Updated: 12/31/2018

Obstructive Lung Disease Overview

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  • Introduction
    • A class of lung diseases characterized by an obstruction to air flow leaving the lungs
    • Types of obstructive lung disease include
      • bronchiectasis
      • chronic bronchitis
      • emphysema
      • asthma
  • Pathophysiology of Obstructive Lung Disease
    • Obstruction of air leaving the lungs leads to ↑ trapped air in the lungs which results in
      • ↑ residual volume (RV)
      • total lung capacity (TLC)
      • functional reserve capacity (FRC)
      • ↓ in FVC
    • V/Q mismatch
      • ↑ in physiologic dead space results in ↓ ventilation and V/Q mismatch
        • the quantifiable result of a V/Q mismatch is an ↑ in the alveolar-arterial gradient (A-a gradient) and ↓ PaO2
  • Evaluation
    • Pulmonary function tests(PFTs)
      • PFTs (spirometry) can be used to distinguish obstructive lung diseases from other types of lung disease (including restrictive lung diseases)
      • the halmark finding of obstructive lung disease is
        • ↓ FEV1 sec/FVC ratio
          • ratio is reduced because FEV1 decreases by a greater amount than FVC
  • Obstructive vs. Restrictive Lung Disease
    • Variables
      Restrictive
      Obstructive
      TLCDecreasedIncreased
      RVDecreasedIncreased (air is trapped)
      FEV1secDecreasedDecreased
      FVCDecreasedDecreased
      FEV1sec/FVCNomal to increasedDecreased (hallmark)
      PaO2DecreasedDecreased
      A-a gradientIncreased (i.e. abnormal)Increased (i.e. abnormal)
  • Treatment
    • Treatment varies by the type of obstructive lung disease

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