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# Obstructive vs restrictive lung disease: the comparison table

- Topic

Obstructive disease narrows the airways and air gets trapped; restrictive disease stiffens the lung or chest so it cannot fill.

Updated Nov 12, 2026

## Key points

- Obstructive: COPD (emphysema, chronic bronchitis), asthma, bronchiectasis, bronchiolitis.
- Obstructive: FEV1/FVC below about 0.7, TLC normal or high (air trapping, hyperinflation).
- Restrictive: low TLC, FEV1 and FVC fall together so the ratio is normal or high.
- Restriction has two sources: the chest wall (obesity, kyphoscoliosis, pleural disease, neuromuscular weakness) and the interstitium (fibrosis, pneumoconioses, sarcoidosis).
- Low DLCO separates emphysema (lost capillary bed) and interstitial disease from chest-wall restriction and asthma.

## What it is

Chronic lung diseases are split by lung function. In obstructive disease air flows out slowly: FEV1 falls more than FVC, so the FEV1/FVC ratio drops below about 0.7. In restrictive disease the lung or chest wall cannot expand, total lung capacity falls and the ratio stays normal or rises. Each group has its own lesions, and the pathologist links them to the numbers.

## Step by step

- In obstruction the airway lumen is narrowed (mucus, wall thickening, spasm) or loses its outward pull (emphysema).
- Expiration becomes slow; air is trapped at the end of each breath and the chest hyperinflates.
- In interstitial restriction fibrosis stiffens the alveolar walls and lowers compliance.
- The stiff lung recoils hard, so airflow is fast for its small volume and the FEV1/FVC ratio is preserved.
- Thickened septa and lost capillaries reduce diffusion: exertional hypoxaemia and, later, pulmonary hypertension.

## Obstructive vs restrictive

| Feature | Obstructive | Restrictive (interstitial) |
| --- | --- | --- |
| Main problem | Resistance to airflow | Reduced expansion |
| [FEV1/FVC](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/) | Low (below about 0.7) | Normal or high |
| [Total lung capacity](https://durgical.com/en/conditions/interstitial-lung-disease/) | Normal or high | Low |
| Examples | Emphysema, chronic bronchitis, asthma, bronchiectasis | Idiopathic pulmonary fibrosis, pneumoconioses, sarcoidosis |
| [Typical sound](https://durgical.com/en/conditions/asthma/) | Wheeze | Fine end-inspiratory crackles |
| Lesion site | Bronchi, bronchioles, acinus | Alveolar septa and interstitium |

## Clinical notes

- Wheeze and prolonged expiration point to obstruction; fine end-inspiratory crackles and clubbing point to interstitial fibrosis.
- Many patients mix both (asthma–COPD overlap; emphysema with fibrosis), so the numbers guide but the lesion decides.

## Memory aid

Obstruction: out is slow. Restriction: in is small.

## Test yourself

Think of the answer, then tap the question to see it.

## How does the FEV1/FVC ratio differ between obstructive and restrictive disease?

It falls below about 0.7 in obstruction and stays normal or rises in restriction, where FEV1 and FVC fall together.

## What are the two groups of causes of restrictive physiology?

Chest-wall and neuromuscular disorders (obesity, kyphoscoliosis, pleural disease) and chronic interstitial diseases (fibrosis, pneumoconioses).

## Which obstructive disease characteristically lowers DLCO?

Emphysema, because destroyed alveolar walls take their capillary bed with them.

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## Elsewhere in DurgiPedia

- [Lung volumes, capacities and spirometry](https://durgical.com/en/physiology/lung-volumes-capacities-and-spirometry/)
- [Lung and chest wall compliance](https://durgical.com/en/physiology/lung-and-chest-wall-compliance/)
- [Airway resistance](https://durgical.com/en/physiology/airway-resistance/)

## Connections

## Related 5

- [Emphysema](https://durgical.com/en/general-pathology/emphysema/)
- [Chronic bronchitis](https://durgical.com/en/general-pathology/chronic-bronchitis/)
- [Asthma: pathology](https://durgical.com/en/general-pathology/asthma-pathology/)
- [Bronchiectasis](https://durgical.com/en/general-pathology/bronchiectasis/)
- [Idiopathic pulmonary fibrosis (UIP pattern)](https://durgical.com/en/general-pathology/idiopathic-pulmonary-fibrosis/)

## Related conditions 4

- [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/)
- [Asthma](https://durgical.com/en/conditions/asthma/)
- [Interstitial lung disease](https://durgical.com/en/conditions/interstitial-lung-disease/)
- [Bronchiectasis](https://durgical.com/en/conditions/bronchiectasis/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [COPD](https://medlineplus.gov/copd.html) (MedlinePlus, US National Library of Medicine, 2025); [Interstitial Lung Disease](https://www.ncbi.nlm.nih.gov/books/NBK541084/) (StatPearls (NCBI Bookshelf), 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/obstructive-vs-restrictive-lung-disease-the-comparison-table/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/obstructive-vs-restrictive-lung-disease-the-comparison-table/