Chronic Respiratory Failure

Front view of a person's lungs.
Chronic respiratory failure is a long-term type of respiratory failure. Respiratory failure is when one or both of these things happen:

  • Oxygen cannot pass from the lungs into the blood, causing the blood oxygen level to drop. Loss of blood oxygen means tissues and organs may not work well.

  • A gas called carbon dioxide cannot pass from the blood into the lungs so the body can get rid of it. The build-up of carbon dioxide can damage the tissues and organs in the body.

Chronic respiratory failure may develop over weeks, months, or years. It is usually the body’s response to another long-term (chronic) condition that affects breathing.

You may also get sudden shortness of breath (acute respiratory failure) when you have chronic respiratory failure. Sudden shortness of breath needs to be treated right away.

What increases the risk?

You are more likely to develop this condition if you have another chronic condition, such as:

  • Chronic obstructive pulmonary disease (COPD).

  • Cystic fibrosis.

  • Neuromuscular weakness from a stroke, spinal cord injury, or myasthenia gravis.

  • Pulmonary fibrosis. This is scarring of the lung tissue.

  • Sleep apnoea.

  • Obesity-hypoventilation syndrome.

  • Congestive heart failure.

What are the signs or symptoms?

Chronic respiratory failure may not have clear symptoms when it happens slowly over time and the body gets used to it.

Symptoms of this condition may include:

  • Shortness of breath or trouble breathing.

  • Feeling very tired, sleepy, or low energy.

  • Blurred vision or headaches.

  • Fast breathing.

  • Confusion.

  • Fingernail beds or toenail beds that look bluish.

  • Fingernails or toenails that look wide, swollen, spongy, or bulging.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your medical history.

  • A physical examination.

  • Other tests. These may include:

    • Blood tests, such as an arterial blood gas test to check oxygen and carbon dioxide levels.

    • Imaging tests, such as a chest X-ray or CT scan.

    • Pulmonary function tests. These help to find out if you have chronic lung disease.

    • An echocardiogram. This test uses sound waves to make pictures of your heart.

How is this treated?

An oxygen tank.
Treatment for this condition depends on the cause. Treatment may include:

  • Oxygen given through a tube with prongs that sit in your nose (nasal cannula) or through a mask that fits over your face.

  • Non-invasive positive pressure ventilation. This is breathing support using a machine to blow air into your lungs through a mask. Examples of these machines are:

    • Continuous positive airway pressure (CPAP) machine.

    • Bilevel positive airway pressure (BIPAP) machine.

  • Medicines to help with breathing, such as:

    • Medicines that open up and relax air passages, such as bronchodilators. These may be given through a device that turns liquid medicines into a mist you can breathe in (nebuliser).

    • Diuretics. These medicines get rid of extra fluid in your lungs.

    • Steroids. These decrease inflammation in the lungs.

  • Pulmonary rehabilitation. This is an exercise programme that strengthens the muscles in your chest and helps you learn breathing methods to manage your condition.

  • A ventilator. This is a breathing machine that sends oxygen to your lungs through a tube that is put into your windpipe (trachea). This machine is used when you can no longer breathe well enough on your own.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as instructed by your healthcare provider.

  • If you were prescribed antibiotics, take them as instructed by your healthcare provider. Do not stop using the antibiotic even if you start to feel better.

General instructions

A sign telling a person not to smoke.

  • Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco and vaping devices, such as e-cigarettes. If you need help quitting, ask your healthcare provider.

  • If you were told to use oxygen therapy at home, follow the instructions from your healthcare provider. Do not use more oxygen than you were told. Getting too much oxygen may be harmful when you have this condition.

  • If you were given a CPAP or BIPAP machine, follow the instructions for use, cleaning, and care as instructed by your healthcare provider.

  • Return to your normal activities as instructed by your healthcare provider. Ask your healthcare provider what activities are safe for you.

  • Stay up to date on all vaccines, especially pneumonia and yearly flu (influenza) vaccines.

  • Stay away from people who are sick, and avoid crowded places, especially during the cold and flu season.

  • Keep all follow-up appointments.

Contact a healthcare provider if:

  • Your shortness of breath gets worse.

  • You have more mucus from your lungs (phlegm/sputum), high-pitched whistling sounds when you breathe (wheezing), coughing, or loss of energy.

  • You get oxygen therapy and you still have trouble breathing.

  • You have a fever of 38°C (100.4°F) or higher.

Get help right away if:

  • Your shortness of breath gets much worse or gets worse very fast.

  • You get pain, tightness, or pressure in your chest.

  • You cannot say more than a few words without having to catch your breath.

  • Your lips, toenails, or fingernails look bluish.

  • You become confused or difficult to wake up.

These symptoms may be an emergency. Get help right away. Call your local emergency services.

  • Do not wait to see if the symptoms will go away.

  • Do not drive yourself to the hospital.

Summary

  • Chronic respiratory failure is a long-term breathing problem that may develop over weeks, months, or years. It is usually the body’s response to another long-term condition that affects breathing.

  • This condition may not have clear symptoms when it happens slowly over time and the body gets used to it.

  • Shortness of breath and trouble breathing are the most common symptoms of this condition.

  • If you were told to use oxygen therapy at home, do not use more oxygen than you were told. Getting too much oxygen may be harmful when you have this condition.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.