Medical Physiology, 3rd Edition

Diffusion of Gases

Gas flow across a barrier is proportional to diffusing capacity and concentration gradient (Fick's law)

Although, early on, physiologists debated whether the lung actively secretes O2 into the blood, we now know that the movements of both O2 and CO2 across the alveolar blood-gas barrier occur by simple diffusion (see p. 108). Random motion alone causes a net movement of molecules from areas of high concentration to areas of low concentration. Although diffusion per se involves no expenditure of energy, the body must do work—in the form of ventilation and circulation—to create the concentration gradients down which O2 and CO2 diffuse. Over short distances, diffusion can be highly effective.

Suppose that a barrier that is permeable to O2 separates two air-filled compartments (Fig. 30-1A). The partial pressures (see p. 593) of O2 on the two sides are P1 and P2. The probability that an O2 molecule on side 1 will collide with the barrier and move to the opposite side is proportional to P1:

image

(30-1)

The unidirectional movement of O2 in the opposite direction, from side 2 to side 1, is proportional to the partial pressure of O2 on side 2:

image

(30-2)

The net movement of O2 from side 1 to side 2 is the difference between the two unidirectional flows:

image

(30-3)

image

FIGURE 30-1 Diffusion of a gas across a barrier.

Note that net flow is proportional to the difference in partial pressures, not the ratio. Thus, when P1 is 100 mm Hg (or torr) and P2 is 95 mm Hg (ratio of 1.05), the net flow is 5-fold greater than when P1 is 2 mm Hg and P2 is 1 mm Hg (ratio of 2).

The term flow describes the number of O2 molecules moving across the entire area of the barrier per unit time (units: moles/s). If we normalize flow for the area of the barrier, the result is a flux (units: moles/[cm2 ⋅ s]). Respiratory physiologists usually measure the flow of a gas such as O2 as the volume of gas (measured at standard temperature and pressure/dry; see Box 26-3) moving per unit time. V refers to the volume and image is its time derivative (volume of gas moving per unit time), or flow.

The proportionality constant in Equation 30-3 is the diffusing capacity for the lung, DL (units: mL/[min ⋅ mm Hg]). Thus, the flow of gas becomes

image

(30-4)

This equation is a simplified version of Fick's law (see p. 108), which states that net flow is proportional to the concentration gradient, expressed here as the partial-pressure gradient.

Applying Fick's law to the diffusion of gas across the alveolar wall requires that we extend our model somewhat. Rather than a simple barrier separating two compartments filled with dry gas, a wet barrier covered with a film of water on one side will separate a volume filled with moist air from a volume of blood plasma at 37°C (see Fig. 30-1B). Now we can examine how the physical characteristics of the gas and the barrier contribute to DL.

Two properties of the gas contribute to DL—molecular weight (MW) and solubility in water. First, the mobility of the gas should decrease as its molecular weight increases. Indeed, Graham's law states that diffusion is inversely proportional to the square root of molecular weight. Second, Fick's law states that the flow of the gas across the wet barrier is proportional to the concentration gradient of the gas dissolved in water. According to Henry's law (see Box 26-2), these concentrations are proportional to the respective partial pressures, and the proportionality constant is the solubility of the gas (s). Therefore, poorly soluble gases (e.g., N2, He) diffuse poorly across the alveolar wall.

Two properties of the barrier contribute to DL—area and thickness. First, the net flow of O2 is proportional to the area (A) of the barrier, describing the odds that an O2 molecule will collide with the barrier. Second, the net flow is inversely proportional to the thickness (a) of the barrier, including the water layer. The thicker the barrier, the smaller the O2 partial-pressure gradient (image) through the barrier (Fig. 30-2). An analogy is the slope of the trail that a skier takes from a mountain peak to the base. Whether the skier takes a steep “expert” trail or a shallow “beginner's” trail, the end points of the journey are the same. However, the trip is much faster along the steeper trail!

image

FIGURE 30-2 Effect of barrier thickness.

Finally, a combined property of both the barrier and the gas also contributes to DL, a proportionality constant k that describes the interaction of the gas with the barrier.

Replacing DL in Equation 30-4 with an area, solubility, thickness, molecular weight, and the proportionality constant yields

image

(30-5)

Equations 30-4 and 30-5 are analogous to Ohm's law for electricity:

image

(30-6)

Electrical current (I) in Ohm's law corresponds to the net flow of gas (image); the reciprocal of resistance (i.e., conductance) corresponds to diffusing capacity (DL); and the voltage difference (ΔV) that drives electrical current corresponds to the pressure difference (P1 − P2, or ΔP).

