side by side comparison
Obstructive vs Restrictive Lung Disease: Air Trapping vs Reduced Expansion — The Fundamental Classification
Every lung disease on the NCLEX maps to one of two patterns — air trapping or restricted expansion. If you can't classify the pattern, you'll misread PFT results, misinterpret breath sounds, and pick the wrong oxygen strategy. This single framework unlocks every respiratory question.
Comparison
Side-by-side2 compared
Dimension
Obstructive
Restrictive
Pathophysiology & risk
- ★Airway narrowing — air can't get OUT
- Asthma, COPD, CF, bronchiectasis
- ★Stiff lungs/chest — air can't get IN
- ARDS, fibrosis, scoliosis, GBS, MG
Signs & symptoms
- Wheezing; prolonged expiration
- Barrel chest; hyperresonant percussion
- Fine crackles (fibrosis); shallow breaths
- Reduced expansion; dull percussion
Diagnostics & labs
- ★FEV₁/FVC < 70% — FEV₁ drops most
- TLC ↑, RV ↑ (air trapped)
- FEV₁/FVC normal/↑ (≥80%)
- TLC ↓, RV ↓ (can't inflate)
Nursing priorities
- COPD: low-flow O₂; high O₂ risks ↑ CO₂
- Position to ease air trapping
- High FiO₂; ARDS needs PEEP for alveoli
- Support ventilation if severe
Management
- Bronchodilators (SABA, LABA); ICS
- Pulmonary rehab; smoking cessation
- Treat the underlying cause; supplemental O₂
- Ventilatory support if severe
Patient teaching
- Inhaler technique; smoking cessation
- Pace exhalation; pursed-lip breathing
- Adhere to cause-directed therapy
- Energy conservation; report ↑ dyspnea
Red flags — escalate
- Rising CO₂, somnolence (COPD)
- Silent chest / no air movement
- Falling vital capacity (GBS/MG)
- Refractory hypoxia (ARDS)
Complications
- Reversibility variable — asthma yes, COPD no
- Cor pulmonale; chronic respiratory failure
- Fibrosis irreversible; depends on cause
- Respiratory failure if expansion fails
Pathophysiology & risk
Obstructive
- ★Airway narrowing — air can't get OUT
- Asthma, COPD, CF, bronchiectasis
Restrictive
- ★Stiff lungs/chest — air can't get IN
- ARDS, fibrosis, scoliosis, GBS, MG
Signs & symptoms
Obstructive
- Wheezing; prolonged expiration
- Barrel chest; hyperresonant percussion
Restrictive
- Fine crackles (fibrosis); shallow breaths
- Reduced expansion; dull percussion
Diagnostics & labs
Obstructive
- ★FEV₁/FVC < 70% — FEV₁ drops most
- TLC ↑, RV ↑ (air trapped)
Restrictive
- FEV₁/FVC normal/↑ (≥80%)
- TLC ↓, RV ↓ (can't inflate)
Nursing priorities
Obstructive
- COPD: low-flow O₂; high O₂ risks ↑ CO₂
- Position to ease air trapping
Restrictive
- High FiO₂; ARDS needs PEEP for alveoli
- Support ventilation if severe
Management
Obstructive
- Bronchodilators (SABA, LABA); ICS
- Pulmonary rehab; smoking cessation
Restrictive
- Treat the underlying cause; supplemental O₂
- Ventilatory support if severe
Patient teaching
Obstructive
- Inhaler technique; smoking cessation
- Pace exhalation; pursed-lip breathing
Restrictive
- Adhere to cause-directed therapy
- Energy conservation; report ↑ dyspnea
Red flags — escalate
Obstructive
- Rising CO₂, somnolence (COPD)
- Silent chest / no air movement
Restrictive
- Falling vital capacity (GBS/MG)
- Refractory hypoxia (ARDS)
Complications
Obstructive
- Reversibility variable — asthma yes, COPD no
- Cor pulmonale; chronic respiratory failure
Restrictive
- Fibrosis irreversible; depends on cause
- Respiratory failure if expansion fails
★ marks the fact that sets a column apart.
Clinical Pearl
Can't blow OUT = obstructive (low FEV1/FVC). Can't breathe IN = restrictive (low TLC, ratio preserved).
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