Restrictive Lung Disease Flashcards
Restrictive Lung Disease
Reduced lung Volumes
Decreased TLC
Affects lung parenchyma, pleura, chest wall or neuromuscular apparatus
Intrinsic Pathology
Lung parenchyma
Inflammation + lung scarring
Intrinsic Outcome
Decreased alveolar:arterial gas transfer
Exudate + debris (pneuomonitis)
Intrinsic Disease example
Interstitial lung diseases
Extrinsic Pathology
Abnormal function of chest wall, pleura + neuromuscular apparatus
Extrinsic Outcome
Impaired ventilator function
Respiratory failure
Extrinsic Disease example
Myasthenia Gravis
Obesity
Interstitial lung disease
> 300 diseases
65% Idiopathic Interstitial Pneumonias + Granulomatous DPLD
35% DPLD of known cause
Major Interstitial lung disease
Idiopathic Pulmonary Fibrosis
Sarcoidosis
Idiopathic Pulmonary Fibrosis survival rate
20% at 5 years
Interstitial lung disease aetiology
1 in 3 unknown
Most ILDs rare
IPF Incidence + mortality
Amongst most lethal ILD
About 5000 people diagnosed
1 in 3 die in 12 months
IPF Aetiology
Airway remodelling –> impaired oxygenation
Progressive + incurable
Risk Factors e.g. smoking cause scarring/honeycombing in lungs –> restricts breathing + oxygen exchange
IPF Pathophysiology
Environmental factors Decreased epithelial cell integrity Accelerated ageing-associated changes Exaggerated fibroblast expansion TGFbeta and FGF
IPF Alveolar damage
Dilated bronchi- traction bronchiectasis
Parenchymal Fibrosis
Alveolar remodelling
Scarred interstitium
IPF symptoms
Clubbing
Exertional dyspnoea
Dry cough
IPF Diagnosis
Fine, high pitched bibasilar inspiratory crackles (Velcro like sound)
Medical history
Physical exam
Lung function
Chest HRCT- changes associated with traction bronchiectasis + honeycombing
IPF Management
Improve symptoms + survival
Preserve Lung Functions
Decreased AEs
IPF Medication
Pirfenidone
Antacid therapy
IPF Medication DO NOT USE
Combo treatment: Prednisone, Azathioprine + N-acetylcysteine
Pirfenidone
Anti-fibrotic agent
Decreases physiological deterioration
Increases progression free survival
SE- GI, photosensitivity, anorexia, skin rash, liver toxicity
Nintedanib
Tyrosine kinase inhibitor
Decreases FVC decline
SE- diarrhoea, weight loss, liver toxicity
Antacid therapy
IPF with Gastro-oesophageal reflux
SE- infection, cognitive function + MI
Pulmonary rehab
Increases physical + psychological
Increases Walking distance
Increases quality of life
Non-pharmacological IPF
Pulmonary rehab
Long term O2
Lung transplant
Long-term O2
Patients with hypoxemia at rest
Lung transplant
Moderate-severe disease
Sarcoidosis
Multi-system granulomas
Immune system overdrive
Most cases acute + self-limiting
INFLAMMATORY
Sarcoidosis age
70% between 20-40
Sarcoidosis organs
Any organ Eyes 25% Lungs + lymph nodes 90% Resp 35-50% Skin 25%
Sarcoidosis pathophys
Formation of sarcoid granuloma
Sarcoidosis diagnosis
Bilateral hair adenopathy on chest radiograph
Lofgren syndrome
Sarcoidosis management
Corticosteroids