Obstructive and restrictive lung diseases: symptoms, treatment.

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One of the first steps in diagnosing lung disease is the differentiation between obstructive lung disease and restrictive lung disease. Although both types can cause shortness of breath , obstructive lung diseases (such as asthma and chronic obstructive pulmonary disease) make it difficult to exhale, while restrictive lung diseases (such as pulmonary fibrosis) can cause problems by limiting a person's ability to breathe air. . …

This difference may not be obvious at first, but it can be discerned using a set of diagnostic tests that assess a person's breathing capacity and strength.

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Causes

There are many different obstructive and restrictive lung diseases, some with common causes and some not.

Obstructive

Obstructive pulmonary disease is characterized by a blockage of the airways with obstruction, defined by a slower and shallow expiration than in people without the disease.

Blockage can occur when inflammation and swelling cause the airways to narrow or become blocked, making it difficult for the lungs to clear the air. This leads to the fact that an abnormally large volume of air remains in the lungs (that is, an increased residual volume). This leads to both air trapping and hyperinflation of the lungs, changes that contribute to worsening respiratory symptoms.

Obstructive lung diseases include:

Restrictive

Unlike obstructive lung disease, limiting conditions are determined by inhalation.   It fills the lungs much less than you would expect from a healthy person.

Restrictive lung diseases are characterized by a reduction in total lung capacity or total residual volume combined with forced vital capacity (the amount of air that can be forcefully exhaled after taking a deep breath).

This is mainly due to the difficulty in filling the lungs completely. Restrictive lung diseases can be caused by internal, external, or neurological factors.

Internal restrictive lung disease

Internal restrictive disorders are those that arise from a restriction in the lungs (often "stiffness") and include:

External restrictive lung disease

External restrictive disorders include those that occur outside of the lungs. These include violations caused by:

Neurological restrictive lung disease

Restrictive neurological disorders are disorders caused by disorders of the central nervous system that interfere with the movement necessary to get air into the lungs. Among the most common reasons :

A person may also have symptoms and tests that suggest a combination of obstructive and restrictive disease (for example, when a person has COPD and pneumonia). Also, some diseases, such as silicosis, cause obstruction in the early stages of the disease and a restrictive pattern as the condition progresses.

Symptoms

The symptoms of restrictive and obstructive lung disease can greatly overlap, so pulmonary function tests are often necessary to make a diagnosis .

Symptoms common to obstructive and restrictive conditions include:

Obstructive symptoms

When it is obstructed, it can be difficult for a person to remove all the air from the lungs. This is often worse with physical activity because as your breathing rate increases, it becomes difficult to get all the air out of your lungs before you breathe again.

Narrowing of the airways can lead to wheezing and increased mucus (phlegm) production.

Restrictive symptoms

With restrictive lung disease, a person may find it difficult to breathe deeply, and this can sometimes lead to a lot of anxiety.

With external lung disease, a person may change positions, trying to find one that makes it easier for them to breathe.

Symptoms of obstructive disease
Symptoms of restrictive disease

  • It's hard to breathe air

  • Breathing problems can cause panic

  • Can change posture to facilitate breathing (external cases)

Diagnostics

The diagnosis of obstructive or restrictive pulmonary disease begins with a complete medical history and physical examination, although pulmonary function tests and imaging tests are very important, especially when the diagnosis is unclear.

These tests can also help doctors understand if there is more than one disease at the same time, especially if a mixed picture is found.

Pulmonary function tests.

Spirometry is a common office test used to assess how well your lungs are working by measuring the amount of air you breathe and the amount / rate of exhalation. This can be very helpful in differentiating between obstructive and restrictive lung diseases, as well as in determining the severity of these diseases.

