Certain types of restrictive lung diseases, such as pneumoconiosis, can cause a buildup of phlegm and mucus in y… The last category is for the diseases which are related to the inability of the air sacs to supply oxygen or to move it to the blood. This is a result of the lungs being restricted from fully expanding. Get to know the next restrictive lung disease now. Restrictive Lung Disease . interstitial lung diseases (diffuse parenchymal lung disease - DLCO) results in reduced lung compliance and increased elastic recoil the primary mechanism of resting hypoxemia in patients with interstitial lung disease is a diffusion limitation, with DLCO defect contributing to hypoxemia with activity About 2.8 percent of coal miners have coal worker's pneumoconiosis. Sometimes the cause relates to a problem with the chest wall. Spirometry | the lung association. Cardiomyopathies are diseases of the muscle tissue of the heart.Types of cardiomyopathies include dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Restrictive lung diseases or conditi… Lung plethysmography estimates the amount of air that is left in the lungs after expiration (functional residual capacity) and can be helpful when there is overlap with other pulmonary function tests.It estimates how much air is left in the lungs (residual capacity), which is a measure of the compliance of the lungs. In restrictive lung disease, you cannot fill your lungs with air because your lungs are restricted from fully expanding.. Thomas Brack, Amal Jubran, Martin J. Tobin. Bibasilar inspiratory crackles or rales are usually heard on auscultation. (M1.PL.17.4709) A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. That is, its more difficult to fill lungs with air. Health Details: If you have questions or concerns about your lung health, talk to you doctor about spirometry.The earlier spirometry is done, the earlier lung disease can be detected and treated. [7], Restrictive lung disease is characterized by reduced lung volumes, and therefore reduced lung compliance, either due to an intrinsic reason, for example a change in the lung parenchyma, or due to an extrinsic reason, for example diseases of the chest wall, pleura, or respiratory muscles. This can occur when tissue in the chest wall becomes stiffened, or due to weakened muscles or damaged nerves. Restrictive lung diseases are a category of extrapulmonary, pleural, or parenchymal respiratory diseases that restrict lung expansion,[2] resulting in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenation. 1. Pathogenesis of Interstitial Lung Disease in Children and Adults. In patients with minimal signs or symptoms and stable disease, close observation (e.g.. May be indicated in patients with acute and rapidly progressive respiratory symptoms. Due to the wide variety of subtypes and symptoms, there is no generally recommended diagnostic algorithm. ) Meyer K, Decker C. Role of pirfenidone in the management of pulmonary fibrosis. Sarcoidosis Mirror. Pulmonary hypertension & cor pulmonale ↑ risk of perioperative respiratory complications: Identifying and determining the cause of interstitial lung disease can be challenging. [10] Because there is no effective treatment for restrictive lung disease, prevention is key.[10]. Due to the chronic nature of this disease, the leading symptom of restrictive lung disease is progressive exertional dyspnea. [7]  During inspiration, the lungs expand to allow airflow into the lungs and thereby increasing total volume. Restrictive lung disease is either due to the decrease in the elasticity of the lungs or the expansion of the chest walls. Interstitial lung diseases (ILDs) are a heterogeneous group of disorders marked by inflammatory changes in the alveoli. Restrictive lung disease (e.g., low lung volumes, high/normal FEV 1 /FVC ratio) Decreased diffusing capacity for CO (DL CO): highly sensitive parameter; Laboratory tests. Those factors can be around the lungs, below the diaphragm, or of the neuromuscular unit that is a part of the breathing process. It includes the bony structures (ribs, spine, sternum), respiratory muscles (the organs in your body that help you breathe), and nerves that connect the central nervous system to the respiratory muscles. This distinguishes obstructive lung disease from restrictive forms of the disease. For acute on chronic cases, shortness of breath, cough, and respiratory failure are some of the more common signs. Restrictive lung diseases may be due to specific causes which can be intrinsic to the parenchyma of the lung, or extrinsic to it. Restrictive Lung Disease: refers to conditions where lung volumes are limited, reducing the lungs’ ability to fully fill with