1. الحمد لله والصلاة والسلام على رسول الله بسم الله الرحمن الرحيم

2. Restrictive Lung Disease

3. Pulmonary Dysfunction can be divided into two main groups: 1-Obstructive lung disease: In which the flow of air is impeded 2-Restructive lung disease : In which the volume of air gas is reduced Definition:. Restrictive lug disease is actually group of disease with differing etiologies The common link among these disorders is difficulty in expanding the lung and the reduction in lung volume. The restriction can come from changes in chest wall such as thoracic burn and scoliosis, or the neuromuscular apparatus, such as Guillian barre syndrome, or muscular dystrophy.The most common among those disorders are the restrictive diseae of the lung parenchyma and or the pleura

4. Pulmonary Parenchymal restriction can be categorized as regard the etiology into four ways 1-The pneumoconiosis (the dust diseases leading to pulmonary fibrosis 2-Immunologically mediated fibrosing alveolitis 3-The collagen diseases 4-Pulmonary fibrosis of unknown cause Pleural thickening and fibrosis can restrict the movement between the lung and the thoracic wall and thereby cause another type of restrictive disease. Radiation therapy and asbestoses exposure are two of the most common causes of pleural thickening Pathogenesis : three major aspects pf pulmonary ventilation must be considered to understood the pathophysilogy of restrictive lung disease, these are 1- Compliance of both lung and chest wall 2-Lung volume and capacities 3-Work of breathing

7. 1- Compliance: It is the physiologic link that establish a relationship between the pressure exerted by the chest wall or the lung and the volume of air that can be contained with the lungs. with RLD, chest wall or lung compliance or both are decreased.A decrease of lung compliance indicates that they are becoming stiffer and thus more difficult to expand, and resistance to lung expansion is increased. 2- Lung volume : Restrictive lung diseases eventually cause all the lung volumes and capacities to become decreased. Because the lung expansion is decreased. 3-Work of breathing : With restrictive lung dysfunction the work of breathing is increased to overcome the decrease of the lung compliance. Therefore, the respiratory rate is to high, the respiratory muscles especially the diaphragm work harder, and the accessory muscles of respiration also work hardly to assist in expanding the thorax

8. Pathophysiology : The particular changes occurring within the lungs depends on the etiologic factors of the restrictive disease.Parenchymal changes result in fibrosis of the alveoli, small airways, and pulmonary vasculature, whereas pleural disease causes pleural thickening and fibrosis. Clinical presentation : Dyspnea is the classic syndrome of restrictive lung diseases, beginning with Dyspnea on exertion and progressing to shortness of breath at rest. A non productive cough is often encountered, and weakness and easy fatigue are common. Signs of restrictive lung disease include rapid, shallow breathing, limited chest expansion, fine end expiratory crackles especially over the lower lung fields, digital clubbing, and cyanosis

9. ***Pulmonary function tests reveal a reduction in vital capacity, functional residual capacity, and total lung capacity. Residual volume may be normal or near normal. ***Lung compliance is significantly reduced, and the diffusing capacity is diminished. Arterial blood gases studies show varying degree of hypoxemia and hypocapnea. Hypoxemia is usually exacerbated by exercise. Exercise may significantly lower Pa O 2, even in patients with normal resting Pao 2.. *** Hypoventilation, which results in a lower than normal Paco2, often occurs

10. General Clinical Presentation : 1-Inability to inspire deeply 2-Tachypnea- patient breathe at an increased rate 3-Cough 4-decreased thorax mobility 5-Postural deviation 6-General weakness and fatigue

11. Treatment of Restrictive lung dysfunction Goals Methods of treatment Maintain adequate ventilation and Re-expand the lung tissues to Prevent atelactasis Deep diaphragmatic breathing Exercise-Incentive Spirometery to Improve inspiratory capacity Assist in the removal and Mobilizing the secretion Deep effective coughing Modified postural drainage with Percussion and vibration to Specific area Maintain adequate circulation in The lower limbs to prevent thrombosis Active exercise especially ankle movements

12. Treatment of Restrictive lung dysfunction Goals Methods of treatment Maintain range of motion in Shoulders and trunk to prevent Postural defect Begin relaxation exercise to Shoulder and trunk Restore exercise tolerance Begin a progressive and graded Ambulation programs

13. نسأل الله أن يعلمنا ما ينفعنا، وأن ينفعنا بما علمنا، وأن يزيدنا علما د فرج عبد المنعم على عضو البورد الأ مريكى للعلاج الطبيعى عضو هيئة التدريس بجامعة القاهرة و جامعة الملك سعود وفي النهاية