COPD & Respiratory Failure: How to Recognize and Prevent it

COPD and respiratory failure


COPD and other respiratory diseases often come with health complications, both big and small. One of the more serious complications of COPD is acute respiratory failure, a medical emergency that occurs when you experience a sudden and serious drop in lung function.


Acute respiratory failure can be deadly, and getting immediate treatment can mean the difference between life and death. Because of this, it's vital for every person with COPD, and other chronic respiratory conditions, to be able to recognize and understand respiratory failure.


That's why, in this post, we're going to explain what respiratory failure is and how COPD can put you at risk. We'll also show you how to identify the symptoms of respiratory failure, what to do if it happens, and what you can do to minimize your risk for developing this life-threatening condition.


What Exactly is Respiratory Failure?

Respiratory failure happens when your lungs are no longer able to function well enough to meet your body's needs. This causes an imbalance of oxygen and/or carbon dioxide in your blood that can severely affect your ability to breathe.


To better understand how this happens, let's consider what healthy lungs are supposed to do: First, the air sacs (called alveoli) in your lungs absorb oxygen from the air you breathe in and transfer it to your bloodstream. Then, your heart pumps that oxygen to all the nooks and crannies of your body, where it's used as fuel for all kinds of vital functions.




When your body uses up that oxygen, it creates a waste product—carbon dioxide—that goes back into your bloodstream to get pumped back up to your lungs. Then, your lungs perform their second important duty; they take the carbon dioxide out of your bloodstream and get rid of it when you exhale.


This whole process is known as “gas exchange”, and healthy lungs can do this quickly and efficiently, even faster than your body needs. This ability is known as “respiratory capacity,” and having extra capacity allows your lungs to keep up even when you need more oxygen than usual (e.g. when you exercise) or when your lung function is reduced (e.g. when you get sick).


In the case of respiratory failure, however the opposite is true: your respiratory function gets lowered to the point that your lungs can no longer exchange gases fast enough to keep up with your body's needs. Essentially, this means that your lungs either can't absorb enough oxygen fast enough, can't get rid of carbon dioxide fast enough, or possibly even both.


As a result, one of three things happens:

  • Your blood oxygen levels fall to dangerous levels, a condition known as hypoxemia
  • Carbon dioxide builds up to dangerously high levels in your blood, a condition called hypercapnea.
  • In some cases, both hypoxemia and hypercapnea can happen simultaneously.


If the hypoxemia or hypercapnea become severe enough, it is diagnosed as either acute or chronic respiratory failure. We'll go into more detail about the differences between the two in the next sections below.





Respiratory failure is often caused by COPD and other chronic respiratory disorders. However, it can also be caused by other serious health conditions, including pneumonia, drug overdoses, and other diseases or injuries that affect the nerves and muscles you use to breathe.


Causes of Respiratory Failure:

  • Lung Conditions:
    • COPD
    • Cystic fibrosis
    • Pulmonary embolism
    • Pneumonia


  • Nerve and Muscle Conditions:
    • ALS
    • Muscular dystrophy
    • Stroke


  • Spine Conditions:
    • Scoliosis
    • Spinal cord injuries


  • Chest injuries
  • Overdosing on drugs or alcohol
  • Acute lung injuries from inhaling dangerous amounts of harmful fumes or smoke (e.g. breathing smoke in a house fire)


Acute vs. Chronic Respiratory Failure


There are two main types of respiratory failure: acute and chronic. Acute respiratory is severe and sudden, which chronic respiratory failure is a long-term health condition that develops gradually over time.


Chronic Respiratory Failure






The symptoms of chronic respiratory failure are, essentially, the main symptoms of moderate to severe COPD. Many people with COPD have chronic respiratory failure, and many people develop it in the later stages of the disease.


In fact, managing chronic respiratory failure is a major aspect of late-stage COPD treatment. You can live with chronic respiratory failure for years and usually manage it at home with the help of medications and your COPD treatment team.