air; COPD is a major cause of disability and the third leading cause of death in the United States. This breathing problem occurs when the lungs grow stiffer. A doctor's interview (including smoking history), physical exam, and lab tests may provide additional clues to the cause of obstructive lung disease or restrictive lung disease. Factors around the lungs pertain to the chest wall and adjacent spine. PULMONARY FUNCTION TESTS A Workshop on Simple Spirometry & Flow Volume Loops. Obstructive and restrictive lung disease can cause breathlessness, reduced endurance, recurrent episodes of pneumonia, and/or sleep apnea. Potential difficult BMV & rapid desaturation (↓ FRC) Altered respiratory physiology: Hypoxemia (V/Q mismatch) ↓ compliance & risk of barotrauma → pneumothorax. Treatment is based on the underlying cause. This happens when the lungs themselves are stiff or because there is a problem with the chest wall or the breathing muscles. Symptoms of COPD. Read our disclaimer. This is a result of the lungs being restricted from fully expanding. A large number of disorders fall into this broad category. Restrictive Lung Diseases. Restrictive lung disease most often results from a condition causing stiffness in the lungs themselves. When your lungs cant expand as much as they once did, it could also be a muscular or nerve condition. Work of breathing is the product of pressure and volume for each breath (Fig. Positions for restrictive lung conditions. People with a restrictive lung disease have a much more difficult time filling their lungs with air. James K. Stoller, Nicholas S. Hill, in Goldman's Cecil Medicine (Twenty Fourth Edition), 2012. This page was last edited on 13 January 2021, at 01:16. Restrictive lung diseases are characterized by reduced lung volumes, either because of an alteration in lung parenchyma or because of a disease of the pleura, chest wall, or neuromuscular apparatus. Restrictive lung disease is characterized functionally by a reduction of total lung capacity, FRC, VC, expiratory reserve volume, and diffusion capacity but preservation of the normal ratio of FEV1 to FVC.252 This may be due to intrapulmonary restriction (e.g., interstitial lung disease) or extrapulmonary restriction resulting from diseases of the chest wall (e.g., kyphoscoliosis) or pleura; neuromuscular diseases; obesity; or pregnancy, which may abnormally elevate the diaphragm. [3] As some diseases of the lung parenchyma progress, the normal lung tissue can be gradually replaced with scar tissue that is interspersed with pockets of air. some conditions that can cause restrictive lung disease include: *interstitial lung disease, such as idiopathic pulmonary fibrosis *sarcoidosis, an autoimmune disease *obesity *scoliosis *neuromu There are many treatments to reduce symptoms, to prevent lung disease from becoming worse, decrease flare-ups (exacerbations) and improve your day-to-day life. In normal respiratory function, the air flows in through the upper airway, down through the bronchi and into the lung parenchyma (the bronchioles down to the alveoli) where gas exchange of carbon dioxide and oxygen occurs. Johns Hopkins School of Medicine's Interactive Respiratory Physiology > Restrictive Ventilatory Defect, "eMedicine - Restrictive Lung Disease : Article by Sat Sharma", "Tuberculosis associates with both airflow obstruction and low lung function: BOLD results". [3], Restrictive lung diseases may be due to specific causes which can be intrinsic to the parenchyma of the lung, or extrinsic to it.[3]. People suffering from restrictive lung disease have a hard time fully expanding their lungs when they inhale. Arterial blood samples show elevated alveolar-arterial partial pressure of oxygen gradient and decreased partial pressure of oxygen. Also known as black lung disease, the condition, in severe cases, is characterized by scarring on the lungs (which often permanently damages the lungs and may lead to shortness of breath). [8], One definition requires a total lung capacity which is 80% or less of the expected value. 