Health & Medicine General Medicine

Obstructive Vs Restrictive Lung Disease


We all know that the main function of the lungs is to carry out gas exchange within the body. That is, through the alveoli, oxygen from the air passes into the blood, and carbon dioxide from the blood is expelled into the air.

During this process, there are other structures of the respiratory system that also play an important role. The respiratory muscles are responsible for the entry and exit of air from the lungs; the trachea supplies air to the bronchi, which branch into smaller tubes called bronchioles until they reach the alveolar sacs where gas exchange takes place.

All this function can be affected if we suffer from a lung disease, our respiratory system becomes damaged and this causes the lungs not to work properly.

Depending on the origin of the problem, respiratory diseases are classified as obstructive or strictive.

What is obstructive lung disease?

Obstructive Lung disease is characterized by limited expiratory airflow due to damage to the interior of the airway. On expiration, the air is more resistant due to partial or complete obstruction of the airways. It is usually caused by thick mucus and lung secretions .

The most common symptoms in patients suffering from this type of disease are: increased secretions, cough and difficulty breathing, especially in situations of physical effort.

Among the best known obstructive pulmonary diseases we find: COPD, chronic bronchitis, bronchiectasis and cystic fibrosis among others.

In other words, Obstructive lung disease includes conditions that make it difficult to breathe out and breathe in general. The main symptom of obstructive pulmonary disease is persistent shortness of breath.

People with obstructive pulmonary disease suffer from shortness of breath, due to the fact that it is difficult for them to exhale the air that has accumulated in the lungs. Exhaled air comes out more slowly due to damage to the lungs or narrowing of the airways. Air can be trapped in the lungs at the end of a full expiration.

Lung obstruction is accompanied by dry cough (or wet cough with a small amount of white sputum), hypoxia. In severe cases, the person feels that he is suffocating. Bronchobstruction is reversible; in order to relieve an attack, it is necessary to inhale medicinal substances through an inhaler. Usually people call an ambulance for a severe attack of obstruction. Then the visiting specialists inject intramuscular corticosteroid drugs to relieve the attack.

The most common causes of obstructive lung disease are:

  • Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
  • Asthma
  • Bronchiectasis
  • Cystic fibrosis

Obstructive pulmonary disease makes breathing difficult, especially with increased physical exertion. As the breathing rate increases, you have less time to exhale all the air before inhaling again.

What is restrictive lung disease?

Restrictive lung disease is characterized by a limitation of inspiratory airflow since there are restrictions that prevent the lungs from fully expanding.

The reason why these restrictions usually appear is damage to the lung tissue itself. Scarring or inflammation of the structure that lines the lungs makes them less elastic and unable to fully expand, and as a consequence the total lung capacity decreases.

General symptoms of restrictive lung diseases include shortness of breath, a choking sensation, and chest pain.

Among the main restrictive lung diseases we find: pulmonary fibrosis, pleural effusion and pneumothorax, among others.

So, Restrictive lung diseases lead to a decrease in lung volume, as well as damage to the pleura, chest wall, diaphragm and impaired neuromuscular transmission. Restrictive lung diseases can be acute or chronic.

People with restrictive lung disease cannot completely fill their lungs with air. Their lungs do not expand completely.

The conditions causing restrictive lung disease are as follows:

  • Interstitial lung disease such as idiopathic pulmonary fibrosis
  • Sarcoidosis, an autoimmune disease
  • Obesity, including obesity hypoventilation syndrome
  • Scoliosis
  • Neuromuscular disease such as muscular dystrophy or amyotrophic lateral sclerosis (ALS)

Symptoms of Obstructive and restrictive lung disease

Obstructive pulmonary disease and restrictive lung disease cause shortness of breath. In the early stages of obstructive or restrictive lung disease, shortness of breath occurs only with exertion.

If lung disease progresses, shortness of breath may occur with minimal activity or even at rest. Cough is a common symptom in restrictive and obstructive lung disease. As a rule, the cough is dry or productive, those are wet, with a discharge of white phlegm.

Symptoms of depression and anxiety are also common among people with obstructive and restrictive lung disease. These symptoms occur more often when lung disease causes significant restrictions on activity and lifestyle.

Obstructive Lung Diseases

The following lung diseases are classified as obstructive:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic bronchitis
  • Asthma
  • Bronchiectasis
  • Bronchiolitis
  • Cystic fibrosis

Restrictive (intrinsic) lung diseases

Intrinsic restrictive disorders are those that occur due to restriction in the lungs (often a “stiffness”) and include:

  • Pneumonia
  • Pneumoconiosis
  • Adult respiratory distress syndrome (ARDS)
  • Eosinophilic pneumonia
  • Tuberculosis
  • Sarcoidosis
  • Interstitial lung diseases due to a known cause (such as   pulmonary fibrosis  ) and   idiopathic pulmonary fibrosis
  • Lobectomy  and  pneumonectomy  (lung cancer surgery)

Restrictive (extrinsic) lung diseases

Extrinsic restrictive disorders refer to those that originate outside of the lungs. These include deterioration caused by:

  • Scoliosis
  • Obesity
  • Hypoventilation syndrome of obesity.
  • Pleural effusion
  • Malignant tumors
  • Ascites (abdominal swelling caused by cirrhosis or liver cancer)
  • Pleurisy
  • Rib fractures

Diagnosis of obstructive and restrictive lung disease

The diagnosis of obstructive or restrictive lung disease begins with a careful history and physical examination, although pulmonary function tests and imaging tests are very important, especially when the diagnosis is unclear. Sometimes these tests can also help doctors understand if more than one condition is present at the same time, especially when a mixed pattern is found.

Most often, people with obstructive or restrictive lung disease see a doctor because they are short of breath and short of breath.

As Restrictive and obstructive pulmonary diseases are detected by pulmonary function tests, when  a person performs various breathing maneuvers, the machine records the volume and flow of air through the lungs. Pulmonary function testing can detect the presence of obstructive pulmonary disease or restrictive lung disease and determine their severity.

Physician surveys (including smoking history), physical examination, and laboratory tests can provide additional information about the cause of obstructive pulmonary disease or restrictive lung disease.

Imaging tests are almost always part of the diagnosis of restrictive and obstructive pulmonary disease. These may include research such as:

  • Chest x-ray
  • Computed tomography (CT) of the chest

In some people with obstructive pulmonary disease, bronchoscopy may be recommended. In a bronchoscopy, a doctor uses an endoscope (a flexible tube with a camera and tools at the tip) to look inside the airway and take samples of lung tissue (biopsy).

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