What is Acute Respiratory Distress Syndrome (ARDS) in COPD?
Respiratory conditions are some of the most common illnesses in the world. According to HealthDay, about one in every seven people in the United States has some type of respiratory disorder such as asthma or chronic obstructive pulmonary disease (COPD) and some people have more than one. While many people are aware of what kinds of lung diseases there are, there isn’t a lot of awareness surrounding the global burden of lung disease and how much harm they actually cause.
Although COPD is a disease that develops slowly over the course of many years, it puts the patient at risk for many other conditions such as recurring lung infections, pulmonary hypertension, and even cardiovascular disease. In this post, we’re going to take a look at one of the lesser-known side-effects of COPD called acute respiratory distress syndrome (ARDS). We’ll discuss exactly what this condition is, its symptoms, as well as how it’s linked to COPD and other chronic illnesses.
As always, if you have any questions about what you read here, don’t hesitate to leave them in the comment section below and we’ll get back to you as soon as possible.
What is Acute Respiratory Distress Syndrome?
Acute respiratory distress syndrome is a life-threatening condition that causes the tiny air sacs in the lungs called alveoli to fill with fluid. It’s referred to as an “acute” illness because it usually develops quickly and without much warning. Since the alveoli are responsible for the exchange of oxygen and carbon dioxide to and from the blood, patients with ARDS will experience a sharp decline in their blood oxygen levels. This is called hypoxemia, and over time, it can lead to tissue and organ damage because they rely on oxygen to function properly.
ARDS is considered a type of respiratory failure. This is an umbrella term that includes a wide range of chronic and acute conditions like COPD, pulmonary fibrosis, pulmonary arterial hypertension, and asthma. There are fewer than 200,000 cases of acute respiratory distress syndrome each year making it a fairly uncommon condition. The survival rate of ARDS is between 50% and 70%. Symptoms of ARDS vary from patient to patient, but severe shortness of breath, low blood pressure, and confusion or dizziness are the most common.
In ARDS, the lungs go through several different phases. These phases vary from patient-to-patient but we’ve outlined the basics of each for your convenience.
“Exudate” is a term that refers to the buildup of fluid due to cellular damage or inflammation. In the case of an ARDS patient, water, protein, and inflammatory and red blood cells leak from surrounding blood vessels into the alveoli, preventing the transfer of oxygen into the blood. What also occurs during this phase is reduced lung compliance. In other words, the lungs become stiff, losing a lot of the elasticity that allows you to fill them with air fully. This is why mechanical ventilation is often the first step in solving ARDS because it reduces the physical burden of breathing for the patient.
Cell proliferation is when a cell grows and divides into two daughter cells. The type of proliferation that occurs in ARDS is called fibroproliferation and it’s when the alveolar structure begins to repair itself and re-establish the barrier function. This is also when fibroblasts begin to proliferate. Fibroblasts are the most common cell found in connective tissue. They secrete the protein collagen which creates a structural framework for many tissues in your body. Typically, the proliferative phase of ARDS lasts around 7 to 14 days after the incident.
The final stage of ARDS is known as the fibrotic stage. Pulmonary fibrosis refers to the development of scar tissue in the lungs. If inflammation and fluid buildup continue in the lungs it can lead to the formation of scar tissue which puts you at a high risk of pneumothorax. This is when one or both of the lungs deflate. Check out this article we wrote that discusses pneumothorax in detail.
What Causes Acute Respiratory Distress Syndrome?
Acute respiratory distress syndrome causes are divided into two different categories: direct (pulmonary or primary) lung injury or indirect (extrapulmonary or secondary) lung injury. Direct lung injury occurs within the lung epithelium and indirect lung injury is a systemic disorder that diffusely damages the lung epithelium.