The total flux of a gas between alveolar air and blood is the summation of multiple diffusion events along each pulmonary capillary during the respiratory cycle

Equation 30-5 describes O2 diffusion between two compartments whose properties are uniform both spatially and temporally. Does this equation work for the lungs? If we assume that the alveolar air, blood-gas barrier, and pulmonary-capillary blood are uniform in space and time, then the net diffusion of O2 (image) from alveolar air to pulmonary-capillary blood is

image

(30-7)

image is the diffusing capacity for O2image is the O2 partial pressure in the alveolar air, and image is the comparable parameter in pulmonary-capillary blood. Although Equation 30-7 may seem sophisticated enough, a closer examination reveals that imageimage, and image are each even more complicated than they at first appear.

image

Among the five terms that make up image, two vary both temporally (during the respiratory cycle) and spatially (from one piece of alveolar wall to another). During inspiration, lung expansion causes the surface area (A) available for diffusion to increase and the thickness of the barrier (a) to decrease (Fig. 30-3A). Because of these temporal differences, image should be maximal at the end of inspiration. However, even at one instant in time, barrier thickness and the surface area of alveolar wall differ among pieces of alveolar wall. These spatial differences exist both at rest and during the respiratory cycle. imageN30-1

image

FIGURE 30-3 Complications of using Fick's law.

N30-1

Spatial Differences in Alveolar Dimensions

Contributed by Emile Boulpaep, Walter Boron

The total area of the lungs is not distributed evenly among all alveoli. First, all else being equal, some alveoli are “naturally” larger than others. Thus, some have a greater area for diffusion than do others, and some have a thinner wall than do others.

Second, the position of an alveolus in the lung can affect its size. As we saw in Chapter 27, when a person is positioned vertically, the effects of gravity cause the intrapleural pressure to be more negative near the apex of the lung than near the base (see Fig. 27-2). Thus, other things being equal, alveoli near the apex of the lung tend to be more inflated, so that they have a greater area and smaller thickness compared to alveoli near the base of the lung.

Third, during inspiration, alveoli undergo an increase in volume that causes their surface area to increase and their wall thickness to decrease. However, these changes are not uniform among alveoli. Again, the differences can be purely anatomical: all other things being equal, some alveoli “naturally” have a greater static compliance (see p. 610) than others. Thus, during inspiration, their area will increase more, and their wall thickness will decrease more. However, other things being equal, the compliance of an alveolus also depends on its position in the lung. We will see in Chapter 31 that the relatively overinflated alveoli near the apex of the lung (in an upright individual) have a relatively low compliance. In other words, during inspiration these apical alveoli have a smaller volume increase (see Fig. 31-5D). Thus, their area for diffusion undergoes a relatively smaller increase, and their wall thickness undergoes a relatively smaller decrease, than alveoli near the base of the lung.

In summary, for all of the reasons we have discussed, the area and thickness parameters vary widely among alveoli at the end of a quiet inspiration, and the relation among these differences changes dynamically during a respiratory cycle.

image

Like area and thickness, alveolar image varies both temporally and spatially (see Fig. 30-3B). In any given alveolus, image is greatest during inspiration (when O2-rich air enters the lungs) and least just before the initiation of the next inspiration (after perfusion has maximally drained O2 from the alveoli), as discussed on page 676. These are temporal differences. We will see that when an individual is standing, image is greatest near the lung apex and least near the base (see pp. 681–682). Moreover, mechanical variations in the resistance of conducting airways (see pp. 681–682) and the compliance of alveoli (see p. 597 or pp. 608–610) cause ventilation—and thus image (see p. 610)—to vary among alveoli. These are spatial differences.

image

As discussed below, as the blood flows down the capillary, capillary image rises to match image (see Fig. 30-3C). Therefore, O2 diffusion is maximal at the beginning of the pulmonary capillary and gradually falls to zero farther along the capillary. Moreover, this profile varies during the respiratory cycle.

The complications that we have raised for O2 diffusion apply as well to CO2 diffusion. Of these complications, by far the most serious is the change in image with distance along the pulmonary capillary. How, then, can we use Fick's law to understand the diffusion of O2 and CO2? Clearly, we cannot insert a single set of fixed values for imageimage, and image into Equation 30-7 and hope to describe the overall flow of O2 between all alveoli and their pulmonary capillaries throughout the entire respiratory cycle. However, Fick's law does describe gas flow between air and blood for a single piece of alveolar wall (and its apposed capillary wall) at a single time during the respiratory cycle. For O2,

image

(30-8)

For one piece of alveolar wall and at one instant in time, A and a (and thus image) have well defined values, as do image and image. The total amount of O2 flowing from all alveoli to all pulmonary capillaries throughout the entire respiratory cycle is simply the sum of all individual diffusion events, added up over all pieces of alveolar wall (and their apposed pieces of capillary wall) and over all times in the respiratory cycle:

image

(30-9)

Here, imageimage, and image are the “microscopic” values for one piece of alveolar wall, at one instant in time.

