The physician will ask the patient questions about their overall health and symptoms, which will include information on their exposure to environmental irritants like pollution and smoke and their medical history. Physical exam. The physician performs a physical exam including listening to the lungs and checking to see if the patient has a widened, barrel chest. Wheezing, crackling, long exhalation time, and decreased breath sounds may be indicative of obstructive lung disease.
Imaging tests. Some imaging tests may be performed, like an X-ray or CT scan of the chest. Sometimes, the physician will look at the patient's lungs with a flexible, thin lighted camera known as a bronchoscope. This procedure checks for obstructions and lung damage. Treatments for obstructive lung disease work by opening up narrowed airways. Smooth muscle spasms in the airway walls often narrow the airways causing bronchospasm. Medication for relaxing these smooth muscles and improving airflow are known as bronchodilators.
These medications are typically inhaled and may include:. In severe life-threatening, end-stage cases of obstructive lung disease, the patient may receive a lung transplant. Individuals with restrictive lung disease can't fill their lungs fully with air due to their lungs being restricted from expanding fully. These individuals find it difficult to take a full breath.
Frequently this occurs due to a condition that causes lung stiffness, muscle weakness, or physical restriction. This condition often results from disorders that cause lung stiffness. In other cases, weak muscles, stiffness of the chest wall or damaged nerves could be causing the lung expansion restriction. You can categorize restrictive lung diseases as intrinsic or extrinsic. Intrinsic disorders come from an issue within the lungs themselves.
They might include:. Extrinsic disorders cause lung issues to occur from conditions outside of the patient's lungs, meaning the lung issues and restriction originate from causes outside of the lungs. These might include:. There are a few common symptoms with the most common being shortness of breath. In the early stages, a patient might experience shortness of breath only with exertion.
As the condition progresses, the patient might begin to experience breathlessness or shortness of breath even during rest or minimal activity. Chronic cough is another common symptom. Often the cough is dry, but it could also create white sputum. Fatigue and weight loss are also common symptoms. Many individuals find it difficult to have sufficient energy to function well and maintain a healthy weight.
Neurological restrictive disorders are those caused by disorders of the central nervous system that interfere with movements necessary to draw air into the lungs. A person may also have symptoms and tests that suggest a combination of obstructive and restrictive disease for example, when a person has both COPD and pneumonia. In addition, some diseases, such as silicosis, cause an obstructive pattern in the early stages of the disease and a restrictive pattern when the condition is more advanced.
There can be significant overlap in symptoms between obstructive and restrictive lung diseases, which is why pulmonary function tests are often needed to make a diagnosis. Symptoms shared by both obstructive and restrictive conditions include:. With obstruction, a person may have difficulty expelling all of the air from the lungs. This often worsens with activity, since when respiratory rate increases, it becomes challenging to blow out all of the air in the lungs before taking the next breath.
Narrowing of the airways may cause wheezing , as well as increased mucus sputum production. With restrictive lung disease, a person may feel like it is hard to take a full breath, and this can cause considerable anxiety at times. With extrinsic lung disease, a person may change positions trying to find a one that makes it easier to breathe. Making a diagnosis of either obstructive or restrictive lung disease begins with a careful history and physical exam, though pulmonary function tests and imaging tests are very important, especially when the diagnosis is unclear.
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. It can be very helpful in differentiating obstructive and restrictive lung diseases, as well as determining the severity of these diseases.
This test can determine the following:. There are other types of pulmonary function tests that may be needed as well:. Lab tests may give an indication of the severity of lung disease, but are not very helpful in determining if it is obstructive or restrictive in nature.
Oximetry, a measure of the oxygen content in the blood, may be low in both types of diseases. Arterial blood gases may also reveal a low oxygen level and, sometimes, an elevated carbon dioxide level hypercapnia.
With chronic lung disease, hemoglobin levels are often elevated in an attempt to carry more oxygen to the cells of the body. Tests such as chest X-ray or chest computed tomography CT scan may give clues as to whether a lung disease is obstructive or restrictive if the underlying condition, such as pneumonia or a rib fracture, can be diagnosed with the help of such imaging. Bronchoscopy is a test in which a lighted tube with a camera is threaded through the mouth and down into the large airways.
Like imaging studies, it can sometimes diagnose the underlying condition. The treatment options are significantly different for obstructive and restrictive lung diseases, though treatments can vary considerably depending on the particular root cause.
With obstructive lung diseases such as COPD and asthma, medications that dilate the airways bronchodilators can be very helpful.
Inhaled or oral steroids are also frequently used to reduce inflammation. Because of that, breathing well becomes harder and air often gets trapped in the lungs. This results in something known as hyperinflation of the lungs. Exhaling becomes slower and shallower than in a person with a healthy respiratory system.
Restrictive lung disease is a condition where the lungs don't function effectively. People with this cannot take a full, deep breath and fill their lungs with air. This can be due to problems within the lungs themselves intrinsic or due to some kind of damage from external forces extrinsic.
With intrinsic disorders , the lungs' restriction is related to weak muscles, stiffness in the chest wall or damaged nerves. With extrinsic disorders , other non-respiratory diseases end up causing problems with the function of the airways and lungs.
These can include: 1. Also, both obstructive and restrictive disease will be diagnosed by using a careful medical history and a variety of pulmonary function tests. The results of those tests and your history will help a doctor determine which type of lung disease you might have.
In general, both types of disease can be progressive and worsen over time, although this is not true of all conditions. How quickly that occurs depends greatly on your stage or level of illness at the time you are diagnosed, as well as other health factors such as age. But both kinds of diseases are treatable and the progression can be slowed. There are varying levels or stages assigned to both restrictive and obstructive lung disease, ranging from mild to severe.
However, keep in mind that different measures are used to place people into those stages. Although some of the symptoms are the same, the actual quality of those symptoms can differ.
For example, COPD, which is an obstructive disease, usually has a chronic cough that includes excess mucus. On the other hand, restrictive diseases tend to have more of a dry cough. However, asthma, which is obstructive, also tends more to a dry cough than a "wet" one.
Lung diseases affect each person differently. Notice in the obstructed lung below left , how FVC is smaller than normal, but also that FEV 1 is much smaller than normal. This is because it is very difficult for a person with an obstructive disease eg. This is because it is easy for a person with a restricted lung e. To continue to the next section: pneumotachometry, click here.
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