Respiratory failure

There are two kinds of respiratory failure:

• Acute respiratory failure: Acute respiratory failure develops due to the failure of the lungs to take in oxygen and filter out the carbon dioxide from the body. In acute cases, however, the primary cause of worry is the lack of oxygen in the blood with the development of conditions such as hypoxemia. It also develops in a short period of time.
• Chronic respiratory failure: In chronic respiratory failure, the respiratory system is not able to remove carbon dioxide from the blood, which leads to the accumulation of the gas inside the body, leading to further complications. It also develops over a longer period of time and may not go away. This condition requires extensive care and management.

Depending on the type of respiratory failure a person may have and the underlying cause, the symptoms can vary. Some of the common signs include:

• Laboured, heavy or rapid breathing (in adults, rapid, shallow breathing or tachypnea means taking over 20 breaths a minute)
• Shortness of breath
• Low oxygen saturation
• Wheezing
• High levels of blood gases
• Confusion
• Discolouration of lips, fingernails and toes (Read more: Skin discolouration)
• Irregular heartbeat (arrhythmia)
• Dizziness or unconsciousness (fainting/syncope)
• Anxiety
• Excessive sweating

While breathing is one of the fundamental functions of the human body, there are several parts involved in smooth functioning of this activity. An obstruction to any of the organs responsible for this basic function can result in this condition, especially if there is a chronic health condition affecting it.

As mentioned earlier, there are several health factors that can be behind the development of acute or chronic respiratory failure. Some of them include:

• Hypoxemia: Hypoxemia occurs when there are critically low levels of arterial oxygen in the blood. It can affect different organs of the body, as not enough oxygenated blood is being sent to those organs. The presence of hypoxemia can also lead to hypoxia, which is a condition where there isn't enough oxygen in the tissues of the body—this is a life-threatening condition.
• Respiratory diseases: Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, acute respiratory distress syndrome (ARDS), cystic fibrosis, pneumonia, etc., are all associated with the development of respiratory failure. In recent months, the COVID-19 infection that has led to a global pandemic is also known to cause respiratory failure.
• Injuries: Brain injury, spinal cord injury or injury to the ribs and the chest may affect the breathing function of the body. The resulting inability to breathe in oxygen can cause the body to have a significant lack of oxygen.
• Infections: Other medical causes that lead to sepsis in the body can also lead to a serious deficit of oxygen in the body.
• Drug/alcohol overdose: Overdose of substances can also lead the body to go into shock, leading to the breathing becoming affected. (Read more: Drug abuse)
• Smoke: Inhaling poisonous gases or pollutants are also linked with the development of respiratory conditions (read more: carbon monoxide poisoning and tear gas exposure). The habit of smoking can also lead to respiratory failure.
• Stroke: A stroke may cause the death or destruction of tissues in the brain, which may lead to respiratory failure.
• Nerve and muscle problems: Other conditions affecting the nerves or the muscles, such as ALS and muscular dystrophy, are associated with respiratory failure as well.
• Scoliosis: Scoliosis affects the curvature of the spine—it is a condition in which the spinal cord curves towards one side of the back. The condition usually develops in the teenage years. It is also linked to respiratory failure.
• Blood clots: If there are blood clots affecting the flow of blood to the lungs, they can also affect the breathing of a person, causing respiratory failure if not addressed in time.

Some of the major causes of respiratory failure are preventable. Avoiding habits such as smoking, alcohol and drug use, and making simple and healthy lifestyle choices are helpful in preventing breathing problems.

Read more: Alcoholism

Eating healthy meals rich in nutrients, as well as keeping the fluid intake of the body at an optimum level, along with daily exercise that helps the heart to pump faster and helps in improving the breathing function of the body are all helpful in maintaining a good state of health.

Living in pollution-free surroundings, however, remains a challenge for urban, city-bred people with rising amounts of pollution. Those with chronic respiratory issues are advised to stay indoors during high levels of pollution, as well as during seasonal changes. Keeping medications for emergency use such as inhalers handy is also useful.

It is also important to be up-to-date with your medical check-ups—visit a doctor if you notice anything unusual with respect to your breathing. Keeping a simple device such as a pulse oximeter at home can also helpful, as it can notify you of your oxygen saturation levels (SpO2) instantly (a reading of or above 94 SpO2 is normal).

If you have been experiencing any kind of trouble with respect to your breathing, it is important to visit a doctor and have it checked to understand the reason behind your difficulty.

A doctor would ask questions about your medical history and perform a basic physical examination which would include checking your breathing, pulse and heart rate, as well as any physical signs such as skin discolouration. They may check your oxygen saturation levels along with ordering other tests to arrive at an accurate diagnosis. Usually, arterial blood is required for further analysis to check for the build-up of toxic gases in the body. (Read more: Arterial blood gas test)

Imaging tests such as an X-ray of the chest may be done to check for abnormalities in the lungs. An electrocardiogram (ECG) may also be ordered to check the electrical impulses of the heart.

As mentioned earlier, there can be many reasons for respiratory failure. The treatment or management of the condition will depend on the factors that have caused it.

Acute respiratory failure requires immediate hospitalization of the patient as it can prove to be fatal if not treated immediately. The person may be put on oxygen support if the oxygen levels in the blood are low. In such a case, an oxygen tank is used to supply additional oxygen to the person through a mask to assist their breathing.

Read more: Oxygen therapy

The patient may also be put on a ventilator, which helps to blow oxygenated air directly into the lungs. The use of a ventilator is usually reserved for when a patient is unable to breathe on their own.

Management of milder or chronic cases requires a long course of medications that one may even be required to take throughout their life. The use of other non-invasive machines such as a BiPAP or CPAP may help in pumping out the excess carbon dioxide from the body as well, and chronic patients may require such a set-up at home.

Depending on the underlying condition causing it, people may recover from this illness as well, although it may require extensive therapy including mild exercise as well as counselling.