STAGE 2 CARDIORESPIRATORY SYSTEM:

OBSTRUCTIVE and RESTRICTIVE DISORDERS

OBSTRUCTIVE DISORDERS
Narrowing of airways OBSTRUCTS airflow

Obstructive and restrictive lung disease

Dr John Patterson

- key feature is REDUCED PEAK FLOW RATE RESTRICTIVE DISORDERS

Various pathologies lead to RESTRICTION of lung volume

- key feature is REDUCED TOTAL LUNG CAPACITY (Remember TLC is Vital Capacity + Residual Volume)

Slide 1
FEV1 versus age - FVC versus height

FEV1 (% of value at age 25)

FEV1: Effects of age and smoking Never smoked

or not susceptible to smoke
Smoked regularly and susceptible to smoke

100 75 50 Disability Death 0 25 50 Age (years)

Stopped at 45 Stopped at 65 75

25

N.B. FEV1 and FVC also vary with gender

Slide 2

Slide 3

Interpreting Spirograms
Measure FEV1
FEV1 > 80% of predicted - normal FEV1 <80% of predicted - abnormal

OBSTRUCTIVE DISORDERS Asthma

- reversible airways obstruction - Smaller airways - smooth muscle - AHR (airway hyper- responsiveness) - often atopic (allergens) Pathogenesis:
bronchconstriction - 2 agonists secretion (of mucus) - muscarinic antagonists inflammation - steroids, etc

Measure FEV1/FVC (FEV1%) FEV1% >80% - possible Restriction Measure FVC and RV If TLC 2 SD below normal - RESTRICTION

FEV1%<70% or 2 SD below predicted for age - OBSTRUCTION

A pathological triad

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Asthma = hyper-reactivity

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OBSTRUCTIVE DISORDERS (COPD)
Chronic Obstructive Airway Disease (COPD) Chronic Bronchitis and Emphysema non (or less) reversible airways obstruction Chronic Bronchitis
- larger airways (eventually) - hypertrophy of bronchial glands, hypersecretion, mucous plugs and infection/inflammation - smoking / irritants

Slide 7
Inflammato ry Mechanisms in Chronic Obstructive Pulmonary Disease

Emphysema
- destruction of lung stroma - bullae, - floppy airways cause obstruction
- -antitrypsin deficiency (smoking/genetic)
Barnes, P. J. N Engl J Med 2000;343:269-280

Slide 9 Slide 8
Lung Pathology - Emphysema

Normal

Emphysema

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RESTRICTIVE DISORDERS
Pneumonia Pneumonthorax Atelectasis Pulmonary fibrosis Pleural thickening Neuromuscular weakness Loss of volume, increase in recoil of lung

Difficulty in production of chest movements

AHR - airway hyperresponsiveness

Ankylosing spondylitis Kyphoscoliosis

External mechanical limitation of lung volume

Slide 12
Pulmonary fibrosis (may be localised, bilateral, diffuse) Normal lung histology Pulmonary fibrosis - collagen blue

Slide 13

www.vh.org/

Pulmonary fibrosis: Cryptogenic fibrosing alveolitis Extrinsic allergic alveolitis: Farmers lung Bird fanciers lung, etc. Occupational (dust exposure): pneumoconiosis silicosis asbestosis

www.meddean.luc.edu/

Kyphoscoliosis

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