Restrictive lung diseases

Pneumonia
Pleurisy
Pleural effusion
Pneumothorax
Acute respiratory distress syndrome (ARDS)
Fibrosing alveolitis
 PNEUMONIA
Definition
Acute inflammation of the lung tissue
Classification of pneumonia
Anatomical lobar, broncho, segmental
Based on organism- bacterial, viral, fungal, protozoal,
atypical
Based on acquired infection hospital acquired
pneumonia, community acquired pneumonia, pneumonia
in immunocompromised patients.
Clinical features:
Cough
Sputum
Dyspnoea
Chest pain pleuritic pain
Wheeze
Crepitation's
Fever
Malaise
Rigor
 Physiotherapy in pneumonia
Aim:
To reduce bronchospasm and to clear lung fields of
secretions
To gain full expansion of lungs
To regain exercise tolerance and fitness
Clearing lung fields
Humidification may be necessary to moisten secretions. The
method will vary according to the severity of the illness and
may be by steam inhalation, nebuliser or IPPB.

Clapping, shaking and breathing exercises may all be

necessary in a postural drainage position appropriate to the
area of the lung affected.

Sometimes suction is required for the very ill patient who

cannot cough or expectorate. If there is an underlying
bronchospasm then a bronchodilator may be given
Re-expansion of the lungs
Positioning should be used to increase ventilation to the
affected area

Exercise tolerance and fitness

As soon as possible, the patient should be mobilised and
start walking short distances which are progressively
increased in length
 PLEURISY
Definition
Pleurisy is a process whereby inflammation occurs on the
visceral and parietal pleura which come into direct
contact with each other to cause pain.
Clinical features
Pleuritic pain
Pleural rub
Cough
Tachycardia and pyrexia may be present
 PHYSIOTHERAPY IN PLEURISY

Physiotherapy is usually inappropriate in the early stages. During

the recovery stage, however, the aims are:

To regain full thoracic expansion

To minimise adhesion formation between the pleural layers

To mobilise the thorax.

 Thoracic expansion is regained by teaching the patient
localised expansion exercises with manual resistance
over the affected area both to guide rib movement and
relieve pain.

General deep breathing exercises and mobility

exercises, such as sitting with trunk bending side to
side, are important to regain mobility of the thorax and
thoracic spine.
 PLEURAL EFFUSION
Definition
Pleural effusion is an excessive accumulation of fluid in the pleural cavity.
Aetiology
Pleural effusion is often secondary to conditions such as:
Malignancy of the lungs or bronchi
Pneumonia
Tuberculosis
Pulmonary infarction
Bronchiectasis
Lung abscess
Blockage of lymph vessels
Rupture of blood vessels
Left ventricular failure.
Clinical features
Breathlessness. The pressure of fluid reduces lung
expansion.
Cyanosis. This may be present in a large effusion.
Pyrexia. This is usually associated with infection.
Lethargy. The person complains of a lack of energy.
Pain. The person complains of pain.
 PHYSIOTHERAPY IN PLEURAL
EFFUSION
The Aims Of Physiotherapy Are:
To Prevent The Formation Of Disabling Adhesions Between The
Two Layers Of Pleura
To Obtain Full Expansion Of The Affected Lung
To Increase Ventilation Of The Lungs
To Increase Exercise Tolerance Following Immobility.
Means:
Breathing exercise to improve localized expansion and ventilation of
the lung, later stage the patient is mobilized to improve the
exercise tolerance.
 EMPYEMA
Definition
Empyema is a collection of pus in the pleural cavity
Aetiology
condition of empyema usually arises secondary to pre-existing
lung disease, such as
bacterial pneumonia,
tuberculosis,
lung abscess, or bronchiectasis
It may also occur due to stab wound or thoracic incision as a
complication
Clinical features
Pyrexia
Lassitude and loss of weight
Tachycardia
Dyspnoea
Pleuritic pain severe at first then decreasing in Severity
Diminished thoracic movements
 PHYSIOTHERAPY IN EMPYEMA
Aims
To minimise adhesion formation within the pleura
To regain full lung expansion
To clear the lung fields
To maintain good posture and thoracic mobility
To improve exercise tolerance
Means
Breathing exercise to improve the ventilation as well as
expansion of th lung
Postural drainage to remove the lung secretions in different
positions based on the auscultation findings
Coughing encouraged with support of the drain tube
Gradual arm and trunk exercise incorporated to improve the
thoracic mobility
Breathing control is taught to the patient in shorter and long
walk in even surface and in stair climbing.
The intensity of the exercise programme increased to improve
the exercise tolerance of the patient.