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Definition: TLC decreased by 20% compared to predicted values based on height, age, gender RESTRICTIVE DISEASES OF THE LUNG.

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Presentation on theme: "Definition: TLC decreased by 20% compared to predicted values based on height, age, gender RESTRICTIVE DISEASES OF THE LUNG."— Presentation transcript:

1 Definition: TLC decreased by 20% compared to predicted values based on height, age, gender RESTRICTIVE DISEASES OF THE LUNG

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4 Fig

5 Pressure Volume Fluid filled lung Air filled lung without surfactant

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7 water molecule surfactant molecule

8 Pressure Volume Full term Preemie Lung Pressure Volume Curves

9 PULMONARY EDEMA

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12 Pulmonary edema

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14 CAUSES OF PULMONARY EDEMA 1.Cardiogenic Myocardial infarction Hypertensive left heart failure 2.Increased capillary permeability Inhaled or circulating toxins Endotoxin High O 2 over long periods of time Radiation SO 2, NO 2 Bacterial and viral pathogens

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16  left atrial pressure  pressure in pulmonary vein  Pcap  fluid flux across the endothelium Cardiogenic pulmonary edema Usually self correcting: increased fluid flux increases P IF increased fluid flux concentrates proteins in capillaries, increasing  cap

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18 Increased capillary permeability Inflammation Increased permeability of pulmonary capillaries Increased protein leak across capillaries ↓  cap ↑ fluid flux across capillaries Usually not self limiting fluid that leaks out has protein in it, increasing the oncotic pressure of the interstitial spaces

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20 Symptoms dyspnea cough (particularly in the recumbent position) the cough is often non-productive in the early stages, but in the advanced stages, it may bring up pink foam, and cyanosis may be present

21 Pulmonary Function the PV curve of the lung is shifted downward and to the right resistance to flow through airways may increase -(fluid forms around airways and isolates them from retractive forces of the lung parenchyma) TLC, VC, FRC decrease

22 How does edema affect lung compliance? Air “Good” lung

23 Air “Good” lung Breath goes evenly to both lungs Compliance =  V/  P

24 Fluid and pus Air “Good” lung “Bad” lung (very stiff) Breath only goes to good lung Compliance =  V/  P 2

25 Gas Exchange If only interstitial edema is present little change in blood gases If alveolar edema is present decreased PaO 2 (due to shunt) PaCO 2 normal or even low (hyperventilation). Reason for hyperventilation: low PaO 2 stimulation of lung receptors by high transpulmonary pressures (lung is stiffer, so it requires greater pressures for ventilation)

26 Pulmonary alveolar proteinosis Lavage Number

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28 Proteinaceous material filling the alveoli, but no inflammatory cells

29 OBESITY AND THE LUNG

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31 How does obesity impact: 1.Pulmonary mechanics 2.Pattern of breathing 3.Blood gases 4.Pulmonary Disease

32 How does obesity impact: 1)Pulmonary mechanics Lung volumes Airway caliber Airway responsiveness 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

33 How does obesity impact: 1)Pulmonary mechanics Lung volumes Airway caliber Airway responsiveness 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

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36 Obesity makes the chest wall stiffer Obese FRC Chest wall in obesity Lean FRC

37 Lean Obese FRC TLC ERV RV Adapted From: Rubinstein et al Ann Intern Med 112: , (293 subjects)  RV  airway closure VC

38 How does obesity impact: 1)Pulmonary mechanics Lung volumes Airway caliber Airway responsiveness 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

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40 Lung Volume Airway Resistance

41 What is the status of the airways in the obese subject?

42 From: King et al: Eur. Respir. J. 25: , 2005 Gaw is corrected for absolute lung volume Gaw = 1/Raw

43 The airways of obese subjects are narrowed. The airway narrowing is more than could be expected on the basis of reduced lung volume alone. Interim conclusion What else is causing airway narrowing?

44 From: Tilg and Moschen Nat Rev Immunol 6(10): , 2006

45 FACTORS PRODUCED BY ADIPOSE TISSUE CYTOKINES TNF  IL-6 IL-1 PBEF TGF  IL-10 CHEMOKINES IL-8 Eotaxin MCP-1 MIP-1  ENERGY REGULATING HORMONES Leptin Adiponectin Resistin ACUTE PHASE REACTANTS Serum amyloid A C-reactive protein PAI-1  1-acid glycoprotein OTHER FACTORS Angiotensinogen Complement B, C3, D Acylation-stimulating protein VEGF IL-1RA Retinol-binding protein-4

46 How does obesity impact: 1)Pulmonary mechanics Lung volumes Airway caliber Airway responsiveness 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

47 From Litonjua et al Thorax 57: , 2002 Weight gain increases the likelihood of developing AHR

48 How does obesity impact: 1)Pulmonary mechanics 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

49 Adapted from Sampson and Grassino, J. Appl. Physiol. 55: , Obesity leads to decreased tidal volume and increased frequency

50 How does obesity impact: 1)Pulmonary mechanics 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

51  work to move larger body weight   CO 2 production  Most obese increase V E to maintain normal PaCO 2 What about PaO 2 ?

52 Lean Obese FRC TLC ERV RV Adapted From: Rubinstein et al Ann Intern Med 112: , (293 subjects)  RV  airway closure VC

53 “Airway closure occurred within a tidal breath in 9 out of 10 (obese) subjects during spontaneous breathing” “P a O 2 correlated with the magnitude of airway closure” Acta Anesthesiol Scand 20:334-42, Airway closure  Shunt  ↓PaO 2

54 How does obesity impact: 1)Pulmonary mechanics 2)Pattern of breathing 3)Blood gases 4)Pulmonary disease

55 Obesity and Pulmonary Disease Asthma COPD Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Pulmonary Hypertension

56 From: Nystad et al, Am J Epidemiol 160: , 2004 Obesity increases the risk of incident asthma

57 Obesity and Pulmonary Disease Asthma COPD Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Pulmonary Hypertension

58 Obesity and COPD From: Guerra et al, Chest 122: , 2002 Issues: lack of exercise, lifestyle factors

59 Obesity and Pulmonary Disease Asthma COPD Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Pulmonary Hypertension

60 Obesity and Obstructive Sleep Apnea

61 Sleep  muscles relax  tongue and soft palate fall against back of throat  obstruction  hypoxemia  arousal Obstruction can occur 5-50 times per hour!

62 Outcomes: Loss of sleep Excessive daytime sleepiness Headaches upon awakening Depression Hypertension Cardiovascular disease Stroke

63 sleephelpusa.com/images/brewster-ginger.jpg Obesity  Fat deposition in soft palate, uvula, neck area, pharynx  Increased risk of obstruction

64 Obesity and Pulmonary Disease Asthma COPD Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Pulmonary Hypertension

65 Obesity Hypoventilation Syndrome (Pickwickian syndrome ) Arterial hypercapnia (increased PaCO 2 ) while awake Hypersomnolence Fatigue Morning headaches Hypoxemia Polycythemia Pulmonary hypertension Right ventricular failure Cause? Sleep disordered breathing combined with chronic hypoxemia and hypercapnia leading to blunting of chemoreceptor responsiveness

66 Obesity and Pulmonary Disease Asthma COPD Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Pulmonary Hypertension

67 Low P A O 2 leads to constriction of pulmonary arterioles “96% of obese subjects living at altitude have pulmonary hypertension” Valencia-Flores et al Int. J. Obesity 28: , 2004

68 Normal Airway Edema


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