Lung Diseases – Restrictive vs Obstructive Types

How are COPD and IPF Different from Each Other?

Nov 7, 2009

COPD is Chronic Obstructive Pulmonary Disease. IPF is Idiopathic Pulmonary Fibrosis. Nearly 30 million Americans suffer from one of these major lung diseases.

Respiratory diseases count for about one in seven deaths every year. Interstitial lung disease affects five million people in the world annually; other major lung diseases include cystic fibrosis, tuberculosis, mesothelioma, sarcoidosis, and pulmonary hypertension.

What is a Lung Disease?

Any disorder that affects one's ability to breathe, including lung cancer, which results in a nagging cough, shortness of breath, pain in the chest and a decrease in one's ability to perform any significant exertion, is a lung disease.

Definitions of Restrictive and Obstructive Lung Disorders

When the airways of the lungs become narrow or are blocked so that one cannot exhale completely, the disorder is defined as "obstructive." Chronic Obstructive Pulmonary Disease (COPD), which includes chronic bronchitis and emphysema, and asthma are considered obstructive lung diseases. Generally these are caused by inflammation in the airways.

When the lungs have lost tissue or the cells stiffen due to invasive environmental factors, the lungs lose their ability to expand on inhalation. They are restricted, and the term "restrictive" is applied to the disease. Lung cancer is a restrictive lung disease as are pulmonary fibrosis (PF) and pneumonia. This eventually impairs the body's ability to transfer oxygen into the bloodstream.

"Interstitial" refers to any restrictive disease of the air sacs around the lung cells. Interstitial Lung Disease (ILD) was a synonym for IPF but now is used as an umbrella term which includes IPF.

Thus, an obstructive lung disease prevents proper exhalation, and a restrictive lung disease prohibits proper inhalation. Someone with obstructive lung disease can take a full deep breath, but cannot exhale it completely (risking the retention of carbon dioxide in the bloodstream and further inflammation of the airways). A person with restrictive lung disease cannot take a deep breath but has no difficulty exhaling all that he does inhale. As his disease progresses, the lung tissue stiffens in greater amounts and the capacity to hold oxygen in the lungs diminishes steadily. Less and less oxygen is supplied to the body's organs.

Differences Between Two Types of Lung Disease

COPD is characterized by heavy mucus production and a constant loose cough. Effective treatments include prescribed inhalants using handheld inhalers, nebulizers or other forced-air equipment. As the disease progresses, supplemental oxygen may be used to assist the active patient. There is no cure for these diseases; current treatments can enable the patient to continue a fairly active lifestyle for a number of years.

Pulmonary Fibrosis (referred to as IPF if it is "idiopathic," or has no known cause) does not produce mucus, nor is it helped by inhalants to clear obstructed airways. Many patients experience a dry cough which becomes extremely debilitating. Other symptoms include increasing demands for supplemental oxygen and a decline in ability to perform daily living tasks. Lung capacity diminishes to as little as 11% of normal, and oxygen requirements can exceed 12 liters per minute (unlike COPD oxygen requirements which seldom exceed 2 liters per minute in most patients.)

A standard of treatment used to be giving the patient high doses of prednisone (a steroid) to halt further progression of scarring thought to be caused by an inflammation. However, prednisone treatment is successful in a smaller percentage of patients than previously thought, and its side effects are so damaging to the body that many health professionals feel prednisone is no longer the preferred choice of treatment. Drug trials have been conducted for many years to find a more successful treatment for IPF, including pirfenidone, which is currently awaiting FDA approval following a series of favorable trials. At present, however, there are no known drugs that successfully treat IPF and the only "cure" available is lung transplant. Progression of the disease is usually more rapid than with COPD.

Since the greater number of lung disease cases tend to be obstructive, such as asthma and COPD, many healthcare professionals are ill-prepared to treat restrictive diseases such as IPF. There is a tendency, unfortunately, to assume that those treatments that succeed with COPD will also work for IPF. Consequently, IPF patients are often taught "pursed-lip exhalation" in which one forces the exhaled breath out between tightly pursed lips. This is a useless strategy for anyone who has no difficulty exhaling but can't inhale sufficiently.

Other misguided treatments include prohibiting IPF patients from having greater amounts of supplemental oxygen than 2 lpm, because "the patient might become dependent on it" or "it will damage the lungs." COPD patients do have issues with high-flow supplemental oxygen, but patients with restrictive lung diseases need all the oxygen they can get. Loss of oxygen to the brain, to the extremities, and to other vital organs can seriously affect quality of life and will hasten death.

Preventing Lung Disease

The most obvious preventive strategy is never to smoke. Quitting is the number one health measure to prevent lung disease. Other measures include maintaining a healthy diet, keeping active with cardiopulmonary exercise, and avoiding exposure to such environmental triggers as asbestos, second-hand smoke, and air pollution. Some lung disorders are inherited, so be aware of family history and prepare accordingly to keep one's lungs as healthy as possible.

If anyone begins to experience symptoms such as unexplained fatigue, shortness of breath on exertion, or a persistent nagging cough, he or she should see his physician as soon as possible. Treatment at the earliest stages of lung disease will prolong life and extend one's quality of life immeasurably.

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The copyright of the article Lung Diseases – Restrictive vs Obstructive Types in Lung Disease Treatment is owned by Barbara Bell. Permission to republish Lung Diseases – Restrictive vs Obstructive Types in print or online must be granted by the author in writing.

Nov 7, 2009 3:58 PM

Guest :

This article succinctly describes COPD and IPF. Especially the section on IPF is extremely useful because most people have never heard of it and mistakenly attribute their symptoms, which may be mild at first, to something else. Many physicians are similarly unaware of IPF. I speak from experience! My husband's doctor told him that his shortness of breath was due to "getting older". By year 2, when symptoms had worsened,a High Resolution CTScan finally diagnosed IPF. He was fortunate and received a lung transplant one year ago.