Restrictive lung disease

Restrictive lung disease
ICD-9	518.89
eMedicine	med/2012

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Overview

Restrictive lung diseases are a category of respiratory disease characterised by a loss of lung compliance, causing incomplete lung expansion and increased lung stiffness.

Complete Differential Diagnosis for Restrictive Lung Disease

• Abestosis
• Ankylosing spondylitis
• Bagassosis
• Berylliosis
• Bird Fanciers Lung
• Dermatomyositis
• Drug treatments
• Farmers Lung
• Fibrothorax
• Hard Metal Fibrosis
• Idiopathic kyphosis
• Interstitial Pneumonia
• Interstitial pneumonitis
• Lymphangioleiomyomatosis
• Massive Pleural Effusion
• Mushroom Worker Lung
• Myopathy
• Myositis
• Obesity
• Phrenic neuropathy
• Pneumoconiosis
• Polymyositis
• Pulmonary Vasculitis
• Rheumatoid Arthritis
• Sarcoidosis
• Scleroderma
• Silicosis
• Systemic Lupus Erythematosus
• Talc

Pathophysiology

The underlying process is usually pulmonary fibrosis (scarring of the lung). As the disease progresses, the normal lung tissue is gradually replaced by scar tissue interspersed with pockets of air. This can lead to parts of the lung having a honeycomb-like appearance.

Causes and classification

Restrictive lung diseases may be due to specific causes which can be intrinsic to the parenchyma of the lung, or extrinsic to it.

Intrinsic

• Asbestosis caused by long-term exposure to asbestos dust.
• Radiation fibrosis, usually from the radiation given for cancer treatment.
• Certain drugs such as amiodarone, bleomycin and methotrexate.
• As a consequence of another disease such as rheumatoid arthritis.
• Hypersensitivity pneumonitis due to an allergic reaction to inhaled particles.
• Acute respiratory distress syndrome (ARDS), a severe lung condition occurring in response to a critical illness or injury.
• Infant respiratory distress syndrome due to a deficiency of surfactant in the lungs of a baby born prematurely.

Many cases of restrictive lung disease are idiopathic (have no known cause). Examples are:

• Idiopathic pulmonary fibrosis
• Idiopathic interstitial pneumonia, of which there are several types
• Sarcoidosis
• Eosinophilic pneumonia
• Lymphangioleiomyomatosis
• Pulmonary Langerhans cell histiocytosis
• Pulmonary alveolar proteinosis

Conditions specifically affecting the interstitium are called interstitial lung diseases.

Extrinsic

Quadriplegia can be a cause of restrictive lung disease.

Clinical Presentation

The main symptoms are:

• Shortness of breath
• Cough

Diagnosis

In restrictive lung disease, both the FEV1 and FVC are reduced so the FEV1/FVC ratio is normal or even increased in contrast to obstructive lung disease where this ratio is reduced. The values for residual volume and total lung capacity are generally decreased in restrictive lung disease.

One definition requires a total lung capacity which is 80% of the expected value.

See Also

• Chronic obstructive lung disease

Additional Resources

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• Baydur A. Respiratory muscle strength and control of ventilation in patients with neuromuscular disease. Chest. Feb 1991;99(2):330-8.
• Bjoraker JA, Ryu JH, Edwin MK, et al. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. Jan 1998;157(1):199-203.
• Douglas WW, Ryu JH, Swensen SJ, et al. Colchicine versus prednisone in the treatment of idiopathic pulmonary fibrosis. A randomized prospective study. Members of the Lung Study Group. Am J Respir Crit Care Med. Jul 1998; 158(1): 220-5.
• Fishbein MC. Diagnosis: to biopsy or not to biopsy: assessing the role of surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis. Chest. Nov 2005;128 (5 Suppl 1): 520S-525S.
• Flaherty KR, Martinez FJ, Travis W, Lynch JP 3rd. Nonspecific interstitial pneumonia (NSIP). Semin Respir Crit Care Med. Aug 2001;22(4): 423-34.
• Flaherty KR, Toews GB, Travis WD, et al. Clinical significance of histological classification of idiopathic interstitial pneumonia. Eur Respir J. Feb 2002; 19(2): 275-83.
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• Goldstein RH, Fine A. Potential therapeutic initiatives for fibrogenic lung diseases. Chest. Sep 1995;108(3):848-55.
• Hunninghake GW, Kalica AR. Approaches to the treatment of pulmonary fibrosis. Am J Respir Crit Care Med. Mar 1995; 151 (3 Pt 1): 915-8.
• Katzenstein AL, Myers JL. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification. Am J Respir Crit Care Med. Apr 1998;157(4 Pt 1): 1301-15.
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• Parambil JG, Myers JL, Ryu JH. Histopathologic features and outcome of patients with acute exacerbation of idiopathic pulmonary fibrosis undergoing surgical lung biopsy. Chest. Nov 2005;128(5): 3310-5.
• Peckham RM, Shorr AF, Helman DL. Potential limitations of clinical criteria for the diagnosis of idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis. Respiration. Mar-Apr 2004;71(2): 165-9.
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• Wells A. Clinical usefulness of high resolution computed tomography in cryptogenic fibrosing alveolitis. Thorax. Dec 1998;53(12):1080-7.
• Winterbauer RH, Hammar SP, Hallman KO, et al. Diffuse interstitial pneumonitis. Clinicopathologic correlations in 20 patients treated with prednisone/azathioprine. Am J Med. Oct 1978;65(4):661-72.
• du Bois RM. Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis. Clin Chest Med. Mar 2006;27(1 Suppl 1):S17-25, v-vi.