Primary Lung Injuries that Cause ARDS
Pneumonia and acute respiratory distress syndrome are very similar. They both result in the buildup of fluid in the alveoli of the lungs. However, pneumonia is caused by either a bacterial, viral, or fungal infection, whereas ARDS has a number of direct and indirect causes. Pneumonia is very common with over 3 million cases in the United States each year. Pneumonia can be a life-threatening condition for infants, people over the age of 65, and people with serious underlying health conditions.
Certain types of pneumonia can be prevented with vaccinations and bacterial infections can be treated effectively with the use of antibiotics. Pneumonia progresses to ARDS when the fluid buildup does not improve and the patient experiences worsening breathlessness and inability to breathe without the use of a ventilator. According to an article published in the Oxford Medical Journal, pneumonia is responsible for 31% of all patients who develop ARDS.
Thoracic trauma is another way of saying physical trauma that’s done to the chest. According to Science Direct, trauma patients account for 10% to 30% of all patients who develop ARDS. If you experience a chest injury, no matter the severity, be sure to speak with your doctor about the potential risk of developing ARDS.
Smoke or Gas Inhalation
Airborne particles like smoke and gas are a risk factor or direct cause of many chronic lung conditions like COPD, pulmonary fibrosis, and more. People who work in industrial settings are highly susceptible to respiratory complications because they’re often exposed to high levels of air pollution for prolonged periods of time. However, everyone is at risk of the negative effects of air pollution. Visit AirNow.gov to learn more about the air quality in your area.
Secondary Lung Injuries that Cause ARDS
Sepsis is a blood condition that results when you have an unusual reaction to an infection. In a normal immune response, your body sends immune cells and various chemicals to fight off the threat. However, sepsis occurs when the immune response spreads throughout your body causing inflammation. If sepsis is severe enough, it can begin to damage organs throughout your body including the lungs. Any type of infection can cause sepsis, so it’s important to keep an eye out for the warning signs.
The group of people most likely to experience sepsis are people over the age of 65 and people with weakened immune systems, so people with diabetes or an autoimmune disease are at high risk The symptoms of sepsis include confusion, body aches, shortness of breath, a fever, and a high heart rate. Sepsis typically develops pretty quickly after an infection, but the longer it prolongs without being treated, the higher the risk there is of the patient developing severe sepsis. Antibiotics are the primary treatment method for sepsis, but if damage has already been done, the patient may require surgery in order to remove damaged tissue.
The pancreas is an organ that sits just behind the lower part of the stomach. It’s part of the endocrine system and it’s responsible for secreting hormones and fluids that assist with the digestion of sugars, fats, and starches. Pancreatitis occurs when the pancreas becomes inflamed and it’s unable to perform its job correctly. Pancreatitis is usually caused by collateral damage from abdominal surgery, alcoholism, certain medications, or gallstones. It can also be acute, coming on quickly, or chronic, developing slowly over the course of many years. Similar to sepsis patients, pancreatitis patients may experience inflammation in other parts of the body due to the release of chemicals into the bloodstream.
According to PubMed, alcohol, cocaine, amphetamines, benzodiazepines, and opiates can all cause acute respiratory distress syndrome. Studies have shown that about 10% of all ARDS cases are drug induced.
How are ARDS and COPD Linked?
ARDS and chronic obstructive pulmonary disease (COPD) are commonly confused, but they are not the same condition. Whereas ARDS is a condition that develops quickly and can often be life-threatening if it’s not treated quickly, COPD is a condition that develops over the course of many years. About 85 to 90% of COPD cases are caused by cigarette smoking, whereas ARDS has a number of different causes, some of which we have listed above. Although COPD doesn’t directly cause ARDS, it is a risk factor.
COPD is very uncommon in people under the age of 40, so the demographic of COPD patients alone puts them at a higher risk of ARDS. Secondly, the vast majority of COPD patients are either current smokers or have smoked in the past. It’s estimated that around 30% of COPD patients are current smokers. Smoking is known to have a number of adverse effects on the immune system including increased susceptibility to influenza and pneumonia.
