*Restrictive Airway Disease Flashcards Preview

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Flashcards in *Restrictive Airway Disease Deck (35):
1

What is restrictive lung disease?

Patient find it difficult to fully inflate their lungs due to the lungs being restricted from fully expanding

2

What are some examples of thoracic restriction due to causes out with the lungs (extrinsic causes)?

Skeletal: (thoracic kyphoscoliosis, ankylosing spondylitis, rib trauma)
Muscle weakness: (intercostal or diaphragmatic due to myopathy, neuropathy, ir myelopathy) e.g. Guillan barre, Motor neurone disease)
Abdominal obesity/ ascites

3

In terms of alveolar ventilation, PaO2, PaCO2, and lung volumes, what effect does thoracic restriction due to causes out with the lungs have (extrinsic causes)?

-chronic alveolar under ventilation
-Low PaO2
-raised PaCO2
-reduced lung volumes

4

What does DPLD stand for?
Other name for this?

Diffuse Parenchymal Lung Diseases
Interstitial lung diseases

5

What are interstitial lung diseases?

A group of conditions that primarily affect the lung parenchyma in a diffuse manner
They are characterised by chronic inflammation +/- progressive interstitial fibrosis
They have a restrictive pulmonary spirometry with reduced carbon monoxide diffusing capacity (DLCO)

6

Clinical features of Diffuse parenchymal lung diseases? (5)

Dyspnoea on exertion
Non-productive paroxysmal cough (with no wheeze)
Finger clubbing
Abnormal breath sounds (inspiraotry lung crackles)
Abnormal chest x-ray or high resolution CT
Restrictive pulmonary spirometry with decreased DLCO

7

What 3 general groups can interstitial lung diseases be grouped into?

Those with a known cause e.g. drugs, occupation, infection, etc.
Those associated with systemic disorders e.g. sarcoidosis, rheumatoid arthritis, etc.
Idiopathic e.g. lymphocytic interstitial pneumonia, idiopathic pulmonary fibrosis

8

Spectrum of DPLD - BTS classification?

1) acute DPLD (e.g. infections, allergy, toxins, etc.)
2) episodic DPLD, all of which may present acutely (e.g. extrinsic allergic alveolitis, eosinophilic pneumonia)
3) Chronic DPLD due to occupational or environmental agents or drugs (e.g. aspestosis, silicosis, etc.)
4) Chronic DPLD with evidence of systemic disease (e.g. rheumatoid arthritis)
5) Chronic DPLD with no evidence of systemic disease e.g. idiopathic pulmonary fibrosis

9

What are the 2 very broad classifications of restrictive lung disease?

Intrinsic (interstitial lung disease)
Extrinsic (due to causes outwith the lungs)

10

Alveolar gas exchange in restrictive thoracic disease due to disease within he lungs? (PaO2 and PaCO2)

PaO2 = decreased
PaCO2 = normal as CO2 exchange unimpaired as alveolar perfusion normal

11

Aetiology of DPLD? (6)

Fluid in the alveolar air spaces
Consolidation of alveolar air spaces
Inflammatory infiltrate of alveolar walls
Dust disease
Carcinomatosis
Eosinophilic

12

What causes fluid in the alveolar spaces?

Cardiac pulmonary oedema (due to raised venous pressure i.e. LVF)
Non-cardiac pulmonary oedema due to leaky capillaries (caused by sepsis or trauma - ARDS aka shock lung) - also due to altitude sickness

13

What causes consolidation of alveolar air spaces?

Infective pneumonia
Infarction e.g. PE/ vasculitis
Other causes i.e. BOOP, rheumatoid disease, drugs

14

What is BOOP?
Other name?

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a rare lung condition in which the small airways (bronchioles) and air exchange sac (alveoli) become inflamed with connective tissue
Cryptogenic organising pneumonia

15

What causes an inflammatory infiltrate of alveolar walls? (5)

Granulomatous alveolitis (extrinsic allergic alveolitis, sarcoidosis)
Drug induced alveolitis
Toxic gas/ fumes
Fibrosing alveolitis (rheumatoid arthritis, idiopathic pulmonary fibrosis)
Autoimmune (Wegeners, Churg-Strauss, etc.)

16

Other name for dust diseases of the lungs?
Types of dust diseases?

Pneumoconiosis
Fibrogenic (asbestosis, silicosis)
Non fibrogenic (Siderosis (iron), stances (tin), baritosis (barium))

17

What type of reaction is extrinsic allergic alveolitis?

Hypersensitivity pneumonitis - type 3 reaction

18

What is carcinomatosis?

The widespread dissemination of carcinoma in the body

19

What are 4 examples of eosinophilic lung diseases?

Drugs e.g. nitrofurantin (antibiotic used to treat bladder infections)
Fungal e.g. aspergillosis
Parisites e.g. toxocara, ascaris, fiaria
Autoimmune e.g. Churg strauss

20

What occurs as the end stage response to chronic inflammation of the lung parenchyma?

Pulmonary firbosis

21

How is DPLD diagnosed?

History e.g. occupation, drugs, pets, arthritis
Reduced lung volumes e.g. decreased FEV1 and FVC with normal ration (>75%)
Reduced gas diffusion (DLCO)
Arterial oxygen desaturation (decreased PaO2 and SaO2)

22

What can be measured in the blood that would indicate some interstitial lung diseases?

antibodies e.g. avian, fungal, auto-antibodies

23

What serum levels are raised in sarcoidosis?

Serum ACE and Ca

24

What could be seen on a chest x-ray of a patient with interstitial lung disease?

Alveolar infiltrates on chest x-ray

25

Why should an ECG be performed on patients with suspected DPLD?

To exclude LVF

26

What might be seen on a high resolution CT scan of a patient with DPLD?

Inflammatory ground glass appearance vs fibrotic nodular component of alveolar infiltrates

27

Why should bronchoalveolar lavage or induced sputum be carried out on a patient with suspected DPLD?

To exclude pneumocystis, TB or another infection

28

Are a transbronchial or thoracoscopic lung biopsy indicated in patients with DPLD?

Rarely

29

Treatment of DPLD? (8)

-Remove any trigger factor (e.g. dust, drug, allergen)
-Treat any inflammation i.e. ground glass on HRCT with immunosuppressives (NB - danger of secondary super-infection due to immune suppression)
-Give systemic corticosteroids ie. oral prednisolone (inhaled corticosteroids are not effective)
-2nd line to corticosteroids = oral azathioprine (steroid sparing)
-Anti-fibrotic agents for IPF e.g. pirfenidone, nintendanib
-anti-oxidant agent can be given for IPF - acetylceysteine
-O2 if hyoxaemic
-lung tranplant is a last resort for end stage disease

30

What is the steroid sparing agent that is used second line to systemic corticosteroids?

Oral Azathioprine

31

What 2 anti-fibrotic agents are available for the treatment of IPF?

Pirfenidone
Nintendanib

32

What anti-oxidant agent can be given for IPF?

Acetylcysteine

33

What lung disease is erythema nodosum a sign of?

Sarcoidosis

34

What causes bilateral hillier lymphadenopathy and lung infiltrates?

Sarcoidosis

35

What causes a non-caveating granuloma?

Sarcoidosis