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Restrictive lung disease must be differentiated from other diseases that cause [[dyspnea]], [[cough]], [[hemoptysis]], and [[fever]] such as [[Acute respiratory distress syndrome|ARDS]], [[hypersensitivity pneumonitis]], [[pneumoconiosis]], [[sarcoidosis]], [[pleural effusion]], [[Interstitial lung disease|interstitial lung disease (ILD)]], [[lymphocytic interstitial pneumonia]], [[obesity]], [[pulmonary eosinophilia]] and [[Neuromuscular disorder|neuromuscular disorders]].
Restrictive lung disease must be differentiated from other diseases that cause [[dyspnea]], [[cough]], [[hemoptysis]], and [[fever]] such as [[Acute respiratory distress syndrome|ARDS]], [[hypersensitivity pneumonitis]], [[pneumoconiosis]], [[sarcoidosis]], [[pleural effusion]], [[Interstitial lung disease|interstitial lung disease (ILD)]], [[lymphocytic interstitial pneumonia]], [[obesity]], [[pulmonary eosinophilia]] and [[Neuromuscular disorder|neuromuscular disorders]].


== '''Spirometry Findings in Various Lung Conditions''' ==
== Spirometry Findings in Various Lung Conditions ==
[[Spirometry]] can help distinguish restrictive lung disease from [[Obstructive lung disease|obstructive lung diseases]]. On [[spirometry]] the findings include:<ref name="pmid16264058">{{cite journal |vauthors=Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J |title=Interpretative strategies for lung function tests |journal=Eur. Respir. J. |volume=26 |issue=5 |pages=948–68 |date=November 2005 |pmid=16264058 |doi=10.1183/09031936.05.00035205 |url=}}</ref><ref name="pmid25506373">{{cite journal |vauthors=Mehrparvar AH, Sakhvidi MJ, Mostaghaci M, Davari MH, Hashemi SH, Zare Z |title=Spirometry values for detecting a restrictive pattern in occupational health settings |journal=Tanaffos |volume=13 |issue=2 |pages=27–34 |date=2014 |pmid=25506373 |pmc=4260070 |doi= |url=}}</ref>
[[Spirometry]] can help distinguish restrictive lung disease from [[Obstructive lung disease|obstructive lung diseases]]. On [[spirometry]] the findings include:<ref name="pmid16264058">{{cite journal |vauthors=Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J |title=Interpretative strategies for lung function tests |journal=Eur. Respir. J. |volume=26 |issue=5 |pages=948–68 |date=November 2005 |pmid=16264058 |doi=10.1183/09031936.05.00035205 |url=}}</ref><ref name="pmid25506373">{{cite journal |vauthors=Mehrparvar AH, Sakhvidi MJ, Mostaghaci M, Davari MH, Hashemi SH, Zare Z |title=Spirometry values for detecting a restrictive pattern in occupational health settings |journal=Tanaffos |volume=13 |issue=2 |pages=27–34 |date=2014 |pmid=25506373 |pmc=4260070 |doi= |url=}}</ref>


Revision as of 20:40, 7 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:ADJ, Cafer Zorkun, M.D., Ph.D. [2]

Overview

Restrictive lung disease must be differentiated from other diseases that cause dyspnea, cough, hemoptysis, and fever such as ARDS, hypersensitivity pneumonitis, pneumoconiosis, sarcoidosis, pleural effusion, interstitial lung disease (ILD), lymphocytic interstitial pneumonia, obesity, pulmonary eosinophilia and neuromuscular disorders.

Differentiating Restrictive Lung Disease from other Diseases

Restrictive lung disease must be differentiated from other diseases that cause dyspnea, cough, hemoptysis, and fever such as ARDS, hypersensitivity pneumonitis, pneumoconiosis, sarcoidosis, pleural effusion, interstitial lung disease (ILD), lymphocytic interstitial pneumonia, obesity, pulmonary eosinophilia and neuromuscular disorders.

