Respiratory Insufficiency - Vestalis-vision

What is respiratory insufficiency? ^[1]

Shortness of breath, breathing difficulties, bluish lips, confusion, drowsiness… These symptoms can indicate respiratory failure. This condition is characterized by inefficient breathing, unable to ensure proper hematosis, i.e. the supply of oxygen and elimination of carbon dioxide from the blood.

Elderly man with mask for respiratory failure

Respiratory failure can be acute, i.e. caused by the worsening or sudden onset of lung disease (a medical emergency), or chronic. The three main causes of chronic respiratory failure (CRF) are chronic obstructive pulmonary disease (COPD), Obesity-Hypoventilation Syndrome (OHS) and neuromuscular diseases.

In addition to clinical examination, diagnosis of CKD relies mainly on measurement of oxygen and carbon dioxide levels in the blood, as well as thoracic imaging.

The main treatments for CKD are mechanical ventilation and oxygen therapy, which can be delivered at home and monitored remotely.

What is COPD?

COPD, or chronic obstructive pulmonary disease, is a chronic respiratory illness. According to the World Health Organization, it is the third leading cause of death worldwide ^[15] and affects almost as many women as men.

COPD is characterized by progressive narrowing and permanent obstruction of the airways (bronchi) and lungs, involving inflammatory mechanisms. It leads to respiratory discomfort that tends to worsen over time, persistent cough and mucous sputum, with periods of exacerbation ^[16], i.e. acute worsening of symptoms ^[17]. Progressive destruction of the pulmonary alveoli leads to emphysema ^[18].

The most common cause of COPD is smoking^19], in 85% of cases ^[20]. Other risk factors include occupational exposure, pollution and genetic factors ^[21]. The risk of mortality from COVID-19 is higher in people with COPD ^[22].

How is it diagnosed and treated?

Since COPD is a disease that progresses quietly, it’s essential to detect it as early as possible. You are 40 or over, you smoke regularly, your breathing is becoming more difficult, you have (in particular) bouts of coughing up sputum ^[23] ? Do not hesitate to consult your doctor for a diagnosis, carried out by spirometry (measurement of the quantity of air contained in the lungs and expelled) ^[24].

What can be done in the event of COPD? The first step is to stop smoking. Vaccinations against influenza and pneumococcal disease are recommended. Depending on the frequency and intensity of symptoms, the care team may call on various therapeutic solutions ^[25]:

Medications alone or in combination: bronchodilators, inhaled corticosterapies… ;
Respiratory rehabilitation, combining physical activity and respiratory physiotherapy ^[26];
Oxygen therapy and/or non-invasive ventilation (NIV) for patients with respiratory failure.

Obesity-Hypoventilation Syndrome (OHS): what is it?

Obesity-Hypoventilation Syndrome (OHS) is defined as the joint presence of obesity and chronic hypercapnic respiratory failure (excess CO₂ in the blood). It is under-diagnosed and on the increase due to the growing prevalence of obesity and overweight ^[27] worldwide: in 2022, 43% of adults aged 18 and over were overweight and 16% obese, according to the WHO ^[28].

The symptoms of OHS are not very specific: shortness of breath, daytime sleepiness, morning headaches… It is very often associated with sleep apnea syndrome (80 to 90% of cases^[29]). If left untreated, quality of life deteriorates, complications can arise (pulmonary hypertension, metabolic and vascular disorders, etc.) and mortality rises. In addition to weight loss, the main treatment for SOH is non-invasive ventilation (NIV), which helps to compensate for impaired respiratory function ^[30].

Neuromuscular diseases: what impact on breathing?

Illustration homme et cerveau maladiesneuromusculaires

Many neuromuscular diseases can affect respiratory muscles: amyotrophic lateral sclerosis (ALS)*, Duchenne and Becker muscular dystrophies, myasthenia gravis, Guillain-Barré syndrome ^[31]… Weakened muscles such as the diaphragm, abdominal and intercostal muscles make breathing less efficient, altering oxygen supply and carbon dioxide elimination.

