33-year-old woman developed back pain that worsened over
several days. She took several medications, but the pain did not
abate. After five days, she developed breathlessness and was
hospitalized. The next day her blood pressure dropped and her
kidneys failed. The following day, her breathing deteriorated and
she required mechanical ventilation. Breathing became more
difficult, and the high pressure required by the ventilator to get
air into her lungs ruptured the lung alveoli, causing air to escape
the lungs and be trapped inside the chest (pneumothorax). This
was treated with a tube through the chest wall to allow the lungs
to expand. She was deeply sedated to reduce the work required by
her respiratory muscles. She developed pneumonia, and, after
about three weeks on the ventilator, a new breathing tube was
placed directly into the trachea (tracheostomy) in preparation
for long-term mechanical ventilation. ortunately, her kidney
function returned, and she was able to clear the fluid in her
lungs. Antibiotics treated the pneumonia. After four weeks in the
hospital, the sedation was stopped, and after nine weeks, the
tracheostomy tube was removed.
Acute respiratory distress syndrome (ARDS) is a
condition in which the lungs suffer severe
widespread injury, interfering with their ability to
take up oxygen. A low blood oxygen level and the
inability to get oxygen to normal levels is the
hallmark of ARDS
The term acute reflects the sudden onset—over
minutes or hours—of an injury. Acute lung injury
(ALI) is a more recently coined term that includes
ARDS but also milder degrees of lung injury.
ALI and ARDS always result from another severe
underlying disease. The range of diseases causing
ARDS is broad, and they may also damage organs
other than the lungs, but the lung injury usually
dominates the clinical picture
The lung contains millions of air sacs or alveoli
that are lined by 2 types of cells – Type I and Type
II. Type II cells secrete a fluid called surfactant.
The surfactant forms a thin layer on the alveoli
and reduces surface tension. The surfactant
prevents the alveoli from collapsing while
The patient presents with following features:
Low levels of oxygen in the blood
This condition could progress to respiratory failure
Causes of ARDS include
aspiration of gastric contents
post cardiopulmonary bypass surgery.
The patient is diagnosed using blood gases estimation
and imaging studies like chest x-ray and CT scan.
The patient is put on a ventilator during treatment.
Fluid and nutrition intake are carefully monitored.
Listening to the chest with a stethoscope
(auscultion)reveals abnormal breath sounds, such as
crackles, which may be signs of fluid in the lungs. Often
the blood pressure is low.(Cyanosis)(blue skin, lips, and
nails caused by lack of oxygen to the tissues) is often
Tests used to diagnose ARDS include:
Arterial blood gas
Blood tests, including CBC and blood chemistries
Chest X- ray
Sputum culture and analysis
Typically people with ARDS need to be in an
intensive care unit (ICU).
The goal of treatment is to provide breathing
support and treat the cause of ARDS. This may
involve medications to treat infections, reduce
inflammation, and remove fluid from the lungs.
A breathing machine is used to deliver high doses
of oxygen and continued pressure called PEEP
(positive end-expiratory pressure) to the damaged
lungs. Patients often need to be deeply sedated
with medications when using this equipment.
Some research suggests that giving medications
to temporarily paralyze a person with ARDS will
increase the chance of recovery.
A 52-year-old woman sought medical attention for
increasing shortness of breath on exertion for over two
years. She used to walk 9 holes of golf with her women’s
group every Wednesday, but over the last year she has
had to use a golf cart. She has attributed this change to
getting old. She was told three years earlier that she
had “a touch of asthma” and was given an inhaler to use
when she was symptomatic. In the last six months, she
had three trips to the emergency department for “acute
bronchitis.” She had smoked for about 15 years, but
stopped 20 years ago. Spirometry showed an FEV of 62
percent of that predicted and an FEV / FVC of 0.58.
(Forced expiratory volume (FEV)Forced vital capacity
Chronic obstructive pulmonary disease (COPD) is
the name for a collection of lung diseases
including chronic bronchitis, emphysema and
chronic obstructive airways disease.
People with COPD have difficulties breathing,
primarily due to the narrowing of their airways,
this is called airflow obstruction.
The symptoms of chronic obstructive pulmonary
disease (COPD) usually develop over a number of
increasing breathlessness when exercising or moving
a persistent cough with phlegm that never seems to go
frequent chest infections, particularly in winter
tiredness and fatigue
To assess how well your lungs work, a breathing test
called spirometry is carried out. You will be asked
to breathe into a machine called a spirometer.
2-Electrocardiogram (ECG) and echocardiogram An
electrocardiogram (ECG) or echocardiogram may be used to
check the condition of your heart.
4-Chest X- ray
5-Peak flow test
To confirm you have COPD and not asthma, your doctor might ask
you to take regular measurements of your breathing using a peak
flow meter, at different times over several days. The peak flow meter
measures how fast you can breathe out.
There is no cure for chronic obstructive pulmonary
disease (COPD), but treatment can help slow the
progression of the condition and reduce the
If you smoke, the best way to prevent COPD from
getting quickly worse is to stop smoking and
avoid further damage to your lungs. There is support
available to help you quit.
There are also medicines that can help relieve the
symptoms of COPD. The type of medicine you take
will depend on how severe your COPD is and what
symptoms you have. You may have to try different
medicines to find which suits you best