INTERSTITIAL LUNG DISEASES

 

Interstitial lung disease (ILD) refers to a broad category of lung diseases rather than a specific disease process. This category includes various illnesses affecting the lung parenchyma. Diseases that affect the supporting structures of the lung rather than the airspaces are covered by the umbrella term ‘interstitial lung disease’ usually related to immune disturbance or exposure to toxic agents. Inflammatory changes lead to alveolitis, which may resolve or progress to patchy fibrosis, thickened alveolar septa, remodeling of parenchyma and shrunken, stiff lungs. Smoking augments the damage. Stiff lungs mean fewer functioning alveoli and often excess elastic recoil. These diseases are grouped under restrictive lung diseases.

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IMPAIRMENTS

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Body structure

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• lung stiffness, which increases the work of breathing

• Reduced surface area of the alveolar-capillary membrane, which impairs gas exchange.

• Reduced lung volume

Investigations: chest radiographs/MRI/chest CT

• Diffuse bilateral opacities over lungs

• Reticulo-nodular appearances/ honeycomb appearance/ground glass appearance

• Atelectasis-  segmental/ lobar

• Elevation of diaphragm due to Atelectasis (dome shaped diaphragm)

• Pleural effusion

• Mediastinal shift

• Mediastinal adenopathy

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Body functions​

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• Dyspnoea- exercise intolerance

• chest tightness

• reduced lung capacities- spirometry

• peripheral cyanosis

• digital clubbing

• fatigue

• increased work of breathing : supraclavicular hollowing, intercostal in drawing

• pulmonary hypertension

• hypoxemia on exercise : reduced PaO2 because of  V_ /Q_ mismatching

• abnormal breathing pattern

• use of accessory muscles for breathing

• reduced chest expansion

• reduced chest excursion

• dull note on percussion over fibrosed lung fields

• reduced TVF over fibrosed lung fields

• impaired inspiration: expiration ratio

• auscultation:

  • end inspiratory crackles

  • bronchial breath sounds over fibrosed lung fields

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GOALS

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Short term goals: (acute phase pulmonary rehabilitation)

1. Patient education

2. Relieve dyspnoea

3. Increase lung capacity and volumes

4. Reduce fatigue

5. Teach correct breathing pattern

6. Increase exercise tolerance

7. Reduce hypoxia

8. Removal of excessive secretions

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Long term goals: (late pulmonary rehabilitation)

1. Strengthen respiratory muscles

2. Improve cardiovascular endurance

3. Prevent long term complications

4. Lifestyle changes/ corrections

 

MANAGEMENT

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Interventions

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Patient education

• Educate patient about the condition, its causes and potential risks and complication.

• Explain the need of treatment along with interventions.

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Relieve dyspnoea

• dyspnoea relieving positions

• glossopharyngeal breathing

• pursed lip breathing

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Increase lung capacities and volumes

• Spirometry

• Chest PNF

• Chest expansion exercises

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Reduce fatigue

• Teach energy conservation techniques

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Improve breathing pattern

• Diaphragmatic breathing pattern should be taught along with biofeedback

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Increase exercise tolerance

• Maintain adequate oxygen saturation levels and improve endurance

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Reduce hypoxia

• Provide oxygen therapy whenever required

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Removal of excessive secretions

• ACBT

• Autogenic drainage

• Chest PT

• Assisted cough techniques

• Forced expiratory techniques

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Strengthen respiratory muscles

• Muscle strengthening exercises such as segmental breathing should be taught.

• Postural correction and stretches to improve chest wall mobility should be incorporated into other active exercises and activities of daily

 

Improve cardiovascular endurance 

• Start with mild isometric muscle contractions of upper limb and lower limb.

• Free exercises with isotonic contractions for axial skeleton and extremities.

• Resisted exercises should be started to improve overall strength and endurance

• Train with activities of daily living and monitor oxygen saturation

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Prevent long term complications

• Vaccinations to certain infections

• Treat other systemic disorders leading to further complications

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Lifestyle changes/corrections

• Environmental modifications: prevention of inhalation of impure air: do not live in polluted areas, wear mask, etc.

• Job modification: helpful to prevent complications in occupational lung diseases

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​REFERENCES

1. Physiotherapy for Respiratory and Cardiac Problems-prior and Prasad (edition 2)

2. Alexandra Hough-Physiotherapy in Respiratory Care(edition 3)

3. Egan's Fundamentals of Respiratory Care (11th Edition) by Robert Kacmarek