R ESTRICTIVE LUNG DISEASE

Diseases which restrict lung expansion ↓ VC and TLC Causes:↑ lung stiffness pleural disease ↓ skeletal mobility abnormal neuro-muscular apparatus

L UNG FIBROSIS Interstitial and alveolar thickening with collagen deposition – stiffens lungs Fibrosis = scarring thus lung fibrosis = scarring of the lung ↓ VC and FEV 1 ↓ TLC and RV

L UNG FIBROSIS Abnormally high pressure needed to distend lungs - ↓ compliance Arterial blood gases - ↓ O 2 and CO 2 Hypoxaemia mild at rest, may fall dramatically with exercising

L UNG 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

C HEST 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

C HEST 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

C OMBINED 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

T REATMENT Medical: corticosteroids (suppress immunity, ↓ inflammation, ↓ fibrosis) Corticosteroids many side-effects Physio: palliative ↓ secretions during infection dypnoea management

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