Restrictive Lung Disease Flashcards by Megan Lewis

Volume of air or gas is REDUCED

Restrictive

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FLOW of air is impeded

Obstructive

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Restrictive Lung DYSFUNCTION (RLD)

Abnormal reduction in pulmonary ventilation causing diminished lung expansion and reduced movement of air in & out

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What kind of effect does a RLD have on the work of breathing

Increased! Tidal volume will decrease and respiratory rate will increase, forcing the patient to work HARDER for more oxygen

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What can happen when RLD progresses?

Patients may present with respiratory muscle fatigue, overuse and respiratory failure

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What effect does RLD have on lung COMPLIANCE, VOLUME, and CAPACITIES

All DECREASED!
Compliance: Lungs become stiff and difficult to expand, increasing the workload of breathing
Volumes: IRV, TV, ERV, RV
Capacities: TLC, VC, FRC

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Signs & Symptoms of RLD

Tachypnea
Hypoxemia (mismatched V/Q)
Decreased breath sounds & lung volumes/capacities
Cor pulmonale
Pulmonary HTN

Symptoms: Dyspnea, Cough, Weight Loss

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Potential Causes of RLD (7)

Maturational/Developmental (fetal lung development)
Pulmonary
Cardiovascular
Neuromuscular
Musculoskeletal
Connective Tissue
Other: Pregnancy, Traumatic, Radiation

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Absence of bronchus and lung parenchyma

Agenesis
*Maturational

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Rudimentary bronchus, lacks normal lung parenchyma

Aplasia
*Maturational

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Incomplete development of lungs - functional, but not normal

Hypoplasia
*Maturational

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Hyaline membrane disease due to prematurity or lack of complete lung maturation. Linked to gestational age & surfactant abnormalities

Respiratory Distress Syndrome
*Maturational

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Treatment for Respiratory Distress Syndrome

Surfactant replacement therapy via AEROSOL administration (2 hours post-birth), ECMO, or corticosteroids prenatally to mother

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Effects of Aging

Compliance decreases at ~20 years old & felt around 6th-7th decade
Decreased max voluntary ventilation and vital capacity
Less sensitive chemoreceptors (can’t sense hypoxia or hypercapnia)
Decalcification of ribs/arthritic changes
Thoracic kyphosis/A-P diameter
Enlarged air spaces with diminished elastic recoil
Thinner alveolar walls
Mismatched V/Q
Decreased max HR/CO and DLCO (increased dead space)

*Maturational

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Pulmonary causes of RLD (10)

Pulmonary Fibrosis, Coal Worker’s Pneumoconiosis, Asbestosis, Bronchiolitis Obliterans, Atelectasis, Pneumonia, ARDs, Bronchogenic Carcinoma, Plueral Effusion & Sarcoidosis

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Chronic, progressive, irreversible & usually lethal inflammation of the alveolar walls (irregular shape/size) that lead to distortion of lungs

*Patchy focal lesions leading to scarring & fibrosis

Everything is decreased except pulmonary arterial pressure = Increased work of breathing

Idiopathic Pulmonary Fibrosis

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Treatment for Idiopathic Pulmonary Fibrosis

Corticosteroids, cytotoxic drugs, smoking cessation, adequate O2, good nutrition, treatment of infections, & transplant

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Interstitial lung disease caused by repeated inhalation of coal dust for 10-12+ years leaving coal macules within bronchioles (“black lung disease”)

Can lead to emphysema, bronchitis, TB, cor pulmonale, or PE

S/S: Severe dyspnea, copious BLACK sputum, barrel chest, weight loss, decreased breath sounds

Coal Worker’s Pneumoconiosis

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Treatment for Coal Worker’s Pneumoconiosis

No cure - Supportive measures

Diffuse interstitial pulmonary fibrotic disease and alveolitis with plaques resulting from asbestos exposure with latency period of 15-20 years

Risks: Miners, construction, shipbuilders, insulation, pipe fitters

S/S: Dyspnea, recurrent INFECTIONS, chronic cough weight loss, increased risk of cancer

Asbestosis

Treatment for Asbestosis

No cure - Supportive measures

Fibrotic lung disease affecting small airways and producing either restrictive and/or obstructive dysfunction. Necrosis of respiratory epithelium in bronchioles that allow fluid/debris to enter and create edema/obstruction to airflow (can lead to atelectasis is full obstruction)

Pediatrics - Caused by viral infection
Adults - Caused by toxic fumes

S/S: Dyspnea, increased RR, hacking/NON-PRODUCTIVE cough, chest wall retractions in infants, CYANOSIS

Bronchiolitis Obliterans (Bronchiolitis)

Treatment for Bronchiolitis Obliterans

Hydration, supplemental O2, clear secretions, postural drainage & suctioning

Incomplete expansion (primary) of lung OR loss of volume (obstructive/compressive). Partial or complete collapse of lung due to deflation of alveoli or fluid-filled alveoli causing difficulty with taking deep breaths and coughing effectively