Symptoms of Chronic Respiratory Failure

  • Difficulty breathing
  • Frequent shortness of breath, especially during physical activity
  • Coughing up mucus
  • Wheezing
  • Headache
  • Rapid breathing
  • Fatigue
  • Anxiety
  • Confusion
  • Bluish skin color, especially in the fingertips or lips


Acute Respiratory Failure





On the other hand, acute respiratory failure is a life-threatening medical emergency that requires immediate treatment. It can happen quickly, without much warning, and is most often caused by illness and COPD exacerbations.


Acute respiratory failure can be either hypoxemic (caused by low blood oxygen levels) or hypercapnic (caused by high blood carbon dioxide levels).


According to medical criteria, acute hypoxemic respiratory failure occurs:

  • If the partial pressure of oxygen in your blood drops below 60 mmHg (91% blood oxygen saturation), OR
  • If the partial pressure of oxygen in your blood drops 10mmHg or more below your usual baseline oxygen saturation.


Acute hypercapnic respiratory failure occurs:

  • If the partial pressure of carbon dioxide in your blood rises above 50 mmHg, OR
  • If the partial pressure of carbon dioxide in your blood rises by 10 mmHg or more above your baseline.


Acute respiratory failure often happens suddenly and begins with irregular breathing patterns like severe difficulty breathing and rapid, shallow breaths. You might also notice other symptoms in the hours and minutes before major breathing problems start, such as anxiety, fatigue, sweating, confusion, or a fast, racing heartbeat.


Symptoms of Acute Respiratory Failure:

  • If caused by high carbon dioxide levels (hypercapnic respiratory failure):
    • Rapid breathing
    • Confusion


  • If caused by low oxygen levels (hypoxemic respiratory failure):
    • An inability to breathe
    • Rapid and shallow breathing
    • Bluish skin color, especially in the fingertips or lips
    • Loss of consciousness
    • Irregular heartbeat
    • Racing heartbeat
    • Profuse sweating
    • Anxiety and restlessness
    • Tiredness and fatigue



In this post, we're going to focus on acute respiratory failure, as it is one of the leading causes of death for people with COPD. In the following sections, we'll explain more about the relationship between COPD and acute respiratory failure, including how to prevent it and how to know if you are at risk.


How Does COPD Cause Respiratory Failure?






As we explained before, acute respiratory failure is caused by an imbalance of gasses in your blood, which happens when your lung's normal function gets severely and suddenly disrupted. Now, we'll take a closer look at how exactly COPD causes respiratory failure.


Essentially, COPD puts you at risk because it reduces your baseline lung function and makes your lungs more vulnerable to infection and inflammation. The lower your lung capacity, the more vulnerable your lungs are to minor respiratory ailments, which can tip the balance of gas exchange to trigger acute respiratory failure.


It works like this: lungs affected by COPD exchange gases more slowly and inefficiently than healthy lungs. This happens because the air sacs responsible for facilitating gas exchange in the lungs get damaged and destroyed by COPD.


In addition to this, the airways that carry air to and from the lungs become narrowed, inflamed, and blocked up by mucus. This makes it more difficult to both inhale enough air and to exhale air from the lungs completely. It also makes it easier for viruses and infections to multiply in your lungs and airways.






Over time, this airway obstruction can lead to lung hyper-inflation, which happens when you can't push all of the air out of your lungs when you exhale. The leftover air stays trapped inside your lungs and prevents them from collapsing completely, which eventually causes your lung tissues to stretch out and expand.


This, in turn, makes it even more difficult to breathe and exhale completely, causing more and more air to become trapped in your lungs. This puts extra strain on the muscles you use to breathe, leading to respiratory muscle fatigue and potentially respiratory muscle failure, which is another potential trigger for acute respiratory failure.

These are some of the main reasons why COPD raises your risk for hypercapnea, hypoxemia, and both acute and chronic respiratory failure. The further disease progresses, the harder it becomes for your lungs to exchange gases fast enough to satisfy your body's needs.


