The
lipid–protein mixture that covers the lung alveoli,
lung surfactant, ensures mechanical robustness and controls gas transport
during breathing. Lung surfactant is located at an interface between
water-rich tissue and humid, but not fully saturated, air. The resulting
humidity difference places the lung surfactant film out of thermodynamic
equilibrium, which triggers the buildup of a water gradient. Here,
we present a millifluidic method to assemble multilamellar interfacial
films from vesicular dispersions of a clinical lung surfactant extract
used in replacement therapy. Using small-angle X-ray scattering, infrared,
Raman, and optical microscopies, we show that the interfacial film
consists of several coexisting lamellar phases displaying a substantial
variation in water swelling. This complex phase behavior contrasts
to observations made under equilibrium conditions. We demonstrate
that this disparity stems from additional lipid and protein gradients
originating from differences in their transport properties. Supplementing
the extract with cholesterol, to levels similar to the endogenous
lung surfactant, dispels this complexity. We observed a homogeneous
multilayer structure consisting of a single lamellar phase exhibiting
negligible variations in swelling in the water gradient. Our results
demonstrate the necessity of considering nonequilibrium thermodynamic
conditions to study the structure of lung surfactant multilayer films,
which is not accessible in bulk or monolayer studies. Our reconstitution
methodology also opens avenues for lung surfactant pharmaceuticals
and the understanding of composition, structure, and property relationships
at biological air–liquid interfaces.