Spirometry Findings in Various Lung Conditions

Spirometry can help distinguish restrictive lung disease from obstructive lung diseases. On spirometry the findings include:[1][2]

Pulmonary Function Test Obstructive Lung Disease Restrictive Lung Disease
Spirometry showing Obstructive and Restrictive Lung Disease ([Source:By CNX OpenStax [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons])
TLC ↑ ↓
RV ↑ ↓
FVC ↓ ↓
FEV1 ↓↓ ↓
FEV1/FVC ↓ N to ↑
MVV ↓ ↓

Approach to Lung Disorders

 
 
 
 
 
 
 
 
 
 
 
 
 
Spirometry
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low FEV1/FVC ratio
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal to high FEV1/FVC ratio
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obstructive Lung Disease
 
 
 
 
 
 
 
 
 
 
 
 
 
Restrictive Lung Disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bronchodilator therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
DLCO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased FEV1
 
 
 
 
 
 
 
No change in FEV1
 
 
 
Normal DLCO
 
 
 
 
 
 
 
Decreased DLCO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asthma
 
 
 
 
 
 
 
COPD
 
 
 
Chest wall disorders
 
 
 
 
 
 
 
Interstitial Lung Disease
 
 

Table below shows the differential diagnosis for dyspnea, cough, hemoptysis, and fever.

Disease Clinical manifestations Diagnosis
History Symptoms Physical exam Lab findings Pulmonary tests Imaging Gold standard of diagnosis
History/Exposure Dyspnea Cough Hemoptysis Fever Cyanosis Clubbing JVD Peripheral edema Auscultation Other prominent findings DLCO CXR CT Method
Acute Respiratory Distress Syndrome (ARDS)[3] + +/- - - +/- - +/- - ↓
  • Bilateral pulmonary infiltrates
    • Initially patchy peripheral
    • Later diffuse bilateral
  • Ground glass
  • Frank alveolar infiltrate
  • Bronchial dilatation within areas of ground-glass opacification
  • PaO2 / FiO2 <300
Hypersensitivity Pneumonitis[4] + + - + - + - -
  • Constitutional symptoms
↓
  • Poorly defined micronodular or diffuse interstitial pattern
  • In chronic form
    • Fibrosis
    • Loss of lung volume
    • Coarse linear opacities
  • Ground-glass opacities or
  • Diffusely increased radiodensities
  • Diffuse micronodules
  • Focal air trapping
  • Mosaic perfusion
  • Occasionaly thin-walled cysts
  • Mild fibrotic changes 
  • Clinical diagnosis
Pneumoconiosis[6] Silicosis[7][8]
  • Occupational history
    • Sandblasting
    • Bystanders
    • Quartzite miller
    • Tunnel workers
    • Silica flour workers
    • Workers in the scouring powder industry
 + + +/- - + + + - ↓
  • Small round opacities
    • Symmetrically distributed
    • Upper-zone predominance
  • Diffuse interstitial pattern of fibrosis without the typical nodular opacities in chronic case
  • Nodular changes in lung parenchyma
  • Progressive massive fibrosis
  • Bullae, emphysema
  • Pleural, mediastinal, and hilar changes
Asbestosis[9]
  • Shipyard workers
  • Pipe fitting
  • Insulators
 + + +/- - + + + - ↓
  • Predilection to lower lobes
  • Fine and coarse linear, peripheral, reticular opacities
  • Subpleural linear opacities seen parallel to the pleura
  • Basilar lung fibrosis
  • Peribronchiolar, intralobular, and interlobular septal fibrosis;
  • Honeycombing
  • Pleural plaques.
Berylliosis[10] 
  • Electronic manufactures
 + + +/- - + + + - ---- ↓
  • Hilar adenopathy
  • Increased interstitial markings.
  • Ground glass opacification
  • Parenchymal nodules
  • Septal lines
Byssinosis [11]
  • Cotton wool workers
 + + +/- - + + + - ↓
  • Diffuse air-space consolidation
  • Pulmonary fibrosis with honeycombing
  • Peri bronchovascular distribution of nodules
  • Ground-glass attenuations
Sarcoidosis (stage 2-5)[12] + + + + - - - -
  • Usually normal
  • Occasional crackles
 ↓
  • High-resolution CT (HRCT) scanning of the chest may identify
    • Active alveolitis
    • Fibrosis
Pleural Effusion Transudate

Exudate

+ + +/- +/- +/- +/- +/- +/-
  • Peripheral edema, distended neck veins, and S3 gallop suggest congestive heart failure.
  • Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome.
  • Cutaneous changes and ascites suggest liver disease.
  • Lymphadenopathy or a palpable mass suggests malignancy.
 N Supine
  • Blunting of the costophrenic angle
  • Homogenous increase in density spread over the lower lung fields

