Types of Restrictive Lung Disease
Intrinsic RLD
Intrinsic restrictive lung diseases
usually result from inflammation
and scarring of lung tissue
● Tuberculosis
● Interstitial lung Disease
● Pneumonia
● Occupational Lung Disease
Extrinsic RLD
Extrinsic restrictive lung diseases
involve the chest wall, pleura, and
respiratory muscles.
Diseases of these structures result
in lung restriction, impaired
function, and respiratory failure.
Tuberculosis
Tuberculosis (TB) is a human disease caused by Mycobacterium tuberculosis. It
mainly affects the lungs, making pulmonary disease the most common
presentation
Etiology
The principal mode of spread is through the inhalation of infected aerosolized
droplets.
The first contact of the Mycobacterium organism with a host leads to
manifestations known as primary tuberculosis. This primary TB is usually
localized to the middle portion of the lungs, and this is known as the Ghon
focus of primary TB. In most infected individuals, the Ghon focus enters a
state of latency.
Latent tuberculosis is capable of being reactivated after immunosuppression in
the host.
Clinical features
A chronic cough, hemoptysis, weight loss, low-grade fever, and night sweats
Secondary tuberculosis differs in clinical presentation from primary progressive
disease. In secondary disease, the tissue reaction and hypersensitivity are more
severe, and patients usually form cavities in the upper portion of the lungs.
miliary tuberculosis characterized by millet-shaped lesions on chest x-ray.
Disseminated tuberculosis may also be seen in the spine, the central nervous
system, or the bowel.
Confirmatory and diagnostic tests

A chest x-ray is indicated to rule out or rule in the presence of active disease in all
screening test-positive cases.
Acid Fast Staining-Ziehl-Neelsen
Culture
Mantoux test
Radiology evidence
Medical management
First-line antituberculosis drugs- I
soniazid (INH), rifampicin (RIF),
ethambutol (EMB),
pyrazinamide (PZA)
streptomycin (SM).
 Etiology

Known cause- Unknown cause-

Drugs IIP - (Pulmonary fibrosis)
Toxins Connective tissue disorder-
SLE
Radiation
Rheumatoid arthritis
Smoking
Ankylosing spondylitis
Hypersensitivity pneumonitis
PULMONARY FIBROSIS
Clinical features-
Middle aged population (M>F)

Progressive breathlessness and dry cough

Examination - Cyanosis,clubbing

Inspiratory crackles

Late feature- peripheral

oedema ,pulmonary hypertension,cor
pulmonale

Fibrosed lung —> increased pressure

capillaries —> inc pressure pulmonary
arteries —> inc. pressure RT heart
 Investigations
1. Blood investigation - ESR elevated
2.Chest X-ray- Reticulonodular opacities
3.HRCT- honeycomb appearance
4.Pulmonary function test- restrictive
pattern
5.Decreased -FEV1,FVC,TLC
FEV1: FVC(Normal or inc)
decreased diffusion lung
MANAGEMENT
PNEUMONIA
STAGES OF PNEUMONIA
CLINICAL FEATURES
CLASSIFICATION OF PNEUMONIA

A) BY SITE
● Alveolar/Lobar Pneumonia
● Interstitial Pneumonia C) BY MODE OF ACQUIRED PNEUMONIA
● Community Acquired Pneumonia
● Bronchopneumonia ● Hospital Acquired Pneumonia (HAP)
● Pneumonia in immunocrompised
patients
A) BY AETIOLOGY ● Healthcare acquired Pneumonia
● (HCAP)
Primary Pneumonia
● Secondary Pneumonia
● Suppurative Pneumonia
 1
RADIOLOGICAL
FEATURES

1. Abnormal Lung
opacity 2
2. Loss of clarity
(silhouette) of 3
Diaphragm and
Heart borders
3. Air filled Bronchi
 Medical
Management
● Fever suppressants
● Erthromyocin, Fluoroquinolone,
doxycyline, ceftriaxone,
Azithromycin, Amoxycilin
(Bacterial Cause)
● Oseltamivir, Zanamivir (Viral
cause)
 PNEUMOCONIOSIS
Pneumoconiosis is any lung disease caused by the inhalation of organic
or nonorganic airborne dust and fibers.
Patients usually encounter these inhalants in the workplace environment,
and therefore it is known as an occupational lung disease.
The most frequently encountered types of pneumoconiosis are asbestosis,
silicosis, and coal miner’s lung
Occupational history plays a vital role- type of industry, period of
exposure,work environment, residence location, protective equipment like
respirators used
Types of occupational lung diseases

INORGANIC
● Coal workers pneumoconiosis- coal dust from coal mines
● Silicosis- silica dust particles in form of quartz
● Asbestosis- asbestos fibers
● Siderosis- iron oxide particles
● Berylliosis- beryllium fumes or gases
● Stannosis- tin oxide

ORGANIC (Hypersensitivity pneumonitis)

● Farmer's lung- hay, straw, grain
● Bird fanciers lung- avian excreta, feathers
● Byssinosis- cotton, hemp fivers from textile industries
● Bagassosis- sugarcane fibers
Pathophysiology
Accumulation of fine inhaled particles that escape mucociliary clearance
(under 5 microns) deposit in the terminal bronchioles and alveoli

Alveolar macrophages phagocytose and inflammatory cytokines (IL-1 and

TNF-alpha) and lysosomal enzymes, free radicals are released

Once the inflammation process is complete, the fibrotic process initiates

via stimulation of growth factors

Type 1 pneumocytes can then grow over them and enclose them in the
interstitium. Fibroblasts then become stimulated to cause fibrosis and
tissue remodeling resulting in scar fibrotic lesions mostly in upper zones

Non-compliant lungs affecting expansion of lungs

Symptoms
Shortness of breath
Chest tightness
Fatigue or reduced exercise
tolerance
cough
Investigations
Prognosis and medical management
Pneumoconiosis progresses even after exposure ceases and can lead to Progressive
massive fibrosis (PMF)

In severe cases can lead to respiratory failure

Silicosis is associated with increased risk of Tb, lung carcinoma and COPD

Asbestosis is also related to benign pleural effusion and plaques, malignant

mesothelioma

There is no cure for pneumoconiosis, and the prognosis is poor in the fibrotic phase of
disorders

However symptomatic relief is given