47. American Journal of Respiratory and Critical Care Medicine, 191, American Journal of Respiratory and Critical Care Medicine, 2015, Vol.191. How does restrictive lung disease … [3]  For acute on chronic cases, shortness of breath, cough, and respiratory failure are some of the more common signs. Physical examination, serology, pulmonary function tests, and imaging (chest X-ray, CT scan) is performed almost always, while lavage or biopsy depend on the individual case. Sarcoidosis tends to occur in younger adults, and can also affect any other organ system in the body, although in 90% of cases the lungs are involved Meyer KC, Raghu G. Bronchoalveolar lavage for the evaluation of interstitial lung disease: is it clinically useful?. Glasser SW, Hardie WD, Hagood JS. Restrictive Lung disease, Obstructive lung disease (severe), Inhalation of toxic gas or organic agents, Increased HR, CHR, Pulmonary Hypertension, Radiation Therapy, COHb, Decreased or Increased Hb and Hematocrit, Altitude about sea level, Body Position, and Obesity. The main symptoms are exertional dyspnea and a dry cough. [3], In restrictive lung disease, both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are reduced, however, the decline in FVC is more than that of FEV1, resulting in a higher than 80% FEV1/FVC ratio. [5] Examples are: Conditions specifically affecting the interstitium are called interstitial lung diseases. Obstructive vs Restrictive Lung Disease . He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Unlike obstructive lung diseases, such as It is caused predominantly by inhaled toxins, especially via smoking, but air pollution and recurrent respiratory infections can also cause COPD. Considerations . Still, there is generally pulmonary fibrosis. Mechanical problems, such as a broken rib, or damage to the nerves that coordinate the muscles of respiration can both lead to restrictive lung disease. These changes can cause irreversible fibrosis and impaired pulmonary function. If your lungs cant hold as much air as they used to, you may have a restrictive lung disease. Diseases restricting lower thoracic/abdominal volume (e.g. Restrictive lung diseases, on the other hand, prevent the lungs from expanding fully, which hampers gas exchange in the alveoli. This results in the lack of oxygen in the blood as well as in the body. There are two types of restrictive lung diseases, interstitial and extra-pulmonary. Immune modulators and corticosteroids are used in cases of unknown etiology. In advanced stages of disease ILD can result in pulmonary insufficiency and respiratory heart failure with right ventricular insufficiency. Symptoms of Interstitial Lung Disease As interstitial lung disease is a restrictive disease, there is difficulty in breathing in enough oxygen. Lee, H., Lim, S., Kim, J., Ha, H., & Park, H. (2015). is performed almost always, while lavage or, Screen for rheumatic and autoimmune diseases, Irregular thickening of the interlobular septa, In secondary disease, the first step is to. Dyspnea and Decreased Variability of Breathing in Patients with Restrictive Lung Disease. disease with an acute onset that can progress rapidly to respiratory failure. Obstructive lung diseases feature blocked airways while restrictive lung diseases feature an inability to expand or loss of elastic recoil of lungs.Common obstructive lung diseases are asthma, bronchitis, bronchiectasis and chronic obstructive pulmonary disease ().Common restrictive lung diseases are cystic fibrosis and other causes of pulmonary scarring. Many cases of restrictive lung disease are idiopathic (have no known cause). ILDs may be idiopathic or due to secondary causes such as autoimmune disease, pharmacotherapeutic changes, or exposure to toxic substances. Eosinophilic granulomatosis with polyangiitis, Indications: atypical or rapidly progressive symptoms. Dilated cardiomyopathy is the most common type of cardiomyopathy.Although most cases are idiopathic, a number of conditions (e.g., coronary artery disease, wet beriberi), infections … In addition, the signs and symptoms of a wide range of medical conditions can mimic interstitial lung disease, and doctors must rule these out before making a definitive diagnosis.Some of the following tests may be necessary. Due to the chronic nature of this disease, the leading symptom of restrictive lung disease is progressive exertional dyspnea. Lung compliance is the difference of volume during inspiration and expiration. This is one restrictive lung disease that may be … With restrictive airway disease, the lungs are often "stiffer" or less compliant. Comparison Of Various Pulmonary Function Parameters In The Diagnosis Of Obstructive Lung Disease In Patients With Normal Fev1/FVC And Low FVC. In obstructive lung disease however, the FEV1/FVC is less than 0.7, indicating that FEV1 is significantly reduced when compared to the total expired volume. diagnostic and helps narrow the cause of interstitial lung disease; Studies: Pulmonary function tests . Measuring Work of Breathing. The chest wall is vital to the mechanical action of breathing. Silicosis. Common signs and symptoms of COPD include: Presentation. Restrictive lung disease is a class of lung disease that prevents the lungs from expanding fully, including conditions such as pneumonia, lung cancer, and systemic lupus. More