Chronic restrictive lung diseasesDiffuse Reduced expansion Decreased total lung capacity

1)Chest wall disorder Severe obesity, Kyphoscoliosis Poliomyelitis2)Interstitial and infiltrative diseases Pneumoconiosis Immunologic lung diseases Collagen vascular diseases Idiopathic pulmonary fibrosis Sarcoidosis

PathogenesisInjurious stimuliInflammatory reactionAlveolitis with L M N EInflammatory destruction of parenchymaFibrosisEnd stage Lung(honey comb lung)

Clical manifestations DyspnoeaTachypnoeaCyanosisNo wheezing

Pneumoconiosis

Group of lung diseases resulting from inhalation of inorganic and organic dust Chemical fumes and vapour

Development of the disease depends onAmount of dust retained in air spacesParticle solubility and cytotoxicitySize and shape of the particleOther irritants

Most dangerous particle size1-5um Three types of reactions 1)Fibrous nodules 2)Interstitial fibrosis 3)Hypersensitivity reactions

Coal workers pneumoconiosisAnthracosis

Simple coal workers pneumoconiosis

Complicated coal workers pneumoconiosis(progressive massive fibrosis)

AnthracosisBenign AsymptomaticNot a lung diseaseSeen in all urban dwellersNo cellular reactionCarbon pigments engulf by macrophages and accumulate along lymphatics

Simple CWPMacules 1-2mm and nodulesCarbon laden macrophages and small amount of collagenUpper lobesFocal dust emphysemaLittle derrangement of lung function

Complicated CWPIn the back ground of Simple CWP after many years(2-8%)Black hard areas 2-10 cmBilateralUpper partsDense collagen and carbon pigmentsNecrosisProgressiveImmunologic basisIncidence of TB increased by 40%

SilicosisInhalation of crystaline silicon dioxideAcute

Chronic

Significant lung disease after 10-15 years

Silicamacrophagesdeath release particleactivate macrophagesGF Fibroblast proliferation and collagen synthesis

Pathological changesHard fibrotic nodules 1-5 mmUpper zonesEgg shell calcifications on chest x rayIschaemic necrosis cavitiesThickened pleuraIncreased susceptibility to TB

Asbestose diseaseThree types of asbestose fibers Crysolit (white)-soft proximalCrosidolite (blue) Rigid reach peripharal parts carcinogenicAmosite (brown)Disease depends on the amount of dust inhaled

PathogenesisExposure macrophages fibrogenic enzymes and GF Fibrosis

Pathological changes3 types of lesions

1) Asbestosis2)Pleural disease3)Tumours

AsbestosisGross pulmonary fibrosisAsbestose bodiesLungs are small and firmCartilage like thickening of pleuraBegins at lower lobes sub pleurallySmoking has an additive effect

Pleural disease3 types of pleural lesions

1)Effusions 2)Visceral pleural fibrosis3)Fibrotic plaques

Effusion5% of cases

Fibrotic pleural plaques Appear as circumscribed flat small (up to 1cm) hard bilateral nodules.They are consist of hyalinized collagenous tissue which may be calcified They DO NOT CONTAIN ASBESTOSE BODIES.

Bronchogenic carcinoma most commonSmoking greatly increases the risk but not that of mesotheliomaMalignant mesotheliomaCA oesophagusCA stomach,colon,larynx,kidney and various haematological malignancies.TUMOURS

Rheumatoid pneumoconiosis Coexistance of rheumatoid arthritis with a pneumoconiosis.Occurs in CWP, silicosis, and asbestosisGrossly firm nodules with central necrosis cavitations or calcificationsMicro-Modified rheumatoid nodulesRheumatoid factor ,antinuclear factor