Lateral decubitus

  • Free flowing effusion as layers
  • Thickened pleura
  • Mild effusions can aslo be detected
Interstitial lung disease[14] ++ + + - +/- +/- +/- +/-
  • Increased A-a gradient
  • Normal PCO2
 Depending on the underlying cause:
  • Elevated ESR
  • Serologic testing for ANA, RF, ANCA & ASCA may be positive
 ↓
  •  Reticular and/or nodular opacities
  • Honeycomb appearance (late finding)
  • Bilateral reticular and nodular interstitial infiltrates
 Video-assisted thoracoscopic lung biopsy
Lymphocytic Interstitial Pneumonia[15] + + + + - + - -
  • Increased A-a gradient
  • Normal PCO2
  • Polyclonal hypergammaglobulinemia
  • Increased LDH
 N
  • Bibasilar interstitial or micronodular infiltrates
  • Determines the degree of fibrosis
  • Cysts (characterstic)
 Open lung biopsy
Obesity[16][17] + + - - - - - + - N
  • X ray findings are often limited due to body habitus
  • CT findings are variable and depends upon severity of obesity
 Clinical
Pulmonary Eosinophilia[18] Infections + + + + + - + +
  • Increased A-a gradient
 ↓
  • Interstitial or diffuse nodular densities
  • Determines extent and distribution of the disease
  • Interstitial infiltrates
  • Cysts and nodules
 Biopsy of lesion (skin or lung)
Neuromuscular disease[19] Scoliosis[20]
  • Postural abnormality
 + - - - - - - -
  • In severe scoliosis, the rib cage may press against the lungs making it more difficult to breathe.
 N
  • Accurate depiction of the true magnitude of the spinal deformity can be assessed by supine anteroposterior (AP) and lateral spinal radiographs
  • N/A
  • Clinical
  • Radiographs
Muscular dystrophy
  • Proximal muscle weakness
 + - - - - - - - N
  • N/A
  • N/A
ALS[21]
  • Muscle weakness
  • Neurological deficit
 + - - - - - - -
  • Symptoms begin with limb involvement diue to muscle weakness and atrophy. 
  • Cognitive or behavioral dysfunction
  • Sensory nerves and the autonomic nervous system are generally unaffected
 N/A N Not significant/diagnostic Not significant/diagnostic
Myasthenia gravis[22] H/O of difficulty getting up from chair + - - + - - - -
  • Extraocular, bulbar, or proximal limb muscles.
  • Breathing as rapid and shallow
  • Respiratory muscle weakness can lead to acute respiratory failure may require immediate intubation.
  • Anti–acetylcholine receptor (AChR) antibody (Ab) test +
 N
  • Thymoma as an anterior mediastinal mass.
  • Thymoma as an anterior mediastinal mass.