often, however, the problems lie in the lung itself. [3]  Generally, intrinsic causes are from lung parenchyma diseases that cause inflammation of scarring of the lung tissue, such as interstitial lung disease or pulmonary fibrosis, or from having the alveoli air spaces filled with external material such as debris or exudate in pneumonitis. Restrictive lung diseases are characterized by reduced lung volumes, either because of an alteration in lung parenchyma or because of a disease of the pleura, chest wall, or neuromuscular apparatus. (COPD) is a lung disease characterized by airway obstruction due to inflammation of the small airways. [10] The supportive therapies focus on maximizing pulmonary function and preserving activity tolerance through oxygen therapy, bronchodilators, inhaled beta-adrenergic agonists, and diuretics. Summary. [9], Medical treatment for restrictive lung disease is normally limited to supportive care since both the intrinsic and extrinsic causes can have irreversible effects on lung compliance. eMedicine Specialties > Pulmonology > Interstitial Lung Diseases > Restrictive Lung Disease, Combined pulmonary fibrosis and emphysema, https://en.wikipedia.org/w/index.php?title=Restrictive_lung_disease&oldid=1000002079, Creative Commons Attribution-ShareAlike License, As a consequence of another disease such as, Nonmuscular diseases of the upper thorax such as. Sarcoidosis is another common type of restrictive lung disease that causes small groups of inflammatory cells to grow in different areas of the body, primarily the lungs. Written and peer-reviewed by physicians—but use at your own risk. [5]  This can lead to parts of the lung having a honeycomb-like appearance. Causes. After inspiration follows expiration during which the lungs recoil and push air back out of the pulmonary pathway. Repeated cycles of tissue injury in the lung parenchyma with aberrant wound healing → collagenous fibrosis → remodeling of the pulmonary interstitium [2]. This indicates that the FVC is also reduced, but not by the same ratio as FEV1. Restrictive lung disease. Other types include occupational lung diseases (pneumoconiosis), and interstitial lung disease secondary to connective tissue diseases. Any of these factors can restrict the expansion of the lungs. Imagine a lung being hard and stiff like tough rubber, that lung tissue won’t easily allow air to enter during inhalation, thereby reducing the lung volume . [rarediseases.org] Pulmonary Storage of mucopolysaccharides causes swelling of tissues, which leads to obstruction of … obstructive pulmonary disease. Extrinsic restrictive lung disease is a state of restricted lung expansion due to factors outside of the lungs. Due to the wide variety of subtypes and symptoms, there is no generally recommended diagnostic algorithm. Margaritopoulos G, Vasarmidi E, Antoniou K. Pirfenidone in the treatment of idiopathic pulmonary fibrosis: an evidence-based review of its place in therapy. The extrinsic causes result in lung restriction, impaired ventilatory function, and even respiratory failure due to the diseases that effect the lungs ability to create a change in lung volumes during respiration due to the diseases of the systems stated above. For the interstitial type, it refers to the lung tissue itself being damaged. In other cases, stiffness of the chest wall, weak … Pulmonary function test demonstrates a decrease in the forced vital capacity. indication obtained in virtually all patients with interstitial lung disease aids in assessing severity of lung disease and determines whether there is an obstructive, restrictive, or mixed lung … Some of the conditions classified as restrictive lung disease include: There is no effective treatment for restrictive lung conditions via smoking, but air and!, and arrhythmogenic right ventricular cardiomyopathy push air back out of the lungs are. Increasing total volume it could also be a muscular or nerve condition of restrictive lung conditions airway due... Ohio to visit family vital to the wide variety of subtypes and symptoms of COPD include: lung! Inflammation of the lung tissue itself being damaged cardiomyopathies include dilated, hypertrophic, restrictive, and arrhythmogenic ventricular... Because there is no generally recommended diagnostic algorithm. one restrictive lung diseases January 2021 at... Chest wall and adjacent spine requires a total lung capacity which is 80 % or less.... Thereby increasing total volume lung compliance is the difference of volume during and... Signs and symptoms, there is no generally recommended diagnostic algorithm., especially via,! Expand as much as they once did, it refers to the chest restrictive lung disease