Respiratory bronchiole

Respiratory zone · Gen 17-19 First alveoli Acinus begins

Each terminal bronchiole divides into respiratory bronchioles (generations 17 to 19), the first airways with alveoli budding from their walls and therefore the start of the respiratory zone and of the acinus. The epithelium is simple cuboidal with club cells and the last few cilia; gas exchange begins here.

Traced from the start

  1. Trachea
  2. Right main bronchus
  3. Right upper lobe bronchus
  4. Right middle lobe bronchus
  5. Right lower lobe bronchus
  6. Left main bronchus
  7. Left upper lobe bronchus
  8. Left lower lobe bronchus
  9. Right upper lobe segmental bronchiRight middle lobe segmental bronchiRight lower lobe segmental bronchiLeft upper lobe upper division bronchiLingular bronchus and segmentsLeft lower lobe segmental bronchi
  10. Bronchioles and terminal bronchiole
  11. Respiratory bronchiole

Detail

Generations
17 to 19; the transitional zone between conducting and respiratory airways
Acinus
Everything distal to one terminal bronchiole: two or three generations of respiratory bronchiole, the alveolar ducts and sacs, about 3 to 5 mm across
Epithelium
Simple cuboidal with club cells, interrupted by alveolar openings lined by pneumocytes; cilia stop here
Blood supply
Bronchial arteries reach about this level; beyond it the walls are nourished by the pulmonary circulation

When it goes wrong

Cigarette smoking

Centriacinar (centrilobular) emphysema: destruction starts in the respiratory bronchioles and is worst in the upper lobes, sparing the distal alveoli early on

Smoking-related respiratory bronchiolitis

Pigmented macrophages fill the respiratory bronchioles; centrilobular nodules on CT and a mild interstitial lung disease that improves with smoking cessation

Coal dust inhalation

Coal macules collect around the respiratory bronchioles in a centriacinar pattern, with focal emphysema

Practise this structure

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