Chronic Respiratory Failure

[Rasel Ali]

What is chronic respiratory failure?

Respiratory failure can happen when your respiratory system is unable to remove enough carbon dioxide from the blood, causing it to build up in your body. The condition can also develop when your respiratory system can’t take in enough oxygen, leading to dangerously low levels of oxygen in your 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 airways 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.

What are the symptoms of chronic 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 mucus
  wheezing
  a bluish tint to the skin, lips, or fingernails
  rapid breathing
  fatigue
  anxiety
  confusion
  daily headache

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, stop breathing, or slip into a coma.

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

Diseases and conditions that commonly lead to chronic respiratory failure include:

• chronic obstructive pulmonary disease (COPD)
  complicated pneumonia
  cystic fibrosis
  spinal cord injuries
  stroke
  muscular dystrophy
  ALS (Lou Gehrig’s disease)
  injury to the chest
  drug or alcohol misuse
  smoking

How is chronic respiratory failure diagnosed?
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. Often an ongoing illness or significant injury has occurred prior to its development.

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
Pulse oximetry 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, the normal oxygen saturation range will be between 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. It also measures the pH, or acid content, of your blood. Your doctor will take blood from an artery at 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, as well as the overall chemistry of 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.

Bronchoscopy
A bronchoscope is a thin, flexible lighted instrument that can be inserted into your airway and lungs. Doctors can use this test to get a closer look at the lung passages, as well as take samples of airway and lung tissue.

How is chronic respiratory failure treated?
Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be managed at home, depending on its cause. In severe cases, medical professionals can help you manage the condition in a long-term healthcare 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.

Tracheostomy
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 directly into your lungs, you don’t have to work as hard to breathe oxygen in on your own. 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.

Other forms of breathing assistance, known as noninvasive ventilation (NIV) include BiPAP and CPAP. These may be appropriate long-term options for certain conditions.

What are the potential complications of chronic respiratory failure?
There often 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.

Source: Healthline