Even though the version of Fick's law in Equation 30-9 does indeed describe O2 diffusion from alveolar air to pulmonary-capillary blood—and a comparable equation would do the same for CO2 diffusion in the opposite direction—it is not of much practical value for predicting O2 uptake. However, we can easily compute the uptake of O2 that has already taken place by use of the Fick principle (see p. 423). The rate of O2uptake by the lungs is the difference between the rate at which O2 leaves the lungs via the pulmonary veins and the rate at which O2 enters the lungs via the pulmonary arteries. The rate of O2 departure from the lungs is the product of blood flow (i.e., cardiac output, image) and the O2 content of pulmonary venous blood, which is virtually the same as that of systemic arterial blood (image). Remember that “content” (see p. 650) is the sum of dissolved O2 and O2 bound to hemoglobin (Hb). Similarly, the rate of O2 delivery to the lungs is the product of image and the O2 content of pulmonary arterial blood, which is the same as that of the mixed-venous blood (image). Thus, the difference between the rates of O2 departure and O2 delivery is

image

(30-10)

For a cardiac output of 5 L/min, a image of 20 mL O2/dL blood, and a image of 15 mL O2/dL blood, the rate of O2 uptake by the pulmonary-capillary blood is

image

(30-11)

Obviously, the amount of O2 that the lungs take up must be the same regardless of whether we predict it by repeated application of Fick's law of diffusion (see Equation 30-9) or measure it by use of the Fick principle (see Equation 30-10):

image

(30-12)

The flow of O2, CO, and CO2 between alveolar air and blood depends on the interaction of these gases with red blood cells

We have been treating O2 transport as if it involved only the diffusion of the gas across a homogeneous barrier. In fact, the barrier is a three-ply structure imageN30-2 comprising an alveolar epithelial cell, a capillary endothelial cell, and the intervening interstitial space containing extracellular matrix. The barrier is remarkable not only for its impressive surface area (50 to 100 m2) and thinness (~0.6 µm) but also for its strength, which derives mainly from type IV collagen in the lamina densa of the basement membrane (often <50 nm) within the extracellular matrix.

N30-2

Three-Ply Structure of the Alveolar Barrier

See the following review:

Maina JN, West JB: Thin and strong! The bioengineering dilemma in the structural and functional design of the blood-gas barrier. Physiol Rev 85:811–844, 2005.

One could imagine that, as O2 diffuses from the alveolar air to the Hb inside an erythrocyte (red blood cell, or RBC), the O2 must cross 12 discrete mini-barriers (Fig. 30-4). A mini-diffusing capacity (D1 to D12) governs each of the 12 steps and contributes to a so-called membrane diffusing capacity (DM) because it primarily describes how O2 diffuses through various membranes. How do these mini-diffusing capacities contribute to DM? Returning to our electrical model (see Equation 30-6), we recognize that D is analogous to the reciprocal of resistance. Therefore, we can represent the 12 diffusive steps by 12 resistors in series. Because the total resistance is the sum of the individual resistances, the reciprocal of DM is the sum of the reciprocals of the mini-diffusing capacities:

image

(30-13)

Of course, these parameters vary with location in the lung and position in the respiratory cycle.

image

FIGURE 30-4 Transport of O2 from alveolar air to Hb. The 12 diffusion constants (D1 to D12) govern 12 diffusive steps across a series of 12 barriers: (1) the interface between the alveolar air and water layer, (2) the water layer itself, (3–5) the two membranes and cytoplasm of the type I alveolar pneumocyte (i.e., epithelial cell), (6) the interstitial space containing the extracellular matrix, (7–9) the two membranes and cytoplasm of the capillary endothelial cell, (10) a thin layer of blood plasma (<0.2 µm in mammals), and (11, 12) the membrane and cytoplasm of the erythrocyte. θ ⋅ Vc describes how fast O2 binds to Hb.

For most of the O2 entering the blood, the final step is binding to Hb (see p. 647), which occurs at a finite rate:

image

(30-14)

θ is a rate constant that describes how many milliliters of O2 gas bind to the Hb in 1 mL of blood each minute, and for each millimeter of mercury (mm Hg) of partial pressure. Vc is the volume of blood in the pulmonary capillaries. The product θ ⋅ Vc has the same dimensions as DM (units: mL/[min ⋅ mm Hg]), and both contribute to the overall diffusing capacity:

image

(30-15)

Because O2 binds to Hb so rapidly, its “Hb” term 1/(θ ⋅ Vc) is probably only ~5% as large as its “membrane” term 1/DM.

For carbon monoxide (CO), which binds to Hb even more tightly than does O2 (see pp. 654–655)—but far more slowly—θ ⋅ Vc is quantitatively far more important. The overall uptake of CO, which pulmonary specialists use to compute DL (see p. 670), depends about equally on the DM and θ ⋅ Vc terms.

As far as the movement of CO2 is concerned, one might expect the DL for CO2 to be substantially higher than that for O2, inasmuch as the solubility of CO2 in water is ~23-fold higher than that of O2 (see p. 593). However, measurements show that image is only 3- to 5-fold greater than image. The likely explanation is that the interaction of CO2 with the RBC is more complicated than that of O2, involving interactions with Hb, carbonic anhydrase, and the Cl-HCO3 exchanger (see pp. 655–657).

In summary, the movement of O2, CO, and CO2 between the alveolus and the pulmonary capillary involves not only diffusion but also interactions with Hb. Although these interactions have only a minor effect on the diffusing capacity for O2, they are extremely important for CO and CO2. Although we will generally refer to “diffusing capacity” as if it represented only the diffusion across a homogeneous barrier, one must keep in mind its more complex nature.