Living with Chronic Respiratory Failure

Respiratory failure is a term used to refer to a condition where your respiratory system is not able to remove adequate levels of carbon dioxide from the bloodstream. This leads to a build-up of carbon dioxide in the body. This condition can also develop when the respiratory system is unable to get sufficient oxygen, leading to a dangerously low level of oxygen in the blood. Chronic respiratory failure is an ongoing condition that develops over a period of time and also requires long-term treatment to manage. Read on to learn about living with chronic respiratory failure and steps to take in case of emergency.

What is Chronic Respiratory Failure and What are it’s Symptoms?

There are two types of respiratory failure – acute and chronic. While chronic respiratory failure develops over a period of time, acute respiratory failure is a short-term condition that can happen suddenly and is considered to be a medical emergency.

Chronic respiratory failure is an ongoing condition, and people require long-term treatment for managing the condition. Chronic respiratory failure occurs when the airways responsible for carrying the air to your lungs become damaged and narrow. This restricts the movement of air throughout your body, meaning that there will be lesser oxygen getting in and lesser carbon dioxide getting out. This can lead to a build-up of excess carbon dioxide inside the body, while less oxygen is able to get in.

Chronic respiratory failure is also known as hypercapnic or hypoxemic respiratory failure. Lower levels of oxygen in the blood can lead to hypoxemic respiratory failure, while high levels of carbon dioxide in the blood can lead to hypercapnic respiratory failure.(1, 2)

The symptoms of chronic respiratory failure are usually not too noticeable in the beginning. They start to develop slowly over an extended period of time. When a person eventually starts to experience the symptoms, they may include the following:

Chronic respiratory failure is a serious condition that will progress and get worse over time. As this condition progresses in severity, people may develop an abnormal heartbeat, stop breathing, or even slip into a coma.(3) This is why it is so essential to get treated when you start noticing the very first symptoms.

Living with Chronic Respiratory Failure

It is possible to continue living with chronic respiratory failure, but this depends on the underlying cause. While acute respiratory failure is considered to be a medical emergency, chronic respiratory failure is not considered to be an immediate medical emergency, and it can be managed at home as well.

In severe cases of chronic respiratory failure, though, you will need the help of medical professionals to help you manage your condition in a healthcare center in the long-term.

Here are some of the common treatment options for chronic respiratory failure that can help you manage the condition and continue to live a good quality of life:

  • Removal of excess carbon dioxide from the bloodstream
  • Increasing the oxygen levels in the blood
  • Treatment of the underlying cause of respiratory failure

Of course, the treatment of the underlying cause responsible for causing respiratory failure is of utmost importance. There can be many causes of chronic respiratory failure. These include many types of lung diseases and conditions that impact the manner in which the muscles, bones, brain, and surrounding tissues support the process of breathing. Here are some diseases and medical conditions that commonly cause chronic respiratory failure:

Here are some of the most common treatment options that help you manage chronic respiratory failure.

Oxygen Therapy

The first step in managing chronic respiratory failure is to provide sufficient oxygen if there is not enough oxygen in the bloodstream. Oxygen therapy is used in such cases to increase the levels of blood oxygen.(7) This is done by increasing the amount of oxygen you inhale.

In most cases, oxygen will be provided from a tank through a tube that is connected through a facemask or a nasal tube. In some cases, a larger tube is inserted directly into the windpipe. There are many small and portable oxygen machines available today that can easily be carried in a bag if you are traveling somewhere outside of your home. Many people can continue to manage their condition with the help of oxygen therapy for several years.

Tracheostomy

In cases of severe chronic respiratory failure, a tracheostomy procedure might be performed. During a tracheostomy, your doctor will place a tube in your windpipe directly to allow you to breathe easily. The tube will be inserted through a hole that is cut in the front of your neck where the windpipe is placed. This tube is either temporary or permanent. In such cases, there will be many precautions that you will need to take while moving about, and you may also need to have a caregiver around to help you move around the house itself.(8)

Mechanical Ventilation

In cases where chronic respiratory failure does not improve with other treatment options, then your doctor is likely to put you on a ventilator, or a breathing machine. This can either be temporary or permanent.

A ventilator pumps oxygen through a tube placed into your nose, mouth, or straight into your windpipe. As the ventilator will blow the oxygen directly into your lungs, your own lungs will not have to work as hard to breathe oxygen for you.

Depending on the severity of your respiratory failure, the ventilator might just be needed to help you breathe easier for some time, or it might be permanent and doing all the breathing for you.

There are also other types of breathing assistance devices that can help you. These are known as non-invasive ventilation techniques and include BiPAP and CPAP. These are more appropriate for long-term options for managing chronic respiratory failure due to certain underlying conditions.

Conclusion

There is usually no cure for chronic respiratory failure, but it is possible to manage the symptoms of this condition with treatment. If you have a long-term lung disease, such as emphysema or chronic obstructive pulmonary disease, then you may need to arrange for a long-term device to help you with your breathing. The exact outlook for living with chronic respiratory failure depends on the underlying cause of respiratory failure, your age, your overall health, and how quickly you began treatment to save yourself from respiratory failure. Your doctor will be the right person to discuss about your options for long-term care in cases of chronic respiratory failure.

References:

  1. MSD Manual Professional Edition. 2020. Acute Hypoxemic Respiratory Failure (AHRF, ARDS) – Critical Care Medicine – MSD Manual Professional Edition. [online] Available at: <https://www.msdmanuals.com/en-kr/professional/critical-care-medicine/respiratory-failure-and-mechanical-ventilation/acute-hypoxemic-respiratory-failure-ahrf,-ards> [Accessed 17 March 2020].
  2. Accessanesthesiology.mhmedical.com. 2020. Hypercarbic Respiratory Failure | Critical Care Examination And Board Review | Accessanesthesiology | Mcgraw-Hill Medical. [online] Available at: <https://accessanesthesiology.mhmedical.com/content.aspx?bookid=2508&sectionid=202424686> [Accessed 17 March 2020].
  3. Corrado, A., De Paola, E., Gorini, M., Messori, A., Bruscoli, G., Nutini, S., Tozzi, D. and Ginanni, R., 1996. Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency. Thorax, 51(11), pp.1077-1082.
  4. Zielinski, J., MacNee, W., Wedzicha, J., Ambrosino, N., Braghiroli, A., Dolensky, J., Howard, P., Gorzelak, K., Lahdensuo, A., Strom, K. and Tobiasz, M., 1997. Causes of death in patients with COPD and chronic respiratory failure. Monaldi archives for chest disease= Archivio Monaldi per le malattie del torace, 52(1), pp.43-47.
  5. Bardsley, P.A., 1993. Chronic respiratory failure in COPD: is there a place for a respiratory stimulant?. Thorax, 48(8), p.781.
  6. Bach, J.R., O’Brien, J., Krotenberg, R. and Alba, A.S., 1987. Management of end stage respiratory failure in Duchenne muscular dystrophy. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 10(2), pp.177-182.

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