3.2 Restrictive Lung Dysfunction

What is the main issue with restrictive lung dysfunctions

can’t get air in

Pathophysiology of restrictive

decreased compliance of lungs and chest wall → decreased lung volumes and capacities → increased work of breathing

define compliance

pressure exerted by the chest wall or lungs and the volume of air that can be contained within the lungs

What happens with TLC and FRC when there is decreased compliance

both decrease

What are the expected lung volumes of restrictive

all volumes and capacities decrease, however TV stays relatively the same

What are the most common capacities used to identify RLD when using a spirometer

TLC and VC

Why does TV stay the same when all the rest are smaller

the bodies way to stay alive

What happens to the workload of breathing with RLD

need to work harder to create a greater transpulmonary pressure required for normal TV

How is normal TV achieved in RLD

decreased VC and increased RR

What is the down side of recruiting more muscles for inspiration

accessory muscles increase O2 demand

What percentage of O2 do we use per breath normally

5%

What percentage of O2 do we use per breath with RLD

20-25%

Classic signs of RLD

tachypnea

hypoxemia

decreased breath sounds

decreased lung volumes/capacities

decreased diffusion capacity

Cor pulmonale

classic symptoms of RLD

dyspnea

dry/unproductive cough

weight loss

SOB with exercise/movement

What are some other potential signs of RLD

muscle wasting

altered CXR

pulmonary hypertension

crackles at end of inspiration

What are the treatment options dependent on

etiologic factors

what are the etiologic factors of treatment options

permanent?

acute/reversible?

chronic, but potentially reversible?

What are the treatment options for permanent RLD

providing support to breathing

What are the treatment options for acute/reversible RLD

O2

What are the treatment options for chronic but potentially reversible RLD

antibiotics/anti-inflammatory

Maturational causes of RLD

congenital issues

normal aging!

How can congenital issues cause RLD

issues in lung development → respiratory distress syndrome

What will likely develop if a vent is required to treat RSD

bronchopulmonary dysplasia

What are the restrictive only causes of RLD

idiopathic pulmonary fibrosis

sarcoidosis

describe idiopathic pulmonary fibrosis

scaring occurs between the sacs

describe sarcoidosis

granulomas form within the lung tissue

What is a combined restrictive/obstructive cause of RLD

bronchiolitis obliterans

describe bronchiolitis obliterans

inflammatory response in epithelial lining causing swelling/closing of bronchioles → prevent inflation

What can cause bronchiolitis obliterans

RSV

toxic fume inhalation

infectious agents

What are the environmental/occupational causes of RLD

coal workers’ pneumoconiosis (coal dust)

silicosis (silica)

asbestosis (asbestos)

what are the treatment options for environmental/occupational RLD

supportive (try to keep/maintain the function they have for as long as possible)

What is an infectious cause of RLD

PNA

types of PNA

healthcare acquired (HCAP)

community acquired (CAP)

ventilator associated (VAP)

Is pneumonia viral or bacterial

either

describe PNA

alveoli fill with fluid/puss → they can no longer exchange gas → unable to inflate alveoli

What is a neoplastic cause of RLD

bronchogenic carcinoma

What are the main types of cancer

small cell or large cell

Is small cell or large cell carcinoma faster

small cell

What another name for small cell carcinoma

oat cell

What another name for large cell carcinoma

undifferentiated

what are other possible types of cancer

squamous cell and adenocarcinoma

How many different causes are there of pleural effusion

60

describe transudate pleural effusion

low protein content, changes pressure in pleural capillaries

Describe exudate pleural effusion

high protein content, changes in permeability of pleural surfaces

What is the treatment for pleural effusion

thoracocentesis

thoracoscopy

chest tube

What is the normal amount of fluid in pleural space

10-25 mL

What does a thoracoscopy do

a wash is done in the pleural space to potentially dilute exudate for drainage

describe atelectasis

incomplete expansion of the lungs or loss of volume (collapsed lung)

