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A restrictive disorder is one that may affect the lung tissue itself or the capacity of the lungs to expand and hold predicted volumes of air. This could be due to fibrosis and scarring, pneumoconiosis, or a physical deformity that is restricting expansion. The restrictive pattern usually presents itself as reduced volumes and normal flow rates on the FVC maneuver.
An obstructive disease affects the lumen of the airways often due to excessive mucus production, inflammation or bronchoconstriction. Asthma and chronic bronchitis are examples of obstructive disorders.
Generally, the obstructive pattern presents itself as reduced flow rates and normal lung volumes, but with a reduced FEV1 on the Forced Vital Capacity maneuver.
With a combined ventilatory disorder, features of both an obstructive and restrictive deficit are exhibited. An example is Cystic Fibrosis, which causes excess mucus production and damage to the lung tissue. Severe asthma may also show combined features.
Obstructive patterns comprise the lion’s share of results in primary care. If the Forced Vital Capacity (FVC) is normal (that is, greater than 80% of predicted), then there is a [cue pure obstruction box] pure obstruction. Generally, if the obstruction shows a significant reversal with a bronchodilator (that is greater than 12% & >200ml. improvement) then the diagnosis is asthma. If there is no significant change, then the diagnosis is COPD.
If on the other hand, the FEV1/FVC ratio is reduced and the FVC is low, then you have a combined defect to sort out. A patient with significant air-trapping and hyperinflation will have a reduced FVC. Thus a bad asthmatic may have a combined defect that will greatly improve with bronchodilator. A lack of response to a bronchodilator demands further investigation with full pulmonary function testing with CO diffusion and Lung Volume measurements. If the defect is moderate to severe, it will likely require referral to a Respirologist for evaluation.
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