130
PART II THE VERTEBRAL COLUMN TABLE 6.1 Muscles Used in Ventilation
Muscles of Quiet Inspiration (Primary Muscles of Inspiration)
Diaphragm Scalenes Intercostals
Muscles of Forced Inspiration (Accessory Muscles of Inspiration)
Primary muscles of inspiration Serratus posterior superior Serratus posterior inferior Levator costarum (longus and brevis) Sternocleidomastoid Latissimus dorsi
Iliocostalis thoracic and cervicis (erector spinae) Pectoralis minor
Pectoralis major (sternocostal head) Quadratus lumborum
structures related to respiration, changes in lung volumes, and impairments in gas exchange and lung defenses. With aging comes a decrease in chest wall compliance and mobility and reduced recoil ability of lung tissues. These changes are due to an increase in the formation of cross-links in collagen fi bers of the connective tissues, an increase in rib calcifi cation, and a decrease in the strength of the respiratory muscles. Changes in spinal curves (i.e., scoliosis, kyphosis, or both) infl uence lung volumes, resulting in decreased compliance. Each of these adverse factors can increase the work required for breath- ing. Although tidal volumes remain fairly constant, lung vital capacity decreases and residual volumes increase with aging. The amount of gas exchanged between the lungs and circulatory system needed for maximal work decreases, reducing the amount of work a person is able to perform. A person’s ability to climb a fl ight of stairs may be limited not only by decreased leg strength associ- ated with aging, but also by an inability to obtain ade- quate oxygen for the given workload. Ventilation, diffusion between alveoli and capillaries, and pulmonary circulation all become less effi cient with aging. The membranes between the alveoli and capillar- ies thicken, hindering gas exchange. The changes in the mechanical properties of ventilation and these alterations in gas exchange increase the energy requirements of res- piration for performing a given amount of work.
DISEASE-RELATED CHANGES
COPD is a general term that includes a group of respira- tory diseases: emphysema, chronic obstructive bronchitis, and asthmatic bronchitis. Each of these conditions has in common an increased resistance to airfl ow with an accompanying increase in the expiratory phase of respi- ration. COPD also decreases lung tissue elasticity. This resistance to airfl ow results in chronic overworking of the respiratory muscles in an effort to maintain suffi cient blood levels of oxygen. Studies show that overworking
The abdomen is pulled upward and inward
The upper ribs move up and out
COPD inhalation
Figure 6.18 The paradoxical respiratory movement patterns displayed by people with COPD differ from patterns displayed by people without pulmonary disease. Accessory muscles elevate the upper ribs, the diaphragm is unable to descend, and the abdominal viscera are pulled up and in. (From Levangie P, Norkin C. Joint Structure and Function: A Comprehensive Analysis, 5th ed. Philadelphia, PA: F. A. Davis Company, 2011: p. 209, with permission.)
these muscles or respiratory muscle dysfunction second- ary to weakness or disease can exacerbate disease and its symptoms, increasing a person’s risk for hospitalization. Because of the decreased thoracic movement during respiration in COPD, the lungs hyperinfl ate. This change in structures shortens the fi bers of the dia- phragm, and over time it becomes fl attened rather than dome shaped. People who have COPD often present with a barrel-shaped thorax, fl attened diaphragm, and protruding abdomen. During inspiration, the fl attened diaphragm pulls the lower rib cage inward, working against infl ation of the lungs. The diaphragm’s ability to expand the thoracic rib cage decreases, and inspiration requires the use of the muscles that elevate the upper rib cage (Fig. 6.18). As these muscles forcefully elevate the upper ribs, the diaphragm and abdominal viscera may be pulled up and in during forceful inspiration. This paradoxical pattern of breathing requires a great deal of energy and greatly increases the work associated with breathing. Regular exercise has been shown to increase
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