What is often seen on a CXR for atelectasis

elevation of diaphragm on affected side

shift of mediastinum toward affected side

treatments for atelectasis

incentive spirometry

deep breathing

bronchoscopy

Clinical presentation of COVID

dyspnea

impaired oxygenation

hypoxemia

pathology of COVID 

causes build up of fluid in alveoli → interstitial edema → pulmonary edema → potentially alveolar collapse

immune response associated with COVID

leads to “cytokine storm” which can cause scarring of lung tissue and leads to significant bronchoconstriction and VQ mismatch

Severe cases of COVID can lead to

ARDs

Cardiac effects of COVID

inflammatory response can cause damage to myocardial tissue

neurological effects of COVID

inflammatory response increases risk for clotting and stroke

describe adult respiratory distress syndrome (ARDS)

severe hypoxemia and increased permeability of the alveolar-capillary membrane

What is ARDS typically associated with

lung injury

What is the prognosis of ARDS

can resolve completely in a few months with the help of a ventilator

other times significant permanent lung damage occurs→ death

What is the mortality rate of ARDS

50-70%

treatment for ARDS

support adequate gas exchange ans tissue oxygenation

prone posture

nutrition/fluid education

Why are pts typically put on a paralytic when prone on the ventilator

typically is pretty traumatic

CV causes of RLD

pulmonary edema

PE

What CV cause of pulmonary edema

L ventricular failure

What is the interstitial space

space between alveolar and capillary membranes

What is the best treatment for PE

prevention

What can cause a PE

DVT travels into pulmonary artery branches

Neuromuscular causes of RLD

SCI

ALS

polio

Guillain-barre

myasthenia gravis

tetanus

duchene muscular dystrophy

What is ALS

progressive degenerative disease of the nervous system that involves upper and lower motor neurons

What is polio

viral disease that attacks motor nerve cells in spinal cord and brainstem

What is Guillain-Barre

demyelinating disease of the motor neurons of the peripheral nerves

What is myasthenia Gravis

chronic neuromuscular disease with progressive muscular weakness on exertion

what is tetanus

disease of the neuromuscular system caused by neurotoxic bacteria

What is duchenne

genetic progressive degenerative myopathy

MSK causes of RLD

Ankylosing spondylitis

kyphoscoliosis

pectus carinatum/excavatum

diaphragm paralysis

What is ankylosing spondylitis

chronic inflammatory disease of the spine resulting in immobility of the SI and vertebral joints

How does ankylosing spondylitis affect lung compliance

decrease due to limited thoracic extension and cand cause lesions

What’s another name for ankylosing spondylitis

bamboo spine deformity

Who is most often seen with bamboo deformity

men 20-40 y/o

What are connective tissue causes of RLD

RA

lupus (SLE)

scleroderma

polymyostis

dermatomyositis

What is polymyositis

proximal muscle weakness and pain

What are immunologic causes of RLD

Wegener’s granulomatosis and goodpasture syndrome

What is Wegener’s granulomatosis

type of vasculitis where the vessel wall thickens causing increased resistance

what is the prognosis of Wegener’s granulomatosis

die within 5 months if receive no treatment 

What are the treatment options for Wegener’s granulomatosis

some medications

What is goodpasture syndrome

autoimmune disease that affects the lungs and kidneys

What is the prognosis for goodpasture syndrome

50% die within a year unless can get a transplant

symptoms of goodpasture syndrome

interalveolar hemorrhage

hematuria

Why is pregnancy considered a RLD

everything moves up and space is limited

nutritional/metabolic causes of RLD

obesity, DM

How does obesity cause RLD

extra soft tissue requires more O2, but also creates more CO2

What is DM

abnormal carbohydrate metabolism and is characterized by inadequate insulin secretion and hyperglycemia

How does DM cause RLD

lung involvement low, but can be significant

traumatic causes of RLD

blunt trauma

penetrating wounds

thermal

What does thermal trauma include

burns

What do penetrating wounds include

pneumothorax

hemothorax

What does blunt trauma include

rib fx

flail chest

contusions

therapeutic causes of RLD

inscisions

What may we give a pt to provide help with breathing when restricted by an incision

a pillow to splint

pharmaceutical causes of RLD

chemo → interstitial lung disease