Eventually, the lungs become so strained that they can't keep up at times when your body needs more oxygen than usual, which is why physical activity can make you feel short of breath if you have COPD. This also means that anything that reduces your lungs ability to function—even minor things like illness or inflammation—can make it impossible for your lungs to keep up.


When this happens, it causes imbalances in the gasses in your blood, leading to hypoxemia, hypercapnea, or both. If this happens slowly and gradually, then it leads to chronic respiratory failure, which can be treated at home with medications like bronchodilators, supplemental oxygen, and other COPD treatments.





On the other hand, acute respiratory failure happens when you experience a sudden drop in respiratory function, which is an immediate, life-threatening emergency. Acute respiratory failure is more likely to happen to people who already have chronic respiratory failure, a condition known as acute-on-chronic respiratory failure.


Acute respiratory failure is usually triggered by something that puts extra strain on your lungs, such as a COPD exacerbation. Acute respiratory failure can also be caused by environmental irritants that cause lung inflammation, like air pollution and smoke, while some cases of respiratory failure have no obvious or traceable cause.


Both acute and chronic respiratory failure can significantly increase your risk of dying from COPD. In fact, research shows that acute-on-chronic respiratory failure is the number one cause of mortality in people with COPD, accounting for about 38% of all deaths.


How Do You Know if You're At Risk for Respiratory Failure?






Respiratory failure is a well-known complication of COPD, but not every person with the disease will experience it. There are a variety of factors that influence your risk for respiratory failure, including the severity of your disease.


For example, the risk is higher if you have certain medical problems, such as heart disease or asthma, in addition to COPD. Behaviors like smoking and excessive drinking can also elevate your risk.


Another risk is using supplemental oxygen incorrectly, whether through misuse of the medication or getting the wrong prescription. In rare cases, this can disrupt gas exchange severely enough to cause acute respiratory failure.


Most cases of respiratory failure, however, are triggered by COPD exacerbations. Exacerbations are essentially major symptom flare-ups that last for days or weeks at a time, causing temporary or permanent lung function decline.


Exacerbations are most likely to happen when you get sick with a respiratory illness—like pneumonia, a common cold, or the flu. If not brought under control quickly, exacerbations can limit your lung function so severely that it causes acute respiratory failure.


Other factors that may increase your risk for respiratory failure:


What Should You Do if You Have Acute Respiratory Failure?






Acute respiratory failure is an extremely serious condition, and it can be deadly if you don't get immediate medical care. If you notice the signs of acute respiratory failure in yourself or someone else, you should call 911 or get someone else to drive you to the emergency room right away.


It's also a good idea to prepare for this type of situation ahead of time, since COPD symptoms can quickly become dangerous without a lot of warning. You should always keep a stash of important information and documents on hand in a place where yo can quickly grab them in an emergency.


This stash should include the addresses and phone numbers of the nearest hospitals, your doctors' contact info, and your emergency contact's info, as well as important medical records and a list of all the medications you take. Having these things available will not only ensure that you can get to the hospital fast, but it will also help doctors treat you more quickly and effectively once you arrive.


How Acute Respiratory Failure is Treated






If you go to the hospital with acute respiratory failure, the first thing that medical personnel will do is try to stabilize your breathing and ensure that your body gets enough oxygen. This usually includes administering supplemental oxygen through an oxygen mask, BiPAP machine, or mechanical ventilation.


If you need mechanical ventilation, that requires your doctor to insert a plastic tube through your mouth or nose and down into your windpipe. This tube is then attached to a breathing machine that delivers oxygen directly to your lungs to keep you stable until you can breathe again on your own.


Your doctor will then confirm the diagnosis of acute respiratory failure by measuring the levels of oxygen and/or carbon dioxide in your blood. This can be done with a simple finger pulse oximeter, or by taking a blood sample for an arterial blood gas test.


If the cause of respiratory failure is an illness or infection, your doctor will treat the underlying cause. Your doctor may also give you a variety of medications—such as steroids, antibiotics, and bronchodilators—to reduce lung inflammation and make it easier to breathe.