Those affected may experience significant difficulties in swallowing and breathing, with major repercussions on their quality of life: weakness, extreme fatigue, headaches… Home treatment with non-invasive ventilation (NIV) is generally proposed when signs of nocturnal respiratory insufficiency appear ^[32].

* progressive paralysis of muscles involved in voluntary motricity (Inserm)[33]

Publications :

• Published by SRETT :

Soler J, Le XL, Nguyen DPQ, et al. (2017). P66 Exacerbation telemonitoring for copd patient under long term oxygen therapy. Step 1: breathing rate measurement validation.Thorax 2017;72:A117
https://thorax.bmj.com/content/72/Suppl_3/A117

• Other publications :

Blouet S, Sutter J , Fresnel E, et al. (2018). Prediction of severe acute exacerbation using changes in breathing pattern of COPD patients on home noninvasive ventilation. Int J Chron Obstruct Pulmon Dis. 2018; 13: 2577–2586
https://www.dovepress.com/prediction-of-severe-acute-exacerbation-using-changes-in-breathing-pat-peer-reviewed-fulltext-article-COPD

Weipeng Jiang, Xiaoyan Jin, Chunling Du, et al. (2024). Internet of things-based management versus standard management of home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: a multicentre randomized controlled non-inferiority trial. eClinicalMedicine 2024;70: 102518 Published Online 10 March 2024 https://doi.org/10. 1016/j.eclinm.2024. 102518
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00097-X/fulltext

Pontier-Marchandise S, Texereau J, Prigent A, et al. (2022). Quality of ventilation in patients on home NIV included in a telemonitoring programme – TELVENT study. Eur Respir J 2022; 60: Suppl. 66, 974. doi: 10.1183/13993003.congress-2022.974
https://erj.ersjournals.com/content/60/suppl_66/974

Réginault T, Bouteleux B, Wibart P, et al. (2023). At-home noninvasive ventilation initiation with telemonitoring in amyotrophic lateral sclerosis patients: a retrospective study
ERJ Open Research 2023 9: 00438-2022; DOI: 10.1183/23120541.00438-2022
https://openres.ersjournals.com/content/9/1/00438-2022

REFERENCES

[1] https://erj.ersjournals.com/content/22/47_suppl/3s
https://www.ncbi.nlm.nih.gov/books/NBK526127/
https://www.msdmanuals.com/fr/accueil/troubles-pulmonaires-et-des-voies-aeriennes/insuffisance-respiratoire-et-syndrome-de-detresse-respiratoire-aigue/insuffisance-respiratoire
https://www.msdmanuals.com/fr/accueil/les-faits-en-bref-troubles-pulmonaires-et-des-voies-aeriennes/insuffisance-respiratoire-et-syndrome-de-detresse-respiratoire-aigue/insuffisance-respiratoire
https://cep.splf.fr/wp-content/uploads/2023/07/ITEM_208_INSUFFISANCE_RESPIRATOIRE_CHRONIQUE_2023.pdf

[15] https://www.who.int/fr/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

[16] https://www.inserm.fr/dossier/bronchopneumopathie-chronique-obstructive-bpco/

[17] https://www.has-sante.fr/jcms/pprd_2974843/fr/bpco-causes-frequentes-tabagisme-et-expositions-professionnelles

[18] https://splf.fr/wp-content/uploads/2014/07/BPCO2010-2.pdf

[19] https://www.inserm.fr/dossier/bronchopneumopathie-chronique-obstructive-bpco/

[20] https://www.has-sante.fr/jcms/pprd_2974843/fr/bpco-causes-frequentes-tabagisme-et-expositions-professionnelles

[21] https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/bpco-et-insuffisance-respiratoire-chronique

[22] https://www.msdmanuals.com/fr/professional/troubles-pulmonaires/broncho-pneumopathie-chronique-obstructive-bpco-et-troubles-apparentes/broncho-pneumopathie-chronique-obstructive-bpco#epidemiologie_v914583_fr

[23] https://www.vidal.fr/actualites/30801-bpco-la-detection-precoce-est-essentielle.html

[24] https://www.ameli.fr/assure/sante/examen/exploration/deroulement-spirometrie