoxia
The Response to Exercise
Altered Breathing Patterns
Key Concepts
Clinical Problems
Suggested Readings
Chapter 10 Nonrespiratory Functions of the Lung
Pulmonary Defense Mechanisms
Nonrespiratory Functions of the Pulmonary Circulation
Metabolic Functions of the Lung
Key Concepts
Suggested Readings
Chapter 11 The Respiratory System Under Stress
Exercise and the Respiratory System
Altitude and Acclimatization
Diving and the Respiratory System
Sleep and the Respiratory System
Key Concepts
Clinical Problems
Suggested Readings
Clinical Problem Answers
Appendix
I. Symbols Used in Respiratory Physiology
II. The Laws Governing the Behavior of Gases
III. Frequently Used Equations
IV. Table of Normal Respiratory and Circulatory Values
Index
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