References

  1. ↑ Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (November 2005). "Interpretative strategies for lung function tests". Eur. Respir. J. 26 (5): 948–68. doi:10.1183/09031936.05.00035205. PMID 16264058.
  2. ↑ Mehrparvar AH, Sakhvidi MJ, Mostaghaci M, Davari MH, Hashemi SH, Zare Z (2014). "Spirometry values for detecting a restrictive pattern in occupational health settings". Tanaffos. 13 (2): 27–34. PMC 4260070. PMID 25506373.
  3. ↑ Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H (June 2013). "Acute respiratory distress syndrome: new definition, current and future therapeutic options". J Thorac Dis. 5 (3): 326–34. doi:10.3978/j.issn.2072-1439.2013.04.05. PMC 3698298. PMID 23825769.
  4. ↑ Spagnolo P, Rossi G, Cavazza A, Bonifazi M, Paladini I, Bonella F, Sverzellati N, Costabel U (2015). "Hypersensitivity Pneumonitis: A Comprehensive Review". J Investig Allergol Clin Immunol. 25 (4): 237–50, quiz follow 250. PMID 26310038.
  5. ↑ Yi ES (November 2002). "Hypersensitivity pneumonitis". Crit Rev Clin Lab Sci. 39 (6): 581–629. doi:10.1080/10408360290795583. PMID 12484500.
  6. ↑ Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ (1998). "Idiopathic pulmonary fibrosis: predicting response to therapy and survival". Am. J. Respir. Crit. Care Med. 157 (4 Pt 1): 1063–72. doi:10.1164/ajrccm.157.4.9703022. PMID 9563720.
  7. ↑ du Bois RM (2006). "Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis". Clin. Chest Med. 27 (1 Suppl 1): S17–25, v–vi. doi:10.1016/j.ccm.2005.08.001. PMID 16545629.
  8. ↑ Neghab M, Mohraz MH, Hassanzadeh J (2011). "Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust". J Occup Health. 53 (6): 432–8. PMID 21996929.
  9. ↑ Billings CG, Howard P (April 2000). "Asbestos exposure, lung cancer and asbestosis". Monaldi Arch Chest Dis. 55 (2): 151–6. PMID 10949878.
  10. ↑ Sood A (December 2009). "Current treatment of chronic beryllium disease". J Occup Environ Hyg. 6 (12): 762–5. doi:10.1080/15459620903158698. PMC 2774897. PMID 19894178.
  11. ↑ McL Niven R, Pickering CA (June 1996). "Byssinosis: a review". Thorax. 51 (6): 632–7. PMC 1090498. PMID 8693449.
  12. ↑ Carmona EM, Kalra S, Ryu JH (July 2016). "Pulmonary Sarcoidosis: Diagnosis and Treatment". Mayo Clin. Proc. 91 (7): 946–54. doi:10.1016/j.mayocp.2016.03.004. PMID 27378039.
  13. ↑ Iannuzzi MC, Rybicki BA, Teirstein AS (November 2007). "Sarcoidosis". N. Engl. J. Med. 357 (21): 2153–65. doi:10.1056/NEJMra071714. PMID 18032765.
  14. ↑ Boros PW, Franczuk M, Wesolowski S (2004). "Value of spirometry in detecting volume restriction in interstitial lung disease patients. Spirometry in interstitial lung diseases". Respiration. 71 (4): 374–9. doi:10.1159/000079642. PMID 15316211.
  15. ↑ Honda O, Johkoh T, Ichikado K, Tomiyama N, Maeda M, Mihara N, Higashi M, Hamada S, Naito H, Yamamoto S, Nakamura H (1999). "Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT". AJR Am J Roentgenol. 173 (1): 71–4. doi:10.2214/ajr.173.1.10397102. PMID 10397102.
  16. ↑ Zammit C, Liddicoat H, Moonsie I, Makker H (2010). "Obesity and respiratory diseases". Int J Gen Med. 3: 335–43. doi:10.2147/IJGM.S11926. PMC 2990395. PMID 21116339.
  17. ↑ O’Neill, Donal (2015). "Measuring obesity in the absence of a gold standard". Economics & Human Biology. 17: 116–128. doi:10.1016/j.ehb.2015.02.002. ISSN 1570-677X.
  18. ↑ de Górgolas M, Casado V, Renedo G, Alen JF, Fernández Guerrero ML (2009). "Nodular lung schistosomiais lesions after chemotherapy for dysgerminoma". Am. J. Trop. Med. Hyg. 81 (3): 424–7. PMID 19706907.
  19. ↑ Polkey MI, Lyall RA, Moxham J, Leigh PN (January 1999). "Respiratory aspects of neurological disease". J. Neurol. Neurosurg. Psychiatry. 66 (1): 5–15. PMC 1736177. PMID 9886443.
  20. ↑ Bowen RE, Scaduto AA, Banuelos S (September 2008). "Decreased body mass index and restrictive lung disease in congenital thoracic scoliosis". J Pediatr Orthop. 28 (6): 665–8. doi:10.1097/BPO.0b013e3181841ffd. PMID 18724205.
  21. ↑ Vitacca M, Clini E, Facchetti D, Pagani M, Poloni M, Porta R, Ambrosino N (July 1997). "Breathing pattern and respiratory mechanics in patients with amyotrophic lateral sclerosis". Eur. Respir. J. 10 (7): 1614–21. PMID 9230256.
  22. ↑ Roy TM, Walker JF, Farrow JR (April 1991). "Respiratory failure associated with myasthenia gravis". J Ky Med Assoc. 89 (4): 169–73. PMID 2040830.

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