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What To Know About Hypercapnia
Hypercapnia, or carbon dioxide (CO2) retention, causes high CO2 levels in the blood. It occurs when your lungs cannot eliminate enough CO2 through breathing. Symptoms include shortness of breath, headaches, confusion, and drowsiness.
Conditions associated with decreased lung function, such as chronic obstructive pulmonary disease (COPD) or asthma, commonly cause hypercapnia. Metabolic changes, certain medications, and illness can also lead to hypercapnia.
Hypercapnia can be dangerous, but there are treatment options and ways to prevent it. Read on to learn what would cause CO2 levels to be high and how to treat it.
Hypercapnia symptoms can depend on whether the development is acute or chronic. Acute symptoms are temporary, while chronic means that symptoms are long-lasting. Acute Acute hypercapnia is the sudden increase in the levels of CO2 in the blood. It usually occurs in response to a specific event or condition that causes an imbalance in the body's ability to eliminate CO2. An asthma attack, an overdose of medication that slows down breathing, or a respiratory infection can trigger acute hypercapnia. Symptoms of acute hypercapnia include: Confusion Dizziness Flushed skin Headache Inability to focus Lethargy or fatigue Nausea Shortness of breath Chronic Chronic hypercapnia is when CO2 levels gradually increase over time. Causes can include an underlying lung or heart disease, such as COPD or heart failure. These conditions can reduce the lungs' ability to eliminate CO2. Symptoms may be less severe and go unnoticed until the condition has progressed. Symptoms of mild hypercapnia include: Drowsiness Fatigue Increased heart rate Irritability Lightheadedness Poor concentration Symptoms of a more severe case of hypercapnia include: Coma Confusion, depression, or paranoia Fainting Heart palpitations Hyperventilation Muscle twitches Panic attack Respiratory failure Seizure Swelling of the optic nerve (papilledema) The body produces CO2 as a waste product of metabolism, or the body's conversion or use of energy. CO2 is normally eliminated through the lungs when you breathe. An imbalance between the amount of CO2 the body produces and the amount of CO2 the lungs eliminate causes hypercapnia. Your body normally sends signals to your brain when CO2 levels in the blood increase. These signals make you breathe more deeply or rapidly until your CO2 levels are within the normal range. Certain conditions can make it difficult to eliminate sufficient amounts of CO2. Lung Diseases Conditions that affect the respiratory system can impair the body's ability to eliminate CO2 effectively, causing hypercapnia. Lung diseases and breathing disorders associated with an increased risk include: Asthma Bronchiectasis COPD Cystic fibrosis Pulmonary embolism Pulmonary fibrosis Sleep apnea Metabolic Changes and Disorders Certain metabolic disorders can trigger changes in the body's metabolism. Other causes include infections, illness, or trauma that cause the body to produce too much CO2. You can develop hypercapnia if your breathing doesn't effectively eliminate the excess CO2. Metabolic changes and disorders that cause the overproduction of CO2 include: Carb-heavy meals Exercise Fever Increased use of steroids Kidney failure Scuba diving Sepsis Thyroid disorders Neuromuscular Problems Neuromuscular problems and disorders that affect the muscles used for breathing can cause hypercapnia. These disorders can make breathing or forcefully exhaling difficult. CO2 can accumulate in the lungs and bloodstream as a result. Some examples of neuromuscular diseases include: Medications and Toxins Certain medications and toxins can cause slow breathing (respiratory depression) or affect the body's ability to use oxygen effectively. As a result, a build-up of CO2 in the lungs can develop. Taking too many sedatives, such as benzodiazepine depressants or tricyclic antidepressants, can cause hypercapnia. Toxins from the following can also cause the condition: Botulism Shellfish poisoning Tetanus Risk Factors Anyone can experience hypercapnia, but other risk factors can increase the likelihood. These risk factors include: Chest or lung injury Excessive alcohol consumption Exposure to fumes or chemicals that can damage the lungs Obesity Older age Smoking Use of opioids or sedatives A healthcare provider will start with a thorough medical history. They'll ask about your symptoms, any conditions you have, and the medications you're currently taking. A healthcare provider will also perform a physical exam to evaluate your breathing rate, listen to your heart rate, and look for any signs of respiratory distress like wheezing or sweating. A blood gas test is the standard diagnostic test for hypercapnia. A blood sample will be taken from an artery or vein and sent to the laboratory to measure CO2, oxygen, and other gasses in the