Management of Restrictive Lung Disease

Pharmacologic Therapy

For patients with restrictive lung disease associated with chronic bronchitis, the American Thoracic Society recommends considering roflumilast in patients with forced expiratory volume in one second (FEV1) <50% predicted 1, 2
Low-dose long-acting oral and parenteral opioids may be considered for treating dyspnea in patients with severe disease, as suggested by the American College of Chest Physicians 1
Medications should be selected based on symptom severity, risk of exacerbations, and comorbidities, according to the American Thoracic Society 3

Long-term oxygen therapy is indicated for stable patients with low oxygen levels (PaO2 ≤55 mmHg or SaO2 ≤88%), with or without high carbon dioxide levels, confirmed twice over 3 weeks, as recommended by the American Thoracic Society 5
Oxygen therapy improves survival in hypoxemic patients and is one of the few interventions shown to modify survival rates, according to the American College of Chest Physicians 4

Exercise training should include a combination of constant load or interval training, strength training, and upper extremity exercise training, as suggested by the American Thoracic Society 1, 2
Pulmonary rehabilitation should be offered to all patients with significant symptom burden, according to the American College of Chest Physicians 4

Non-invasive ventilation (NIV) may be considered for patients with recent hospitalization for acute respiratory failure, as recommended by the American Thoracic Society 5
For patients with both restrictive lung disease and obstructive sleep apnea, continuous positive airway pressure (CPAP) is indicated, according to the American Academy of Sleep Medicine 5

For selected patients with advanced emphysema refractory to medical care, surgical or bronchoscopic lung volume reduction may be beneficial, as suggested by the American Thoracic Society 5
Lung transplantation should be considered for appropriate candidates with progressive disease, according to the International Society for Heart and Lung Transplantation 5

Annual influenza vaccination is recommended for all patients, as suggested by the Centers for Disease Control and Prevention 3
Pneumococcal vaccinations (PCV13 and PPSV23) are recommended for all patients older than 65 years of age, according to the Centers for Disease Control and Prevention 5

Educational programs should include strategies to minimize dyspnea, as recommended by the American Thoracic Society 1
Discussion of advance directives should be included in educational programs when appropriate, according to the American College of Chest Physicians 5

Nutritional supplementation is recommended for malnourished patients, as suggested by the American Thoracic Society 5
Weight loss and muscle wasting contribute significantly to morbidity and should be addressed, according to the American College of Chest Physicians 4