RESTRICTIVE LUNG DISEASE

RESTRICTIVE LUNG DISEASE

Diseases which restrict lung expansion

↓ VC and TLC

Causes: ↑ lung stiffnesspleural disease↓ skeletal mobilityabnormal neuro-muscular

apparatus

LUNG FIBROSIS

Interstitial and alveolar thickening with collagen deposition – stiffens lungs

Fibrosis = scarring thus lung fibrosis = scarring of the lung

↓ VC and FEV1

↓ TLC and RV

LUNG FIBROSIS

Abnormally high pressure needed to distend lungs - ↓ compliance

Arterial blood gases - ↓ O2 and CO2

Hypoxaemia mild at rest, may fall dramatically with exercising

LUNG FIBROSIS

Breathing pattern – rapid and shallow High resting respiratory rate Dyspnoea

Auscultation – late inspiratory, fine crackles in dependant lung areas

Diagnosis by CT-scan abnormalities and biopsy

CHEST WALL RESTRICTION

Anything which limits chest wall expansion – restrictive ventilatory effect

↓ lung volumes, TLC may be normal

No associated lung abnormality – gas transfer ↓ but normal

CHEST WALL RESTRICTION

Causes: skeletal disease (scoliosis)neuromuscular disease (muscular dystrophy)pleural disease (effusion)

Long-standing restriction – areas of atelectasis, if widespread - ↓ lung compliance

Severe disease – hypoxaemia and hypercapnia

COMBINED RESTRICTIVE AND OBSTRUCTIVE

Any disease of lung parenchyma which scars and narrows airways – mixed picture

Sarcoidosis – multisystem granulomatous inflammatory disease

Pulmonary oedema – fluid narrowing smaller airways and stiffening lungs

TREATMENT

Medical: corticosteroids (suppress immunity, ↓ inflammation, ↓ fibrosis)

Corticosteroids many side-effects

Physio: palliative↓ secretions during infectiondypnoea management

REFERENCES

Downie, P.A. 1987. Cash’s textbook of chest, heart and vascular disorders for physiotherapists. 4th edition. London: Faber and Faber

www.medicinenet.com