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Respiratory Disease
Restrictive lung diseases or restrictive ventilatory defects
Restrictive lung disease is a condition marked most obviously by a reduction in total lung capacity. A restrictive ventilatory defect may be caused by a pulmonary deficit, such as pulmonary fibrosis (abnormally stiff, non-compliant lungs), or by non-pulmonary deficits, including respiratory muscle weakness, paralysis, and deformity or rigidity of the chest wall(1).
The Treatment
In conventional medicine perspective
Treatments are depending to the underline causes in diagnosis
F.1.1. Non medication Therapies
1. Pulmonary rehabilitation
Pulmonary rehabilitation programs improve exercise tolerance, muscle strength, and dyspnea in patients with COPD. In the study to assess prospectively the effectiveness and feasibility of pulmonary rehabilitation in patients with restrictive lung diseases by Department of Respiratory Medicine, Ghent University Hospital, showed that patients with RLD respond well after 12 weeks of pulmonary rehabilitation, and even better results were seen after 24 weeks. Clinically significant improvements were obtained in the majority of the patients after 24 weeks(26).
2. Oxygen therapy
Collective experience with pulmonary rehabilitation and disease management has shown that patients with lung diseases including COPD and restrictive lung diseases live a longer and more productive quality of life if they can remain active(27).
3. Continuous positive airway pressure (CPAP)
The aim of CPAP is to provide continuous positive pressure to maintain a continuous level of positive airway pressure of that can improve oxygenation in a patient whose hypoxemia is refractory to oxygen therapy. Evidence suggests that use of CPAP for longer than 6 hours decreases sleepiness, improves daily functioning, and restores memory to normal levels(28).
4. Mechanical ventilation support
The aim of Mechanical ventilation is to mechanically assist or replace spontaneous breathing, if the patient is on his/her way to respiratory failure. High levels of prolonged pressure support ventilation promote diaphragmatic atrophy and contractile dysfunction. Furthermore, similar to controlled mechanical ventilation, pressure support ventilation-induced diaphragmatic atrophy and weakness are associated with both diaphragmatic oxidative stress and protease activation(29).
F.1.2. Medication therapy
1. Inhaled corticosteroids
Inhaled corticosteroids act locally in the lungs to inhibit the inflammatory process and support the function to relieve the symptoms of Restrictive lung disease. In the study of nine pregnant women with interstitial and restrictive lung disease between 1981 and 1994, showed that hree patients had severe disease, characterized by vital capacity < or = 1.5 L (50% predicted) or diffusing capacity < or = 50% predicted. Five patients had exercise-induced oxygen desaturation, and four required supplemental oxygen. Five patients required corticosteroids. One patient had an adverse outcome; she was delivered at 31 weeks and required mechanical ventilation for 72 hours. All other patients were delivered at or beyond 36 weeks with no adverse intrapartum or postpartum complications(30).
2. Immunosuppressive therapy
The aim of Immunosuppressive therapy is to reduce the immune response. Some researchers suggested that adverse drug reactions should be considered in patients with concomitant lung and liver disease(31).
3. Reducing fluid buildup in the lungs
If the underlined causes of the disease is as a result of cardiac problem.
F.1.3. Surgery
If the underlined causes as a result of abdominal problems, such as obesity, remove abdominal tumors, repair diaphragmatic hernias, etc. In the study to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity, showed that corrective scoliosis surgery in pediatric patients with severe restrictive lung disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy(32).
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Sources
(1)http://oac.med.jhmi.edu/res_phys/Encyclopedia/RestrictVentDefect/RestrictVentDefect.HTML
(26) http://www.ncbi.nlm.nih.gov/pubmed/19858229
(27) http://www.ncbi.nlm.nih.gov/pubmed/18539725
(28) http://www.ncbi.nlm.nih.gov/pubmed/18250209
(29) http://www.ncbi.nlm.nih.gov/pubmed/22425820
(30) http://www.ncbi.nlm.nih.gov/pubmed/7485285
(31) http://www.ncbi.nlm.nih.gov/pubmed/22779302
(32) http://www.ncbi.nlm.nih.gov/pubmed/19590906
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