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Pathophysiology · Chapter 23. Typical Forms of Pathology of the External Respiration System

Alveolar hypoventilation

*Hypoventilatio alveolaris*

Alveolar hypoventilation is a pathological condition characterized by a decrease in pulmonary ventilation volume, leading to impaired gas exchange. The underlying process involves disorders of respiratory biomechanics or failures in its regulatory mechanisms.

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Types of disordersObstructive (airway narrowing) and restrictive (decreased compliance).
Main mechanismIncreased work of respiratory muscles and energy expenditure of the body.
DiagnosticsSpirometry: assessment of FVC, Tiffeneau index, and residual volume.
Causes of obstructionForeign bodies, bronchospasm, tumors, and expiratory compression.
2 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Obstructive type: airflow limitation

Obstruction impairs airway patency, which sharply increases resistance to airflow. This forces the respiratory muscles to work harder, increasing energy expenditure.

Main causes:

  • Obturation: foreign body aspiration, aspiration of vomitus, accumulation of mucus or blood.
  • Spasm: bronchospasm (e.g., in asthma) or laryngospasm.
  • Compression: tumors, enlarged lymph nodes, or thyroid gland.
  • Dynamic compression: collapse of small bronchi during forced expiration (typical for emphysema).

Restrictive type: impaired expansion

Restriction is associated with the lungs' loss of ability to fully expand. As a result, their ventilational capacity decreases, and the load on the respiratory apparatus increases.

Causes are divided into two groups:

  1. Intrapulmonary: fibrotic tissue changes, atelectasis, diffuse tumor processes.
  2. Extrapulmonary: pathologies limiting chest excursion or respiratory muscle function.
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Diagnostic criteria

Spirometry is used for differential diagnosis. In obstructive disorders, the following changes are observed:

ParameterParameter
FVCDecrease
Tiffeneau indexDecrease
RVIncrease
TLCNormal

Briefly: answers to topical questions

What specific extrapulmonary pathologies lead to restrictive hypoventilation?

Extrapulmonary causes of restrictive disorders cause limitation of pulmonary excursion magnitude. Specific pathologies and conditions include:

  • Exudative pleurisy.
  • Pronounced ossification of the costal cartilages.
  • Decreased mobility of the chest joints in osteochondrosis.
  • Mechanical compression of the chest — for example, during structural collapses or car accidents; referred to as crush syndrome.

What disorders of the central regulation of breathing can lead to alveolar hypoventilation?

Disorders of the central regulation of breathing associated with hypoventilation or respiratory depression include:

  • Suppression of respiratory center neuronal activity by toxins during an infectious process: microbial and endogenous toxins.
  • Action of narcotic substances in high doses: depression of respiratory center neurons.
  • Respiratory depression in substance abuse, toxicomania, and poisoning, caused by decreased sensitivity of respiratory center neurons to blood pCO₂.
  • Alkalosis: decreased excitation of inspiratory neurons and reduced alveolar ventilation, i.e., hypoventilation.
How to memorize

Obstruction is a "fence" (barrier in a pipe), restriction is a "corset" (inability to expand).

Class and exam questions

What is the key difference between obstruction and restriction?

Obstruction is caused by narrowing of the airway lumen and increased resistance, whereas restriction is due to decreased elasticity and compliance of the lung tissue itself.

Why does residual lung volume increase in obstruction?

Due to bronchial narrowing, air is "trapped" in the alveoli as expiration is hindered, leading to lung hyperinflation.

What is the Tiffeneau index and how does it change in obstruction?

This is the ratio of forced expiratory volume in 1 second to forced vital capacity. In obstruction, it decreases as expiration becomes disproportionately slow.

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What else to study on this topic

  • Neurogenic mechanisms of respiratory regulation.
  • Afferent and efferent disorders of respiratory control.
  • Pathophysiology of expiratory bronchial compression.
  • Impact of cystic fibrosis on airway patency.
  • Extrapulmonary causes of restrictive disorders.

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Other topics of section "Chapter 23. Typical Forms of Pathology of the External Respiration System"

Pathology of the external respiration systemExtrapulmonary causes of hypoventilationPathological types of breathingAlveolar hyperventilationPulmonary perfusion disordersVentilation-perfusion mismatchImpaired pulmonary diffusion capacityRespiratory failureNeonatal respiratory distress syndromeAcute respiratory distress syndromePathogenesis of ARDS
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