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4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Lung Disease . About Lung Disease and Disability How Respiration Occurs Red blood cells must be brought as closely as possible to the air we breathe, so that hemoglobin in the cells can give up waste carbon dioxide from cellular metabolism and take on oxygen. To accomplish this, the lungs have millions of tiny air sacs (alveoli) with very thin walls (alveolar membranes) containing microscopic blood vessels (capillaries) ( see Figure 1 below ). This anatomy of the lungs allows exposure of a large surface area of the blood to the air. Oxygen (O 2 ) and carbon dioxide (CO 2 ) gases diffuse (move) across the one cell thick alveolar membrane in opposite directions with the oxygen entering the blood and the carbon dioxide leaving it. This process is known as gas exchange. Figure 1: Bronchi and lungs. The gas exchange part of the lungs is known as the lung parenchyma ( see Figure 2 below ). Air is delivered to the parenchyma of the lungs through the bronchial tree — a repetitively branching tubular system for air conduction. It consists of the trachea, from which arises a right and left main (primary) bronchus to the right and left lungs. Smaller bronchi branch from the main bronchus of the right or left lung, then to smaller bronchi to the various lobes of the lungs, then to even smaller bronchi (bronchioles) that eventually reach the alveoli. Figure 2: Mechanism of gas exchange. How Respiration Is Impaired Many diseases can affect breathing. The most useful classification of respiratory disorders is based on the manner in which the ability of air to come into contact with the hemoglobin in red blood cells (RBCs) is disrupted. There are only two ways in which respiration can be impaired, regardless of the exact nature of the disorder: 1. Disease that prevents adequate amounts of air from reaching the gas-exchange leve...
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