Chronic Respiratory Failure

You breathe approximately 20,000 times every day. This breathing wouldn’t be possible without the respiratory system, which is a collection of organs responsible for taking in oxygen and getting rid of carbon dioxide. When you inhale, you breathe in oxygen-rich air. The oxygen moves through your bloodstream and into the organs and tissues of your body. This oxygen is vital for maintaining essential body functions. When you exhale, you release carbon dioxide from your body. Carbon dioxide is a waste product that’s produced when the cells in your body break down sugar from the foods you eat. It’s important for carbon dioxide to be removed from your blood, as high levels of the gas can cause organ damage.

Respiratory failure can happen when your respiratory system is unable to remove carbon dioxide from the blood, causing it to build up in the body. The condition can also develop when your respiratory system can’t take in enough oxygen, leading to dangerously low levels of oxygen in the blood. Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure, however, is an ongoing condition. It gradually develops over time and requires long-term treatment.

Chronic respiratory failure usually happens when the tubes that carry air to your lungs become narrow and damaged. This limits air movement through the body, which means that less oxygen gets in and less carbon dioxide gets out.

Chronic respiratory failure can also be classified as hypoxemic or hypercapnic respiratory failure. Low blood oxygen levels cause hypoxemic respiratory failure. High carbon dioxide levels cause hypercapnic respiratory failure.

Symptoms of chronic respiratory failure may not be noticeable at first. They usually occur slowly over an extended period of time. When symptoms do develop, they may include:

• difficulty breathing or shortness of breath, especially when active
• coughing up mucous
• wheezing
• bluish tint to the skin, lips, or fingernails
• rapid breathing
• fatigue
• anxiety
• confusion

Chronic respiratory failure is a serious illness that gets worse over time. As the condition increases in severity, people may develop an abnormal heart rhythm or slip into a coma.

Certain lung diseases can cause chronic respiratory failure. Conditions that affect the way in which muscles, bones, or tissues support breathing can also cause chronic respiratory failure.

Common diseases and conditions that may lead to chronic respiratory failure include:

• chronic obstructive pulmonary disease (COPD)
• pneumonia
• cystic fibrosis
• spinal cord injuries
• stroke
• muscular dystrophy
• injury to the chest
• drug or alcohol abuse
• smoking

Your doctor will be able to diagnose chronic respiratory failure by performing a physical exam and by asking you about your symptoms and medical history. They may also run certain tests to confirm the diagnosis.

Medical History

Your doctor will ask you about lung diseases or conditions you currently have or have had in the past to learn more about your medical history.

Physical Examination

During a physical exam, your doctor will use a medical device called a stethoscope to listen for abnormal sounds in your lungs and heart.

Pulse Oximetry Test

A pulse oximetry test is a simple and painless test that evaluates how well oxygen is being sent to various parts of the body. Your doctor will place a small sensor on the tip of your finger or ear lobe to determine whether you are getting enough oxygen. In healthy people, normal oxygen saturation will be 96 to 100 percent. Any percentage under 90 indicates an abnormally low oxygen level.

Arterial Blood Gas Test

An arterial blood gas test is a safe, easy procedure that measures the amount of oxygen and carbon dioxide in the blood. Your doctor will take blood from an artery in your wrist. They will then send the blood to a lab for analysis. The results of this test indicate oxygen and carbon dioxide levels in your blood.

Imaging Tests

Your doctor can use a chest X-ray or CT scan to obtain a better view of your lungs. These tests may reveal possible causes of chronic respiratory failure.

Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be treated at home. In severe cases, medical professionals can help you manage the condition in a long-term health care center.

Treatment options typically include:

• treating the underlying cause of respiratory failure
• removing excess carbon dioxide from the blood
• increasing oxygen levels in the blood

Oxygen Therapy

You may receive oxygen therapy if you don’t have enough oxygen in your blood. Oxygen therapy raises oxygen levels by increasing the amount of oxygen you inhale. Oxygen is distributed from a tank through a tube. The gas enters the lungs through a facemask, nasal tubes, or one larger tube directly inserted into the windpipe. There are small, portable oxygen machines available that can be carried in a shoulder bag.

Tracheotomy

In severe cases of chronic respiratory failure, a tracheostomy may be needed. During this procedure, your doctor places a tube in your windpipe so that you can breathe more easily. The tube is inserted through a cut in the front of your neck where your windpipe is located. This tube may be temporary or permanent.

Mechanical Ventilation

If chronic respiratory failure doesn’t improve with other treatments, your doctor may put you on a ventilator, or breathing machine. This machine pumps oxygen through a tube that is placed into your mouth or nose and down into your windpipe. Since the ventilator blows air down into your lungs, you don’t have to breathe it in manually. Depending on the severity of your condition, the ventilator may just need to help you with breathing, or it may need to do all of the breathing for you.

There isn’t any cure for chronic respiratory failure, but symptoms can be managed with treatment. If you have a long-term lung disease, such as COPD or emphysema, you may need continuous help with your breathing. Your specific outlook depends on the exact cause of your respiratory failure, your overall health, and how quickly you receive treatment. Speak with your doctor to learn more about the outlook for your particular case.