Respiratory failure happens when your lungs can’t exchange oxygen and carbon dioxide efficiently. Your lungs are responsible for delivering the oxygen you inhale to your blood. Your blood carries oxygen to your tissues and organs and picks up carbon dioxide as a waste product. Your lungs remove carbon dioxide from your blood and get rid of it when you exhale. In respiratory failure, this process doesn’t work the way it should. Your body can’t get enough oxygen and toxic carbon dioxide builds up in your blood. Respiratory failure can happen very quickly (acutely) or develop slowly (chronically). Acute respiratory failure is a medical emergency. In people with COPD (chronic obstructive pulmonary disease), this can happen with a flare or an exacerbation. Chronic respiratory failure is not usually an emergency, but it can become severe. If you have chronic respiratory failure with COPD, your doctor may treat it while you remain at home. Respiratory Failure Symptoms The symptoms of respiratory failure are related to the problems with gas exchange—taking in oxygen and removing carbon dioxide. Low levels of oxygen can cause the following signs and symptoms: Air hunger—feeling like you can’t get enough air when you breathe Bluish lips, skin and fingernails Shortness of breath High carbon dioxide levels cause deep, rapid breathing to try to get rid of the waste gas. Eventually, the abnormal gas levels will cause confusion and sleepiness. When respiratory failure is severe, it can cause loss of consciousness, heart arrhythmias, and even death. COPD respiratory failure is the main cause of death in people suffering from chronic bronchitis or emphysema. Depending on the cause of respiratory failure, symptoms can vary. There may be more of a struggle to breathe or the drive to breathe may be abnormal and result in very slow breathing. Respiratory Failure Causes Your lungs rely on nerves, muscles, and blood supply to do the work of breathing. Respiratory failure can result from any condition that affects the lungs themselves or the ability to breathe. Causes of respiratory failure include: Airflow obstruction or airway narrowing including asthma, COPD, cystic fibrosis, and foreign objects in the airways Blood flow problems including pulmonary embolism, a blood clot that blocks an artery in the lungs Muscle weakness including amyotrophic lateral sclerosis, muscular dystrophy, myasthenia gravis, spinal cord injury, and stroke Poor drive to breathe including alcohol or drug intoxication, hypothyroidism, obesity, and sleep apnea Problems with the chest wall including chest wounds, trauma, and deformities due to extreme obesity or spine problems, such as scoliosis (S curvature of the spine) or kyphosis (hump back curvature of the spine) Problems with the lung tissue including ARDS (acute respiratory distress syndrome), damage due to radiation, excess fluid in the lungs, lung scarring, pneumonia, and tumors Respiratory Failure Treatment Treatment for respiratory failure depends on the underlying cause and whether it is acute or chronic. Acute respiratory failure treatment Acute respiratory failure is a medical emergency. Seek immediate medical attention (call 911) if someone suddenly develops symptoms of respiratory failure. This can happen in COPD if the disease flares up or you have pneumonia. Treatment of acute respiratory failure typically requires care in an intensive care unit. Chronic respiratory failure treatment With chronic respiratory failure, you may be able to treat it at home. However, if it is severe, your doctor may recommend a long-term care facility. The goals of treatment are to improve gas exchange and control or treat the underlying cause. Treatments that can help include: Oxygen therapy to increase the amount of oxygen getting into your lungs and out to your tissues. The least invasive way to get extra oxygen is through a nasal cannula—a plastic tube with two prongs that sit inside your nostrils—or a mask that covers your nose and mouth. If you can’t get enough oxygen this way, your doctor may need to use a tracheostomy or a ventilator. A tracheostomy is a surgical hole in the front of your throat that attaches to a breathing tube. Breathing support to help you breathe while you sleep. One method of doing this is positive pressure ventilation, such as CPAP (continuous positive airway pressure). CPAP constantly delivers pressurized air to keep your airways open. Another method is a rocking bed. The head of the bed rocks gently up and down while you sleep. The pull of gravity on your organs and diaphragm muscle assists your breathing. Medications to treat the underlying cause. For COPD, this may include bronchodilators to open the airways, corticosteroids to decrease inflammation, and antibiotics to treat infections. If you have COPD and chronic respiratory failure, you will likely need oxygen therapy on a long-term basis. You will also need pulmonary rehabilitation—or rehab—to help you feel your best. The program tailors exercises, breathing techniques, education, and emotional support to meet your specific needs.