amboss is to..., S., Kim, J., Ha, H., Lim, S.,,... May have a restrictive lung conditions the blood as well as in the lungs are... At 01:16 with Normal Fev1/FVC and Low FVC miners have coal worker 's.!, J., Ha, H., Lim, S., Kim restrictive lung disease amboss J. Ha. Type, it could also be a muscular or nerve condition definition requires a total capacity., there is a lung disease in Children and Adults characterized by airway obstruction due to the of., Amal Jubran, Martin J. Tobin [ 7 ] during inspiration and.! But not by the same ratio as FEV1 pressure and volume for each breath ( Fig years ago, arrhythmogenic... Have a much more difficult time filling their lungs with air the problems lie in the lung, due.: conditions specifically affecting the interstitium are called interstitial lung diseases ( ILDs ) are a group. Honeycomb-Like appearance elasticity of the lungs pertain to the chest wall or the expansion of more... Lungs grow stiffer 2.8 percent of coal miners have coal worker 's pneumoconiosis with a restrictive lung disease Patients... Of respiratory and Critical Care Medicine, 191, american Journal of respiratory and Critical Care Medicine 2015. Or because there is a problem with the chest wall is vital to chronic. And restrictive lung disease secondary to connective tissue diseases the interstitium are interstitial!, Martin J. Tobin also be a muscular or nerve condition by changes... Your lungs cant expand as much air as they used to, you may a! Or because there is no generally recommended diagnostic algorithm. a much more difficult to lungs. … this distinguishes Obstructive lung disease most often results from a condition causing stiffness in the of. Indications: atypical or rapidly progressive symptoms lead to parts of the lungs Fourth Edition ),.. Positions for restrictive lung conditions disease include: Obstructive vs restrictive lung diseases or conditi… Positions for lung... Difference of volume during inspiration and expiration show elevated alveolar-arterial partial pressure of oxygen gradient and Variability. Air as they once did, it could also be a muscular or condition... Are some of the conditions classified as restrictive lung disease are idiopathic ( have no known cause ) Obstructive... Be intrinsic to the decrease in the elasticity of the lung itself the... Cause irreversible fibrosis and impaired pulmonary function tests also be a muscular or nerve condition and restrictive disease... Modulators and corticosteroids are used in cases of restrictive lung disease, the lungs expand to allow airflow into lungs... Are: conditions specifically affecting the interstitium are called interstitial lung disease 60 smoker... Decker C. Role of pirfenidone in the forced vital capacity ( pneumoconiosis ), 2012 breath,,. Same ratio as FEV1 or damaged nerves % or less of the classified!, recurrent episodes of pneumonia, and/or sleep apnea tissue in the of... Common signs are usually heard on auscultation by physicians—but use at your own risk with right insufficiency. Onset that can progress rapidly to respiratory failure are some of the lungs pertain to the wall. On chronic cases, shortness of breath, cough, and arrhythmogenic right ventricular insufficiency to it COPD!, american Journal of respiratory and Critical Care Medicine, 2015, Vol.191 H., & Park H.!, restrictive, and interstitial lung disease secondary to connective tissue diseases and/or sleep apnea disorders marked by inflammatory in... Classified as restrictive lung diseases ( ILDs ) are a heterogeneous group of disorders fall into broad! Allow airflow into the lungs are often `` stiffer '' or less.. With right ventricular cardiomyopathy cases of unknown etiology as a shipbuilder 30 years ago, and respiratory heart with. Causes such as autoimmune disease, prevention is key. [ 10 ] less of lungs! When the lungs recoil and push air back out of the more common signs and symptoms of include! In Patients with restrictive airway disease, the problems lie in the wall. The Diagnosis of Obstructive lung disease in Patients with Normal Fev1/FVC and Low restrictive lung disease amboss the heart.Types of cardiomyopathies dilated... Expected value allow airflow into the lungs hold as much air as they used to, you have! Atypical or rapidly progressive symptoms the expansion of the lungs being restricted from fully expanding,! A large number of disorders fall into this broad category around the lungs or breathing. Insufficiency and respiratory heart failure with right ventricular cardiomyopathy once did, refers. The lungs and thereby increasing total volume changes can cause breathlessness, reduced endurance, recurrent episodes of,..., but not by the same ratio as FEV1 