Atelectasis

Treatment of Atelectasis

Deep breathing, incentive spirometry, coughing

Inflammatory process of lung parenchyma caused by bacteria/virus/fungi/mycoplasma that begins in LOWER respiratory tract. Most commonly acquired through INHALATION or ASPIRATION S/S: Decreased lung volume/capacities/compliance, chills, dyspnea, tachypnea, PRODUCTIVE cough, PLEURITIC pain

Pneumonia

Treatment of Pneumonia

Drug therapy! ANTIBIOTICS Oxygen, temporary ventilation, postural drainage, percussion/vibration, assisted cough, hydration, & nutrition

What are the MOST COMMON antibiotic resistant microbes?

MRSA & C-diff

What are the 4 categories of pneumonia?

1. Community-acquired 2. Hospital-acquired 3. Health care associated 4. Ventilator associated

SEVERE HYPOXEMIA and widespread inflammation affecting pulmonary tissues. Alveoli become filled with fluid, decreasing compliance and volume (increase workload). Caused by acute lung injury, pneumonia, inhalation injury, aspiration, chest trauma, near drowning, sepsis or burns S/S: Appear acutely ill, DYSPNEIC with REST & activity, fast/labored breathing, cyanotic, impaired mental status, anxiety LIFE-THREATENING with high mortality rate

Adult Respiratory Distress Syndrome (Acute Lung Injury) - ARDS

Treatment of ARDS

Treat precipitating cause/complications & supportive measures

Three Phases of ARDS

1. Exudative - Alveoli fill with fluid 2. Proliferative - Chronic inflammation 3. Fibrotic - Scar formation due to inflammation

Malignant growth of abnormal epithelial cells in bronchus (squamous, small, adenocarcinoma, or large cell). Primary cause is SMOKING or occupational agents S/S: Chest pain, CLUBBING, dyspnea, UNEXPLAINED weight loss, hypoxemia 4-Stages (<3 cm, <6 cm with single metastasis, >6 cm with lymph node involvement, metastasis to other organs)

Bronchogenic Carcinoma (Lung cancer)

Treatment for lung cancer

Surgery, radiation, chemo

What is a Pack-Year in regards to smoking?

Pack year = 20 cigarettes (1 pack) everyday for 1 year Ex: 10 cigarettes (1/2 pack) per day for 10 years = 0.5 x 10 = 5 Ex: 20 cigarettes (1 pack) per day for 5 years = 5 Calculate by multiplying # of packs smoked per day by the # of years the person has smoked

Accumulation of fluid within pleural space causing a disruption in balance of fluid reabsorption. Transudative vs Exudative Diagnose via thoracentesis S/S: Dyspnea, PLEURITIC CHEST PAIN, dry/non-productive cough

Pleural Effusion

Treatment for Pleural Effusion

Treat underlying cause, change positions, and perform activities as tolerated

Most common cause of Transudative Pleural Effusion

CHF! Other causes: LVF, cirrhosis, pericardial disease, PE, atelectasis or systemic issues

Exudative pleural effusion

Increase permeability of pleural spaces leading to fluid leaking between cells. Caused by bacterial or viral pneumonia, infection, SLR, or RA

Multisystem disease marked by presence of EPITHELIOID granulmonas in multiple organs. Unknown etiology but more common in young adults & women. May experience PERMANENT lung dysfunction as well as visual, neurologic and multi-joint involvement Three features: Alveolitis, Round/Oval granulomas & pulmonary fibrosis S/S: Cough, fever, fatigue Tx: Corticosteroids

Sarcoidosis

Three key features of sarcoidosis

1. Alveolitis 2. Round/Oval Granulomas 3. Pulmonary Fibrosis

Cardiovascular Causes of RLD (2)

Pulmonary Edema - Cardiogenic (L heart failure) vs Non-cardiogenic (ARDS) Pulmonary Emobli

Common complaints of Cardiovascular-related RLD

"Suffocation" sensations, SOB, cyanotic, PINK/FROTHY sputum Acute dyspnea, rapid/shallow breathing, chest pain, + Wells Criterion

Neuromuscular Causes of RLD (5)

Cervical SCI, ALS, Guillain-Barre, Myasthenia Gravis, & Muscular Dystrophy

Musculoskeletal Causes of RLD (4)

Diaphragmatic paralysis, Kyphoscoliosis (>70 deg; most serious >120 deg), Ankylosis Spondylitis, & Pectus Excavatum

Connective Tissue Causes of RLD (3)

Rheumatoid Arthritis, SLE, & Scleroderma (+Raynauds)

Other Causes of RLD (5)

Pregnancy (3rd Tri), Obesity (BMI >30), Trauma, Pharmaceuticals (100+), & Radiation (2-6 months post-treatment)