blood. Hypercapnia is diagnosed if the partial pressure of CO2 (PaCO2) exceeds 42 millimeters of mercury (mmHg). Additional tests may also be performed to identify the underlying cause, such as: Chest computed tomography (CT) scan: Creates detailed images to look for lung abnormalities and diseases Chest X-ray: Looks for lung abnormalities or diseases Complete blood panel (CBC): Checks blood for markers of anemia, or a lack of red blood cells Electrocardiogram (ECG) or electromyography (EMG): Measures heart, muscle, and brain activity to check for nervous system disorders and neuromuscular diseases Lung function tests: Measures how well the lungs work Metabolic panel: Checks many body functions and processes, including metabolism and liver health Sleep study: Measures brain waves, heart rate, breathing, and oxygen level in the blood during sleep and diagnoses sleep disorders Acute hypercapnia is an emergency, so it's important to get medical attention right away. A healthcare provider generally initially treats hypercapnia with oxygen therapy to promote ventilation and rid the body of excess CO2. Additional oxygen is supplied to the body through a face mask or nasal cannula to help reduce the level of CO2 in the blood. Other treatment options depend on the severity of the condition. Common hypercapnia treatments include: Invasive mechanical ventilation (IMV): IMV involves using a ventilator machine to take over the work of breathing and balancing blood gases. A tube is placed down the throat (intubation). This treatment is used for severe cases. Medications: Bronchodilators can help open up the airways and make breathing easier. Corticosteroids can also be used to reduce lung inflammation. Non-invasive mechanical ventilation (NIV): NIV uses a mask or a mouthpiece to deliver air or a mixture of air and oxygen. The pressure provided helps open up the airways and makes breathing easier. Pulmonary rehab: This is usually a combination of exercise training, education, and breathing techniques to improve lung function and overall physical fitness. Underlying conditions that cause hypercapnia require ongoing treatment. A healthcare provider can help you manage the condition and prevent future hypercapnic episodes. Preventing hypercapnia can be challenging since some risk factors are out of your control. There are still things you can do to reduce your risk: Avoid triggers: It's important to avoid triggers that can cause an asthma attack or make it more difficult to breathe if you have asthma or COPD. Triggers can include dust, pollen, or cigarette smoke. Be aware of medication side effects: Certain medications can slow breathing and lead to hypercapnia. Take your medicines as prescribed. Talk to a healthcare provider if you have concerns about potential side effects. Maintain a healthy weight: Hypercapnia and other breathing troubles are more common in people with obesity. Manage underlying conditions: It's vital to manage conditions that increase hypercapnia risk. Follow a healthcare provider's treatment recommendations. This includes taking medications as prescribed, avoiding triggers, and having regular check-ups. Quit smoking: Smoking can lead to lung damage and chronic lung conditions like COPD. Quitting smoking can improve lung function and prevent or slow the progression of lung diseases. Hypercapnia can sometimes lead to complications. Acute hypercapnia can lead to short-term consequences, such as: Cardiovascular collapse Confusion Irregular heartbeat Panic attacks Paranoia Unconsciousness Long-term complications can occur in those with chronic hypercapnia, such as: Cognitive impairment Depression Irregular heartbeat Low oxygen levels in the blood (hypoxemia) and tissue death Muscle loss Respiratory failure from hypercapnia can occur when the amount of carbon dioxide in the blood is between 45 to 60 mmHg. Hypercapnia can also worsen existing conditions, such as COPD, making them more challenging to manage. Hypercapnia, or a build-up of carbon dioxide (CO2) in the blood, occurs when the body cannot effectively eliminate CO2. Lung diseases, sleep apnea, neuromuscular disorders, metabolic changes, and certain drugs can cause hypercapnia. Symptoms can range from mild to severe and include shortness of breath, headache, confusion, and fatigue. Severe hypercapnia is a medical emergency that requires prompt treatment to prevent complications. It can be diagnosed through medical history, a physical exam, and laboratory tests. Treatment includes oxygen therapy, mechanical ventilation, and medications.Thanks for your feedback!
7 Myths About COPD Debunked
Several misconceptions surround COPD (chronic obstructive pulmonary disease), an umbrella term for inflammatory lung conditions such as emphysema and chronic bronchitis. To set the record straight on this condition, characterized by obstructed airflow from the lungs, here are seven common myths about COPD you should know.
