Chapter 30 - Restrictive and Interstitial Respiratory Disorders

Restrictive Respiratory Disorders

• Impairs the ability of the chest wall and diaphragm to move with respiration.

• Diagnosis by PFT:

  • Hallmark characteristic:

    • DECREASED total lung capacity (TLC)

Two Types of Restrictive Respiratory Disorders

• Extrapulmonary

• Intrapulmonary

Extrapulmonary Restrictive Respiratory Disorders

• Lung tissue is normal, but certain conditions alter respirations.

• Examples:

  • CNS

  • NM

  • Chest wall

Intrapulmonary Restrictive Respiratory Disorders

• Damage to the lung due to:

  • Inflammation: interstitial

  • Damage to air spaces: pneumonitis

  • Damage to pleura: empyema

Pleural Effusion

• Abnormal accumulation of fluid in the pleural space

• Type is classified according to protein content.

Transudate Pleural Effusion

• Clear fluid

• Too little protein in the blood

• Vessels cannot hold fluid, and it leaks into the pleural space.

Exudate Pleural Effusion

• Cloudy fluid

• Contains cells and protein due to inflammation of the pleura.

Pleural Effusion: Clinical Manifestations

• Dyspnea

• Pleuritic chest pain

• Cough

• With empyema:

  • Fever

  • Hemoptysis

  • Weight loss

Pleural Effusion: Physical Examination Findings

• Decreased breath sounds on the affected side

• Decreased movement of the chest on the affected side

Pleural Effusion: Diagnosis

• Chest X-ray

• CT

Thoracentesis

• Aspiration of fluid for:

  • Diagnostic purposes

  • Therapeutic purposes

• Procedure visual:

  • Syringe on a catheter removes fluid from around the lung.

  • A vacuum bottle collects pleural fluid.

Chemical Pleurodesis: Administration and Effect

• Treatment of malignant pleural effusion

• An inflammation-producing agent is injected into the pleural space through:

  • Chest tube

  • VATS/robotics

• The resulting inflammatory reaction leads to pleural fibrosis:

  • Visceral and parietal pleura fuse.

  • Fusion prevents reaccumulation of fluid.

Chemical Pleurodesis: Agents

• Talc: magnesium silicate

• Tetracycline derivative: doxycycline

• Antineoplastic: bleomycin

Chemical Pleurodesis: Chest-Tube Management

• Chest tube is placed and clamped for 8 hours.

• Frequent repositioning is performed.

• Chest tube is removed when drainage is less than 150 mL/day.

Pleurisy

• Inflammation of the pleura

• Causes:

  • Infection

  • Heart disease

  • Autoimmune

  • Cancer

Pleurisy: Symptoms

• Painful breathing

• Cough

• Fever

• Chills

Pleurisy: Treatment

• Drain fluid.

• Anti-inflammatories

• Antibiotics

• Cancer treatment

Atelectasis

• Complete or partial collapse of the lung when alveoli become deflated

• Caused by obstruction of small airways with secretions

Atelectasis: Patients Most Commonly Affected

• Bedridden patients

• Postoperative abdominal surgery patients

• Postoperative thoracic surgery patients

Atelectasis: Treatment

• Deep breathing

• Coughing

Interstitial Lung Disease: Exposure-Related Etiologies

• Mold

• Bacteria

• Birds

• Medications

• XRT

• Dusts

• Cigarette smoke

Interstitial Lung Disease: CTD-Related Etiologies

• RA

• Systemic sclerosis

• PM/DM

• Sjögren’s syndrome

• MCTD

• UCTD

• SLE

• IBD

Interstitial Lung Disease: Genetic Etiology

• FPF

Interstitial Lung Disease: Idiopathic Etiologies

• IIP

• Sarcoidosis

• LAM

Pulmonary Fibrosis

• Chronic, progressive disease isolated to the lung

• Chronic inflammation and formation of scar tissue in connective tissue

• Cause: cigarette smoking

• No known cure:

  • Scarring is not reversible.

Pulmonary Fibrosis: Symptoms

• Exertional dyspnea

• Dry cough

• Clubbing of fingers

• Inspiratory crackles

Pulmonary Fibrosis: Diagnosis

• Lung biopsy

Pulmonary Fibrosis: Treatment

• Corticosteroid:

  • Prednisone

• Immunosuppressive:

  • Methotrexate

  • Cyclosporine

Sarcoidosis

• Chronic multisystem granulomatous disease

  • Primarily affects the lung.

• Granulomas consist of inflamed tissues.

• Cause is unknown.

• Can appear and disappear.

Sarcoidosis: Systems and Organs Involved

• Skin

• Lungs

• Eyes

• Liver

• Kidney

• Heart

• Lymph nodes

Sarcoidosis: Symptoms and Population Primarily Affected

• Symptoms:

  • Dyspnea

  • Cough

  • Chest pain

• Primarily affects African Americans.

Sarcoidosis: Treatment

• Suppress the inflammatory response