Mechanical stimuli regulate cell function in much the same way as chemical signals do. This has been studied in various cell types, particularly those with defined mechanical roles. The alveolar type II cell (ATII) cell, which is part of the alveolar epithelium of the lung, is responsible for the synthesis and secretion of pulmonary surfactant. It is now widely believed that stretch of ATII cells, which occurs during breathing, is the predominant physiological trigger for surfactant release. To study this, investigators have used an increasingly sophisticated array of in vitro and in vivo models. Using various stretch devices and models of lung ventilation and expansion, it has been shown that stretch regulates multiple activities in ATII cells. In addition to surfactant secretion, stretch triggers the differentiation of ATII to alveolar type I cells, as well as ATII cell apoptosis. In doing so, stretch modulates the proportion of these cells in the lung epithelium during both development and maturation of the lung and following lung injury. From such studies, it appears that mechanical distortion plays an integral part in maintaining the overall structure and function of the lung.