What’s more, smokers experience more severe and longer-lasting illness due to a lack of protective antioxidants in the blood. Current or previous smokers are at a higher risk of contracting and experiencing severe symptoms from sepsis, pneumonia, and pancreatitis, all of which are causes of ARDS.
How is ARDS Treated?
A ventilator is a device that assists a patient with the physical act of breathing. Since ARDS causes the lungs to fill with fluid, breathing becomes very labored meaning the patient will struggle to catch a breath and they may even struggle to expel air from the lungs. The ventilator will ensure that the patient is able to completely fill their lungs.
Oxygen therapy differs from ventilation in that the air is not forced into the patient’s lungs. Rather, a high concentration of oxygen is released into either a nasal cannula or an oxygen mask and then it’s inhaled by the patient. Depending on your circumstances, your doctor may put you on both a ventilator and supplemental oxygen. Maintaining healthy blood oxygen levels is imperative because it promotes the proper function of all organs in your body, thus reducing the risk of complications due to ARDS.
In order to get ARDS patients off of ventilation and supplemental oxygen the fluid that has built up in the lungs needs to be drained. This is a very difficult task because consuming too many fluids can exacerbate this issue and consuming none could lead to heart and kidney problems. Many doctors will prescribe a medication called a diuretic which helps them gradually release fluids from their system.
Extracorporeal membrane oxygenation (ECMO)
ECMO is an extremely complex process that involves removing blood from the body, removing carbon dioxide, then re-oxygenating it and putting it back in the body. Essentially, this process allows medical specialists to bypass the heart and lungs allowing them to heal. ECMO is only done in medical emergencies because there are a lot of risks involved.
How Can ARDS be Prevented?
Smoking is the leading cause of preventable illness in the world. According to the Centers for Disease Control and Prevention (CDC), smokers have a life expectancy that is 10 years less than that of nonsmokers. Smoking not only damages and inflames the lungs, but it also suppresses your immune system which is needed to fight off infections that can cause ARDS.
If you’re someone who’s at high risk of acute respiratory distress syndrome, getting vaccinated for pneumonia, influenza, and other diseases could be life-saving. However, before getting any vaccines you should speak with your doctor who will examine your medical history and help you determine which vaccines you should get and which ones to avoid. It’s estimated that about 5% of critical coronavirus (COVID-19) cases lead to ARDS so if you’re concerned about this, address them with your doctor.
Visit a Doctor if You’re Sick
Most healthy people simply stay home if they’re sick. However, if you’re at high risk for ARDS, you should keep in touch with your doctor to discuss your symptoms. Since ARDS develops quickly and it can be life-threatening, it’s best to know ahead of time what the warning signs are so that you can visit the emergency room.
COPD and ARDS are two separate conditions, but they are linked in a number of ways. Firstly, the damage to the alveoli in ARDS patients is similar to that found in emphysema patients. What’s more, COPD patients are more likely to experience severe ARDS in relation to the general population. Many COPD patients are smokers which also puts them at a high risk of experiencing ARDS. If you want to reduce your risk of severe respiratory events like this, your best bet is to follow your treatment plan and quit smoking immediately. It’s also important to seek immediate medical attention if you experience a traumatic injury or develop a lung infection.
One of the most beneficial things you can do for yourself if you have COPD is to follow your daily treatment plan. This includes maintaining a healthy and well-balanced diet, sticking to a moderate and consistent exercise routine, and keeping your blood oxygen levels normal. At LPT Medical, we aim to simplify your oxygen therapy routine by offering low-cost and convenient oxygen devices called portable oxygen concentrators. Devices like the Caire FreeStyle Comfort and Inogen One G5 weigh under 5 pounds and they’re small enough to carry under your shoulder without discomfort. Since portable oxygen concentrators are electronic devices, you simply need to keep them charged.
Give us a call or send us an email today to speak with an oxygen concentrator specialist.