1. Myth: Only People Who Smoke Get COPD"Although cigarette smoking is the main cause of COPD, not everyone who smokes will develop COPD symptoms, and not all people with COPD have a history of smoking," says Jonnie Korinko, a registered respiratory therapist and an education team member with the COPD Foundation.
A report published in 2019 by the Centers for Disease Control and Prevention (CDC) estimated that about 2.4 million adults who never smoked had the condition and about 1 in 4 people with COPD were nonsmokers.[1]
Other factors that may lead to COPD include a history of childhood respiratory infections, smoke exposure from coal or wood burning stoves, secondhand smoke, a history of asthma, and underdeveloped lungs, according to the American Lung Association.[2]
Recent research has shown that air pollution may be a significant contributor to COPD risk as well.[3] Particulate matter — a complex mixture of solid and liquid particles suspended in the atmosphere — are the main pollutants globally and are associated with an increased risk of hospitalization in people with COPD.
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Sanjay Sethi, MD, chief of the division of pulmonary, critical care and sleep medicine at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo in New York, says that old age ups the odds of getting COPD — a factor that former smokers especially need to be aware of.
"For some former smokers, your lung function may not bounce back to normal — the lung damage is already done, and on top of that, we lose lung function as we age," says Dr. Sethi, who has done extensive research on COPD.[5]
2. Myth: You Can't Exercise if You Have COPDRegular exercise can actually make people feel better and breathe easier — as long as they don't over do it.
When physical activity is performed without overexertion, scientists have found that it can make a difference — reducing fatigue, improving fitness and lung function, helping with depression and anxiety, and enhancing overall quality of life.[6]
As regular exercise builds stronger muscles, heart, and lungs, the body becomes more efficient at getting oxygen into the bloodstream.
People with COPD just have to be careful not to exercise too long or intensely, or they can experience shortness of breath and possible injury.[7]
While people differ in their capacities for physical activity, the American Lung Association says that in general a moderate amount of exercise is 20 to 30 minutes for three to four days a week. Activities may include a combination of stretching, strength building (such as lifting weights), and aerobics (walking, swimming, and bike riding).[7]
3. Myth: COPD Only Affects Older Men Because of the high prevalence of smoking among men, COPD has been considered a disease that primarily affects elderly men.[8]
However, research shows that more women die from COPD than men in the United States. According to data from the American Lung Association, in 2021, 72,727 women died from the condition versus 66,098 men.[9] This may be due in part to women having an increased vulnerability to cigarette smoke and smaller lungs.
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"Millions of women have COPD — the disease doesn't discriminate," says Meilan King Han, MD, chief of the division of pulmonary and critical care at the University of Michigan Health in Ann Arbor, and a spokesperson for the American Lung Association.
4. Myth: Treatments for COPD Aren't EffectiveWhile COPD may not have a cure, "that doesn't mean there are no effective treatments," says Seyedmohammad Pourshahid, MD, pulmonologist at Temple Lung Center and assistant professor of clinical thoracic medicine and Surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia. "There are multiple pharmacological and nonpharmacological therapies that relieve the symptoms and prevent further exacerbation."
Some treatments include smoking cessation, inhaler therapies like bronchodilators, oral steroids, managing other health conditions, vaccination for pneumonia, nutrition, oxygen and noninvasive ventilation, pulmonary rehabilitation, lung volume reduction (bronchoscopy or surgical), and even lung transplant.[11]
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"A lot of active research is going into new treatments for COPD," says Dr. Han with the American Lung Association. "I anticipate within the next few years, we will have even more therapies for this disease."
5. Myth: Living a Healthy Lifestyle Won't Improve Your COPD Symptoms Again, just because there is no cure, some people believe that lifestyle changes won't make a difference. Although living with the disease is difficult, the National Emphysema Foundation says that people can ease breathing, reduce exacerbations, and improve their overall quality of life by changing their lifestyle habits.[13]
These include quitting smoking, exercising regularly, managing stress, and avoiding air pollutants.
"Eating foods that support lung health is crucial for minimizing COPD symptoms," says Korinko with the COPD Foundation. "If you are unsure which diet is right for you, consult your healthcare provider for nutrition counseling to help you make the best food choices."[14]
The American Lung Association suggests that eating a diet with fewer carbohydrates and more fat may help ease breathing in COPD patients.[14]
Individuals with COPD have a harder time exhaling carbon dioxide. When your body metabolizes carbohydrates, it produces more carbon dioxide for the amount of oxygen used.
