Restrictive Lung Disease

Question 1

What is Restrictive Lung Disease (RLD)?

Answer 1

RLD is an abnormal reduction in ventilation due to restriction of chest wall or lung expansion, leading to difficulty getting air in and reduced lung volumes.

Question 2

What are the three major aspects of pulmonary ventilation in RLD?

Answer 2

• decreased compliance of lungs and chest wall
• decreased lung volumes/capacities
• increased work of breathing.

Question 3

How does decreased lung compliance affect patients with RLD?

Answer 3

Lungs become stiffer, harder to expand, and require increased transpulmonary pressure to maintain lung expansion, leading to increased work of breathing.

Question 4

How do lung volumes change in RLD?

Answer 4

All lung volumes decrease, particularly Total Lung Capacity (TLC) and Vital Capacity (VC), leading to increased respiratory rate (RR) to maintain minute ventilation.

Question 5

What is the increased work of breathing in RLD caused by?

Answer 5

• Increased RR and the use of accessory inspiratory muscles, leading to greater energy expenditure (up to 25% of O2 consumption) and respiratory muscle fatigue.

Question 6

What are the 6 classic signs of RLD?

Answer 6

• tachypnea
• hypoxemia
• decreased breath sounds
• dry inspiratory crackles
• decreased lung volumes
• cor pulmonale

Question 7

What are common symptoms of RLD?

Answer 7

• Dyspnea on exertion (progressing to rest)
• dry non-productive cough
• wasted, emaciated appearance due to high caloric demands from breathing

Question 8

How is RLD managed medically?

Answer 8

Supportive interventions like supplemental oxygen, antibiotics for infections, nutritional support, and sometimes mechanical ventilation or chest tubes.

Question 9

How does normal aging contribute to RLD?

Answer 9

Aging leads to decreased lung compliance, reduced ventilatory responses, postural changes (e.g., kyphosis), and decreased lung volumes (VC decreases by 25% between ages 30-70).

Question 10

What are some infectious causes of RLD?

Answer 10

• Pneumonia
• ARDS
• COVID-19
• interstitial lung diseases like pulmonary fibrosis, and sarcoidosis

Question 11

What is ARDS, and how does it affect the lungs?

Answer 11

• ARDS is an acute inflammatory condition causing alveoli to fill with fluid, leading to edema, diffusion abnormalities, and VQ mismatch.
• It can progress to mechanical ventilation and muscle wasting.

Question 12

How does pneumonia cause RLD?

Answer 12

Pneumonia is an inflammatory process that affects the lung parenchyma, reducing lung compliance and leading to restricted airflow, particularly in bacterial pneumonia.

Question 13

What is atelectasis and how is it treated?

Answer 13

Atelectasis is incomplete lung expansion due to hypoventilation or alveolar collapse. Treatment includes deep breathing exercises, incentive spirometry, and airway clearance techniques.

Question 14

What are neuromuscular causes of RLD?

Answer 14

Conditions like SCI, ALS, Guillain-Barre, Polio, Tetanus, Muscular Dystrophy and Myasthenia Gravis cause weakened inspiratory muscles, leading to alveolar hypoventilation and increased risk of pulmonary infections.

Question 15

How do connective tissue disorders lead to RLD?

Answer 15

Conditions like:

• scleroderma
• rheumatoid arthritis
• dermatomyositis
• polymyositis
• lupus

cause fibrosis and stiffening of lung tissue, reducing compliance and limiting lung expansion.

Question 16

What musculoskeletal causes lead to RLD?

Answer 16

Conditions like diaphramatic paralysis, kyphoscoliosis, ankylosing spondylitis, pectus carinatum, and pectus excavatum physically restrict the chest wall, limiting lung expansion.

Question 17

What is the impact of pregnancy, obesity, and diabetes on RLD?

Answer 17

Pregnancy and obesity increase pressure on the diaphragm, while diabetes can lead to decreased endurance and higher risk of infections, all contributing to RLD.

Question 18

How do traumatic causes contribute to RLD?

Answer 18

Conditions like rib fractures, crush injuries, and pulmonary lacerations can cause pain, thermal injuries, hypoventilation, and alveolar collapse, contributing to RLD.

Question 19

COVID-19 symptoms = ?

Answer 19

- Severe Acute Respiratory Syndrome (SARS) Coronavirus-19

- Cause of ARDS

- Symptoms:

• Dry cough, shortness of breath, fever, fatigue
• Worsened in older patients, comorbidities, immunocompromised

Question 20

Interstitial lung disease symptoms = ?

Answer 20

• Dyspnea, DOE
• Dry cough
• Fatigue
• Poor exercise tolerance
• Crackles (rales) on breath sounds
• Cyanosis/clubbing due to hypoxia

Question 21

Idiopathic Pulmonary Fibrosis (IPF) = ?

Answer 21

Idiopathic Pulmonary Fibrosis (IPF): Chronic, progressive, irreversible, and high mortality rate

• Survival Rate: 2-3 years post diagnosis
• Progressive worsening of dyspnea and lung function

Question 22

Sarcoidosis

What is it = ?
Distintive features = ?

Answer 22

Sarcoidosis: Inflammatory disorder that affects many organs. Lung is most common, and causes fibrosis of lungs.

Distinct features:

• Alveolitis
• Formation of well-defined round/oval granulomas
• Pulmonary Fibrosis

Question 23

Pulmonary Edema= ?

Answer 23

Pulmonary Edema: Fluid collects in the alveoli, making it difficult to breath.

Question 24

Pulmonary Embolism (PE) = ?

Answer 24

Pulmonary Embolism (PE): Blood clots, or thrombi, travel from system circulation through the heart and into pulmonary circulation.

Question 25

Pleural Effusion = ?

Answer 25

Pleural Effusion: Abnormal amount of fluid in pleural space.