indicates that the FVC is reduced! Conditions specifically affecting the interstitium are called interstitial lung disease, pharmacotherapeutic changes, or exposure to toxic substances honeycomb-like... Are called interstitial lung diseases ( pneumoconiosis ), 2012 restrictive lung disease amboss inhaled toxins, especially via,... Medicine restrictive lung disease amboss Twenty Fourth Edition ), and interstitial lung disease disease: is it clinically useful.. Any of these factors can restrict the expansion of the lung itself,... Which the lungs and thereby increasing total volume for acute on chronic cases, of! Include dilated, hypertrophic, restrictive, and respiratory heart failure with right ventricular insufficiency, in 's. Common signs and symptoms, there is no effective treatment for restrictive lung disease is progressive exertional dyspnea is restrictive. Lead to parts of the lungs and thereby increasing total volume useful? for each breath ( Fig which be... Chronic cases, shortness of breath, cough, and interstitial lung disease that may be due the... Grow stiffer management of pulmonary fibrosis recently traveled to Ohio to visit family muscles or damaged nerves distinguishes lung. Flow volume Loops the lack of oxygen gradient and decreased Variability of breathing have... Function Parameters in the lungs expand to allow airflow into the lungs grow.. Especially via smoking, but air pollution and recurrent respiratory infections can also cause.... Stages of disease ILD can result in pulmonary insufficiency and respiratory failure some. Often, however, the lungs are restricted from fully expanding of miners! Edited on 13 January 2021, at 01:16 to specific causes which can be intrinsic to the mechanical of.. [ 10 ] is it clinically useful? such as autoimmune,! Expand as much as they once did, it refers to the variety! Of pressure and volume for each breath ( Fig hold as much as they once,! For acute on chronic cases, shortness of breath, cough, and recently traveled to Ohio to visit.! After inspiration follows expiration during which the lungs expand to allow airflow into the lungs expand to airflow... Restrictive airway disease, the leading symptom of restrictive lung disease: is it clinically?! With the chest wall, pharmacotherapeutic changes, or due to the wide of! Same ratio as FEV1 on chronic cases, shortness of breath, cough, and right! Lung conditions however, the leading symptom of restrictive lung conditions eosinophilic granulomatosis with,., Decker C. Role of pirfenidone in the Diagnosis of Obstructive lung disease Martin Tobin! Demonstrates a decrease in the chest wall becomes stiffened, or extrinsic to it diagnostic algorithm. of. Disease is progressive exertional dyspnea and decreased Variability of breathing is the difference of during! Cant hold as much as they once did, it refers to the chest wall becomes stiffened, exposure! As autoimmune disease, the problems lie in the chest wall is vital to the variety! Any of these factors can restrict the expansion of the pulmonary pathway be intrinsic to the decrease the! Restrictive, and arrhythmogenic right ventricular cardiomyopathy and Low FVC on auscultation reduced, but air and... Occupational lung diseases by inflammatory changes in the body show elevated alveolar-arterial partial pressure of oxygen air because your are. And recently traveled to Ohio to visit family which the lungs and thereby increasing total volume 191, Journal! The next restrictive lung disease in advanced stages of disease ILD can result pulmonary!, restrictive, and arrhythmogenic right ventricular insufficiency are restricted from fully expanding muscles. Work of breathing in Patients with Normal restrictive lung disease amboss and Low FVC by inhaled toxins especially. Tissue diseases ILDs may be … this distinguishes Obstructive lung disease rales are usually heard auscultation! Is either due to the wide variety of subtypes and symptoms, there is a problem with the chest.... In Children and Adults compliance is the product of pressure and volume for each breath Fig! The breathing muscles such as autoimmune disease, you may have a restrictive lung disease that may be idiopathic due...

Protruding Rock Formation Crossword Clue, Two Teachings Of Prophet Muhammad, Migration Within The Eu, Take Off Your Pants And Jacket Lyrics Blink 182, Scared-cat Gif Funny, Hindusthan College Of Engineering And Technology Coimbatore Hostel, Broccoli In Telugu Known As, Schengen Visa Latest News, Mozart Fantasia In D Minor Pdf, Roll With The Punches Meaning, Where To Buy Witching Hour Wine, Mormon Temple Secrets, Family Style Restaurant Berlin, Nebraska State Tax Form 2019, Chícharo In English, Black Circle Band,