Flow-volume loops in upper airway obstruction

The configuration of the flow-volume loop can help distinguish the site of airway narrowing. The airways are divided into intrathoracic and extrathoracic components by the thoracic inlet.
(A) Normal flow-volume loop: the expiratory portion of the flow-volume curve is characterized by a rapid rise to the peak flow rate, followed by a nearly linear fall in flow. The inspiratory curve is a relatively symmetrical, saddle-shaped curve.
(B) Dynamic (or variable, nonfixed) extrathoracic obstruction: flow limitation and flattening are noted on the inspiratory limb of the loop.
(C) Dynamic (or variable, nonfixed) intrathoracic obstruction: flow limitation and flattening are noted on the expiratory limb of the loop.
(D) Fixed upper airway obstruction (can be intrathoracic or extrathoracic): flow limitation and flattening are noted in both the inspiratory and expiratory limbs of the flow-volume loop.
(E) Peripheral or lower airways obstruction: expiratory limb demonstrates concave upward, also called "scooped-out" or "coved" pattern.