become further deranged in a smoker's transition to clinically defined COPD. Restrictive lung diseases Some types of chronic lung diseases are classified as restrictive lung disease, because of a restriction in the amount of lung tissue involved in respiration. These include pulmonary fibrosis which can occur when the lung is inflamed for a long period of time. Fibrosis in the lung replaces functioning lung tissue with fibrous connective tissue. This can be due to a large variety of occupational lung diseases such as Coalworker's pneumoconiosis, autoimmune diseases or more rarely to a reaction to medication. Severe respiratory disorders, where spontaneous breathing is not enough to maintain life, may need the use of mechanical ventilation to ensure an adequate supply of air. Cancers Lung cancer can either arise directly from lung tissue or as a result of metastasis from another part of the body. There are two main types of primary tumour described as either small-cell or non-small-cell lung carcinomas. The major risk factor for cancer is smoking. Once a cancer is identified it is staged using scans such as a CT scan and a sample of tissue from a biopsy is taken. Cancers may be treated surgically by removing the tumour, the use of radiotherapy, chemotherapy or a combination, or with the aim of symptom control. Lung cancer screening is being recommended in the United States for high-risk populations. Congenital disorders Congenital disorders include cystic fibrosis, pulmonary hypoplasia (an incomplete development of the lungs)congenital diaphragmatic hernia, and infant respiratory distress syndrome caused by a deficiency in lung surfactant. An azygos lobe is a congenital anatomical variation which though usually without effect can cause problems in thoracoscopic procedures. Pleural space pressure A pneumothorax (collapsed lung) is an abnormal collection of air in the pleural space that causes an uncoupling of the lung from the chest wall. The lung cannot expand against the air pressure inside the pleural space. An easy to understand example is a traumatic pneumothorax, where air enters the pleural space from outside the body, as occurs with puncture to the chest wall. Similarly, scuba divers ascending while holding their breath with their lungs fully inflated can cause air sacs (alveoli) to burst and leak high pressure air into the pleural space. Examination As part of a physical examination in response to respiratory symptoms of shortness of breath, and cough, a lung examination may be carried out. This exam