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Q. What does restrictive disorder in spirometry test imply?

Answered by
Dr. Sunil Kumar Nookala
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 30, 2019

Hi doctor,

I have breathing difficulties. I had a spirometry test that showed a restrictive disorder. I recently had a CT scan and waiting to see my specialist in the end of the month. I was wondering what could indicate this type of problem? I can attach my CT scan. I am currently taking Plaquenil to help urticaria.

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome to icliniq.com.

I have seen your reports. (attachment removed to protect patient identity).

The CT (computed tomography) scan which you attached is showing ground glass with mild reticular changes in your basal regions and from the history which you gave it could be an interstitial lung disease (restrictive pattern in spirometry and ggo in CT chest), and in the next visit, I would advise you to go for a DCLO (diffusing capacity for carbon monoxide) and serum IgE (immunoglobulin E) levels.


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Thank you doctor,

I will do as per your advice.

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome back to icliniq.com.

Kindly give me information about what happened when you visit your consultant there.


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Thank you doctor,

I just had another spirometry test. I have been on Symbicort for six weeks and it has made a remarkable improvement except when I exert myself. I am still breathless. The spirometry test was normal and the DLCO was just one point above normal. So this is good news as I am obviously responding to inhalers and steroids. Is this still a form of restrictive pattern? The CT scan obviously shows a problem. Also, I wanted to ask if there is any scarring present? What condition could this be? As I have read restrictive does not usually respond to bronchodilators.

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hello,

Welcome back to icliniq.com.

Yes, it is true that restrictive disease does not respond to inhaler and as you see responding to inhalers there might be a mixed pattern in spirometry. Please attach your spirometry and DLCO reports so that I can explain them. There is no scarring on the CT film which you uploaded. (attachment removed to protect patient identity).


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Thank you doctor,

I will attach the reports and a few more photos.

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome back to icliniq.com.

I have seen those reports. (attachment removed to protect patient identity).

Initial spirometry was suggestive of mixed pattern with both obstructive and restrictive components and there is reversibility in it and the later one which includes DLCO also showed significant improvement post bronchodilation (13%) which indicate that you will have definite benefit by using bronchodilators that are inhalers.

Secondly, regarding your CT it shows ground glassing and reticulation which may also be seen in hypersensitive pneumonitis (HP) as I remember you do have a dermatological problems like urticaria. Do suggest to your physician if it might be HP.


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Thank you doctor,

I also have chronic gastritis. Would that have a bearing on the lungs?

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome to icliniq.com.

If you do have chronic gastritis there is a chance of microaspiration which might increase your respiratory symptoms. So use a proton pump inhibitor like Omeprazole or Esomoprazole.


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Thank you doctor,

I have a mild chronic inactive gastritis but no esophagal damage. Is a lung biopsy necessary to find out the cause?

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome back to icliniq.com.

You do not need to undergo a lung biopsy for this, and as there is ground glassing predominantly in your CT chest it may be resolved with the use of steroids.


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Thank you doctor,

How will we know what caused it? Especially as I have autoimmune like problems.

Dr. Sunil Kumar Nookala

Allergy Specialist Pulmonology (Asthma Doctors) Sleep Medicine
#

Hi,

Welcome back to icliniq.com.

As you do have autoimmune like problems to know the causative agent, you need to know the allergen which might have resulted in that kind of problem.

Regarding biopsy, I do not think any body would like to do a biopsy in a ground glass picture which is diffuse in lower lobes.

Regarding your autoimmune condition, there are a number of blood tests that can detect what kind of autoimmune disease you do have.


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