This test can determine the following:

  • Forced Vital Capacity (FVC) : Forced Vital Capacity measures how much air you can forcefully exhale after inhaling as deeply as possible.
  • Forced Expiratory Volume in One Second (FEV1) : Forced Expiratory Volume in One Second measures the total amount of air that can be forcefully exhaled in the first second of the FVC test. Healthy people typically expel 75% to 85% during this time. FEV1 decreases in obstructive lung diseases and from normal to minimally reduced in restrictive lung diseases.
  • FEV1 / FVC Ratio : The FEV1 to FVC ratio measures the amount of air that a person can forcefully exhale in one second, relative to the total amount of air that they can exhale. This relationship is reduced in obstructive lung disease and, usually, in restrictive lung disease. In an adult, the normal FEV1 / FVC ratio is 70% to 80%; a child has a normal ratio of 85% or more. The FEV1 / FVC ratio can also be used to determine the severity of obstructive pulmonary disease .
  • Total Lung Capacity (TLC) : Total Lung Capacity (TLC) is calculated by adding the volume of air remaining in the lungs after expiration (residual volume) with the FVC. Normal or increased TLC in obstructive defects and decreased in restrictive defects. In obstructive lung disease, air remains in the lungs (air trapping or hyperinflation), causing an increase in TLC.

Other types of lung function tests may be required:

  • Lung plethysmography measures the amount of air that remains in the lungs after expiration ( functional residual capacity ) and may be helpful when there is overlap with other lung function tests. It calculates how much air is left in the lungs (residual capacity), which is a measure of the elasticity of the lungs. With restrictive airway disease, the lungs often become stiffer or less elastic.
  • Diffusing capacity (DLCO) determines how well oxygen and carbon dioxide can diffuse between the tiny air sacs ( alveoli ) and blood vessels ( capillaries ) in the lungs. This number may be low in some restrictive lung diseases (eg, pulmonary fibrosis) because the membrane is thicker; it can be low in some obstructive diseases (eg, emphysema) because the surface area for this gas exchange is less.

Obstructive and restrictive pulmonary patterns

Measurement

Obstruction pattern

Restrictive pattern

Forced vital capacity (FVC)

Decreased or normal

Reduced

Forced expiratory volume
in one second (FEV1)

Reduced

Decreased or normal

FEV1 / FVC ratio

Reduced

Normal or elevated

Total lung capacity (TLC)

Normal or elevated

Reduced

Lab tests

Laboratory tests can indicate the severity of the lung disease, but are not very helpful in determining whether it is obstructive or restrictive in nature.

Oximetry, which measures oxygen in the blood, can be low in both types of disease. Arterial blood gases can also indicate low oxygen levels and sometimes elevated levels of carbon dioxide ( hypercapnia ). In chronic lung disease, hemoglobin levels often rise in an attempt to transport more oxygen to the cells of the body.

Visual investigation

Tests such as a chest x-ray or chest computed tomography (CT) scan can provide clues as to whether the lung disease is obstructive or restrictive if such images can diagnose an underlying condition such as pneumonia or rib fracture. …

Procedures

Bronchoscopy is a test in which a lighted tube with a camera is passed through the mouth and down into the large airways. As with imaging studies, it can sometimes be used to diagnose the underlying disease.

Watch out

Treatment options for obstructive and restrictive pulmonary disease vary considerably, although treatment options can vary significantly depending on the specific underlying cause.

Medicines that widen the airways (bronchodilators) can be very helpful for obstructive lung diseases like COPD and asthma. Inhaled or oral steroids are also often used to reduce inflammation.

Treatment options for restrictive lung disease are more limited. For extrinsic restrictive lung disease, treatment of the underlying cause, such as pleural effusion or ascites, may improve. For congenital restrictive lung disease, such as pneumonia, treating the condition can also help. Until recently, there was little that could be done to treat idiopathic fibrosis , but medications are now available that can reduce its severity .

Supportive care can be beneficial for both types of lung disease and can include supplemental oxygen, non-invasive ventilation (such as CPAP or BiPAP), or mechanical ventilation. Pulmonary rehabilitation can be helpful for those who have COPD or have had surgery for lung cancer.

In severe cases, lung transplantation is also sometimes possible.

Forecast

The prognosis for obstructive or restrictive lung disease depends more on the specific condition than on the category of lung disease. In obstructive pulmonary disease, reversible disease often has a better prognosis than not.

Get the word of drug information

Waiting for test and exam results can be frustrating, but keep in mind that diagnosing a lung disease as obstructive or limiting can involve several steps. And getting an official diagnosis is important, as this distinction helps ensure effective treatment for you. Find a healthcare team you trust and make sure the channels of communication are open, ask questions, and seek answers so you can take responsibility for your health.

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