Respiratory Failure Causes and Risk Factors

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Any condition or injury that affects breathing can cause respiratory failure. The condition or injury may affect your airways or lungs. Or it may affect the muscles, nerves, and bones that help you breathe.

When you can't breathe well, your lungs can’t easily move oxygen into your blood or remove carbon dioxide. This causes a low oxygen or high carbon dioxide level in your blood.

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Respiratory failure can be caused by several factors.

• Conditions that make it difficult to breathe in and get air into your lungs: Examples include weakness following a stroke, collapsed airways, and food getting stuck in and blocking your windpipe.
• Conditions that make it difficult for you to breathe out: Asthma causes your airways to narrow, while COPD can cause mucus to build up and narrow your airways. Both can make it hard for you to breathe out.
• Lung collapse: When no air can enter your lungs, your lungs may collapse. This can happen in certain situations, such as when the muscles that you use to breathe become extremely weak, mucus blocks one of the large airways, or a rib is broken or fractured and severe pain makes it difficult to take a deep breath. Chest or lung injury can also cause air to leak from the lung, filling the space around it, which is called a pneumothorax.
• Fluid in your lungs: This makes it harder for oxygen to pass from the air sacs into your blood and for carbon dioxide in your blood to pass into the air sacs to be breathed out. Pneumonia, acute respiratory distress syndrome (ARDS), drowning, and other lung diseases can cause this fluid buildup. It can also be caused by heart failure, which is when your heart can’t pump enough blood to the rest of your body. Severe head injury or trauma can also cause sudden fluid buildup in the lungs.
• A problem with your breathing muscles: These problems can occur after a spinal cord injury or when you have a nerve and muscle condition such as muscular dystrophy. This may also happen when your diaphragm and other breathing muscles do not get enough oxygen-rich blood, when the heart is not pumping well enough (cardiogenic shock), or when you get a severe infection called sepsis.
• Conditions that affect the brain’s control over breathing: In opioid overdose, for example, the brain may not detect high levels of carbon dioxide in the blood. Normally, the brain would signal to you to deepen your breathing so that you breathe out the carbon dioxide. Instead, carbon dioxide builds up in the body while oxygen levels fall, leading to respiratory failure.

Age

• Premature babies who have neonatal respiratory distress due to an under-developed lung, pulmonary hypertension, or certain lung birth defects have a higher risk of respiratory failure.
• Older adults have more risk factors for respiratory failure. It is more likely that food will accidentally go down the windpipe instead of the food pipe or that a cold will lead to a severe chest infection. Older adults are also more likely to have muscle weakness that can affect breathing.

Environment or occupation

Breathing in lung irritants can lead to lung damage over the long term and put you at risk of serious lung diseases. You may breathe in these irritants from the air where you live or work. Lung irritants include air pollution, chemical fumes, asbestos, aniline (artificially produced) dyes and paints, dust, and secondhand smoke (smoke in the air from other people smoking).

Other medical conditions

You may have a greater risk of respiratory failure if you have certain medical conditions or injuries, such as the following:

• Nerve and muscle disorders including amyotrophic lateral sclerosis, Guillain-Barre syndrome, and myasthenia gravis
• Lung and airway diseases such as asthma, cystic fibrosis, COPD, and interstitial lung diseases
• Fluid buildup in the lungs or pulmonary embolism (a blood clot in your lungs)
• Infections in your brain or spinal cord (such as meningitis), lungs (such as pneumonia), or airways (such as bronchiolitis)
• Blocked airway when food or another object gets stuck in your airways
• Chest or back injuries, which may damage your ribs or lungs
• Severe scoliosis, which happens when the spine is curved from side to side
• Severe allergies to food or medicine, which can cause your throat to swell up

Lifestyle habits

• Smoking can cause lung diseases that raise your risk of respiratory failure.
• Using drugs or alcohol raises your risk of an overdose. A drug or alcohol overdose affects the area of the brain that controls breathing. During an overdose, breathing becomes slow and shallow, and which may cause acute respiratory failure. This can happen from using illegal drugs or misusing prescription opioid painkillers.

Medicines or medical procedures

Certain sedatives used during surgery affect your breathing. This can put you at risk of respiratory failure, especially if you have other risk factors. Complications from major surgery can also raise your risk of respiratory failure.

If you have a condition that puts you at risk of respiratory failure, talk to your healthcare provider. They can ask questions and do a physical exam to look for issues that may put you at risk of getting respiratory failure in the future. You can also talk with them about how to manage your condition to prevent respiratory failure. They can also screen you if you have a planned surgery.

There are things you can do to keep your lungs healthy, including not smoking, quitting or limiting alcohol, and not misusing opioids or taking recreational drugs.

Your doctor may also talk to you about other healthy lifestyle changes that can help lower your risk. This may include being physically active, choosing a diet such as the DASH eating plan, aiming for a healthy weight, managing stress, and getting good-quality sleep.