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Respiratory failure in chronic obstructive pulmonary disease.

P M A Calverley1

  • 1Dept of Medicine, Clinical Sciences Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. pmacal@liv.ac.uk

The European Respiratory Journal. Supplement
|November 19, 2003
PubMed
Summary

Acute respiratory failure in chronic obstructive pulmonary disease (COPD) involves ventilation/perfusion mismatching. Management includes reducing mechanical load, treating precipitating factors, and appropriate oxygen therapy, with noninvasive ventilation revolutionizing care.

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Area of Science:

  • Pulmonology
  • Critical Care Medicine

Background:

  • Acute respiratory failure is a significant complication of chronic obstructive pulmonary disease (COPD).
  • Hospitalization for acute exacerbations indicates a poor prognosis, with comorbid conditions like cardiovascular disease also predicting mortality.
  • Understanding the physiological basis of acute respiratory failure in COPD is crucial for effective management.

Purpose of the Study:

  • To clarify the physiological underpinnings of acute respiratory failure in COPD.
  • To outline current treatment strategies for acute respiratory failure in COPD patients.
  • To emphasize the importance of prevention and identifying relapse factors.

Main Methods:

  • Review of the physiological mechanisms leading to hypercapnia and acidosis in COPD exacerbations.

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  • Analysis of treatment approaches including bronchodilators, corticosteroids, oxygen therapy, and ventilatory support.
  • Discussion of prognostic markers and preventative strategies.

    • Main Results:

    • Acute respiratory failure in COPD is characterized by ventilation/perfusion mismatching and increased physiological dead space, leading to hypercapnia and acidosis.
    • Treatment involves reducing mechanical load, addressing precipitating factors (e.g., infection), and maintaining gas exchange.
    • Noninvasive ventilation has significantly improved patient management, but appropriate oxygen prescription and prevention of relapse remain critical.

    Conclusions:

    • Acute respiratory failure in COPD is a manageable medical emergency.
    • Effective management requires a multi-faceted approach addressing physiological derangements, precipitating factors, and appropriate ventilatory support.
    • Future efforts should prioritize prevention of exacerbations and identification of factors contributing to early relapse.