Obstructive and restrictive pulmonary disorders affect breathing in different ways. Obstructive disorders limit airflow, while restrictive disorders reduce lung volumes. Both can cause shortness of breath and other respiratory symptoms.
Management of these disorders involves various diagnostic tests and treatments. Bronchodilators and corticosteroids are common for obstructive disorders, while restrictive disorders may require treatment of underlying causes and supportive care.
Obstructive Pulmonary Disorders
Obstructive vs restrictive pulmonary disorders
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Obstructive pulmonary disorders
Airflow limitation impairs normal breathing characterized by increased airway resistance
Normal or increased total lung capacity (TLC) due to air trapping
Decreased forced expiratory volume in 1 second (FEV1) indicates difficulty exhaling quickly
Reduced FEV1/FVC ratio below 70% suggests airflow obstruction (FVC: forced vital capacity)
Restrictive pulmonary disorders
Reduced lung volumes limit the amount of air the lungs can hold
Decreased TLC indicates overall reduction in lung capacity
Normal or increased FEV1/FVC ratio as both values decrease proportionally
Reduced lung compliance makes breathing more difficult due to stiff lung tissue
Clinical presentation differences
Obstructive: wheezing during exhalation, prolonged expiration, barrel chest deformity
Restrictive: rapid, shallow breathing pattern, reduced chest expansion during inhalation
Pathogenesis of obstructive pulmonary disorders
Chronic Obstructive Pulmonary Disease (COPD)
Pathogenesis
Chronic inflammation of airways leads to thickening and narrowing
Destruction of lung parenchyma results in emphysema and reduced gas exchange
Loss of elastic recoil impairs ability to fully exhale
Risk factors
Smoking tobacco primary cause of COPD
Occupational exposure to irritants (dust, chemicals, fumes)
Alpha-1 antitrypsin deficiency genetic disorder increases susceptibility
Clinical manifestations
Chronic cough often worse in mornings
Sputum production may be clear, white, or yellowish
Dyspnea on exertion progressively worsens over time
Pursed-lip breathing helps relieve shortness of breath
Asthma
Pathogenesis
Airway hyperresponsiveness causes exaggerated bronchial constriction to stimuli
Reversible bronchoconstriction occurs during asthma attacks
Chronic airway inflammation leads to remodeling over time
Risk factors
Genetic predisposition increases likelihood of developing asthma
Allergies to environmental substances (pollen, dust mites)
Environmental triggers (cold air, exercise, stress)
Clinical manifestations
Episodic wheezing during asthma exacerbations
Chest tightness sensation of constriction
Shortness of breath varies in severity
Nocturnal cough often worse at night or early morning
Restrictive Pulmonary Disorders
Features of restrictive pulmonary disorders
Interstitial lung diseases (ILDs)
Pathophysiology
Inflammation and fibrosis of lung interstitium reduce lung elasticity
Reduced lung compliance increases work of breathing
Impaired gas exchange leads to hypoxemia
Causes
Idiopathic pulmonary fibrosis unknown etiology
Sarcoidosis granulomatous disease affecting multiple organs
Occupational exposures (asbestosis, silicosis, coal worker's pneumoconiosis)
Clinical features
Nonproductive cough dry and persistent
Progressive dyspnea worsens over time
Fine crackles on auscultation heard at lung bases
Clubbing of fingers late sign of chronic hypoxemia
Neuromuscular disorders affecting the respiratory system
Pathophysiology
Weakness of respiratory muscles impairs ventilation
Reduced lung volumes due to inadequate inspiration
Impaired cough reflex increases risk of respiratory infections
Causes
Amyotrophic lateral sclerosis (ALS) progressive motor neuron degeneration
Myasthenia gravis autoimmune disorder affecting neuromuscular junction
Guillain-Barré syndrome acute inflammatory demyelinating polyneuropathy
Clinical features
Shortness of breath initially with exertion, progresses to rest
Orthopnea difficulty breathing when lying flat
Weak cough ineffective clearance of secretions
Respiratory failure in advanced stages may require ventilatory support
Management of pulmonary disorders
Diagnostic approaches
Pulmonary function tests (PFTs)
Spirometry measures airflow and lung volumes
Lung volumes measurement assesses TLC and residual volume
Diffusion capacity evaluates gas exchange efficiency
Imaging studies
Chest X-ray identifies structural abnormalities
High-resolution computed tomography (HRCT) detailed lung parenchyma imaging
Blood gases analysis assesses oxygenation and ventilation
Exercise testing evaluates functional capacity and oxygen needs
Management strategies for obstructive disorders
Bronchodilators (beta-2 agonists, anticholinergics) relax airway smooth muscle
Inhaled corticosteroids reduce airway inflammation
Smoking cessation crucial for slowing COPD progression
Pulmonary rehabilitation improves exercise tolerance and quality of life
Oxygen therapy for severe cases with chronic hypoxemia
Management strategies for restrictive disorders
Treatment of underlying cause (if known) may slow disease progression
Corticosteroids for inflammatory conditions reduce lung inflammation
Antifibrotic medications for certain ILDs (pirfenidone, nintedanib)
Supportive care and symptom management improve quality of life
Mechanical ventilation for respiratory failure when necessary
General management approaches
Vaccination against respiratory infections (influenza, pneumococcal)
Nutritional support maintains muscle strength and immune function
Patient education on disease management improves self-care
Regular follow-up and monitoring of disease progression guides treatment adjustments