How to Prevent Acute Respiratory Failure


Respiratory failure is not always preventable, but there are certain things you can do to lower your risk. The next sections include a variety of practical tips to help you avoid the most common causes of respiratory failure, including exacerbations and improper supplemental oxygen use.


Avoid Exacerbations and Getting Sick

COPD exacerbations are responsible for the majority of cases of acute respiratory failure in people with COPD. Because of this, taking steps to avoid exacerbations is one of the most effective things you can do to reduce your risk for respiratory failure.


Fortunately, exacerbations are often avoidable if you follow your COPD treatment plan and do everything you're supposed to do to avoid getting sick. That includes practicing proper hygiene, getting vaccinated against pneumonia and the flu, and doing all the other things your doctor tells you to do to keep your symptoms under control.


The more illnesses and exacerbations you can prevent, the fewer chances you'll have to develop serious COPD complications like acute respiratory failure. It can also help you avoid permanent lung function loss, which can happen during severe exacerbations.


To learn more about how to prevent COPD exacerbations, read our comprehensive guide on the topic here. In the meantime, here are some helpful tips to start with.


Basic Steps to Avoid COPD Exacerbations

  • Take your medications on time every day.
  • Keep up with vaccinations, including yearly influenza shots and the adult Pneumonia vaccine.
  • Use mucus clearance techniques to get rid of excess mucus in your lungs and airways (which can trap bacteria and cause infections).
  • Always practice proper hygiene in public places (e.g. wash your hands often, avoid dirty surfaces, and avoid transferring pathogens from your hands to your nose, mouth, and eyes).
  • Avoid irritants and triggers that make your COPD symptoms worse, including allergens, dust, mold, smoke, and air pollution.


Treat Exacerbations Promptly






Not all exacerbations are avoidable, even if you do your best to stay healthy. In fact, research shows that people with COPD have about one exacerbation every year on average, which increases to two every year for people with severe COPD.



Fortunately, exacerbations are not an all-or-nothing thing; some exacerbations are life-threatening, while others are mild enough to to treat at home. The trick is to catch them early and to take the proper steps to keep it under control.


Exacerbations are easiest to treat in the beginning, right when you first notice your symptoms flaring up. It's much easier to prevent the symptoms from getting worse than it is to reduce them once they're already worsened.


Here are some of the early signs of a COPD exacerbation that you should learn to recognize:

  • An increase in the severity of your usual COPD symptoms, including:
    • Worse coughing
    • Coughing up more sputum than usual
    • A change in color of your mucus or sputum
    • Worsened shortness of breath
    • Increased wheezing or rattling in your chest when you breathe
    • Needing to use your rescue inhaler more than usual


  • New symptoms, including:
    • Irregular or uneven breathing
    • Morning headache
    • Difficulty sleeping
    • Difficulty eating
    • Fever






So what should you do if you feel the beginnings of an exacerbation coming on? Well, it depends on your individual COPD treatment plan and the severity of your disease.


The first thing you should do is look at your COPD action plan, which should tell you exactly what actions and medications to take when you notice your symptoms flaring up. This often includes things like reducing your physical activity, taking extra inhaler doses, or starting a preventative antibiotic or steroid regimen.


Your action plan should also tell you when you should call your doctor for extra help and treatment. For example, it might instruct you to call if your symptoms don't improve within a few days, or it might recommend calling as soon as your symptoms start to get worse.


When in doubt, don't hesitate to ask your doctor for advice or to clarify the instructions in your COPD action plan. If you don't have a COPD action plan or aren't sure whether or not you have one, you should schedule time to speak to your doctor about it ASAP.


A COPD action plan is a vital tool that every person with the disease should have; it tells you how to treat your COPD in a variety of different circumstances and how to recognize medical emergencies like the signs of respiratory failure. That's why it's vital to work with your doctor to come up with a COPD action plan that's easy to follow and understand.


Here are some links to helpful guides and information about COPD action plans:


Monitor Your Symptoms





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