When your body metabolizes fat, it produces the least amount of carbon dioxide. The Cleveland Clinic advises following a Mediterranean diet, which emphasizes eating healthy fats from fish, nuts, avocados and olive oil, and few carbohydrates.[15]
Korinko also notes the importance of socializing and getting support from others to help you cope with the disease which in turn can promote overall mental well-being.
6. Myth: COPD Only Affects Your Lungs COPD may be categorized as a respiratory illness, but its effects can extend to the whole body. In the disease's advanced stages, the lungs can become severely damaged and no longer supply sufficient oxygen to the rest of the body, according to the Institute for Quality and Efficiency in Health Care.[16]
The condition can cause systemic inflammation, affecting the body's circulatory system leading to conditions like high blood pressure and possibly heart failure as the heart weakens. The risk of heart attack and stroke may also increase.
The American Lung Association warns that the extra exertion required to breathe with COPD can cause muscle loss, which in turn can lead to fatigue and weaken the immune system, potentially leaving the body vulnerable to severe infections.[17]
A state of low oxygen (hypoxia) from COPD can also influence bone health and increase the chances for developing osteoporosis.[18]
Dr. Pourshahid notes that people may experience more depression and anxiety connected to the stress from coping with the disease.
7. Myth: You Can't Live a Full Life With COPDPeople with COPD may have to handle the everyday challenges of living with the condition, but they can work, enjoy activities, see friends and family, and accomplish common tasks. They can live meaningful and productive lives.
Research suggests that being proactive — taking control of your health and improving self-management to better handle day-to-day living can be key to living a full life with COPD.[19]
"I tell most of my patients that they may not be able to run a marathon, but there is no reason why they can't do a lot of things that are pleasurable in life and contribute to life," says Sethi. "In the end, if you develop a positive attitude and take steps to live with the condition, you can have a productive life."
The TakeawayCOPD is a serious lung condition with many misconceptions, but understanding the facts can help you live a full life even with the diagnosis. Whether it's knowing nonsmokers can develop COPD or learning that exercise can benefit you despite your symptoms, knowledge is key. Take small steps to quit smoking, stay active, and eat a nutritious diet to manage your symptoms better.
How To Manage COPD Fatigue: 9 Strategies To Boost Energy
3. Consider Pulmonary Rehabilitation Pulmonary rehabilitation educates people about COPD and exercise to give them extra tools for COPD management. The exercises involve cardiovascular training, strength training, and flexibility: all types of movement that can improve lung function, reduce symptom severity, and improve your quality of life.[2]
Pulmonary rehabilitation can also provide patients with social support, according to Meredith McCormack, MD, an associate professor of medicine at Johns Hopkins Medicine in Baltimore. "People are in an environment where they're trying to increase their physical activity with peers who are like them and facing similar issues," Dr. McCormack says.
Pulmonary rehab programs can be very helpful in finding ways to conserve and boost energy with COPD.
"We teach and encourage exercise, but we also teach energy conservation techniques," says Scott Marlow, the director of the pulmonary rehabilitation program at Cleveland Clinic in Ohio. "With more advanced COPD, people can have shortness of breath doing many everyday activities, such as combing their hair or brushing their teeth."
Small changes, such as sitting down on a stool during a shower or stopping to rest a few times while preparing a meal, can make a big difference.
The main goal is to educate people about their condition, says Marlow. The information and strategies that pulmonary rehab teaches can reduce anxiety, which can also help prevent exacerbations. "The more you know, the more you are able to go out and do," he says.
4. Stop Smoking If you smoke and have COPD, quitting is probably the most important thing you can do, says McCormack. According to the Centers for Disease Control and Prevention (CDC), if a person is just beginning to experience COPD symptoms such as mild shortness of breath with heavy work or exercise, stopping smoking may reduce further lung damage and slow the progression of COPD.[3]
The COPD Foundation suggests that this will help preserve the lung function you still have.[4] The more normal your lung function is, the less energy your body will have to expend on breathing. Many options can help you kick the smoking habit, including:
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There is increasing evidence that people with COPD who have overweight face worse outcomes, says McCormack.
A review linked an increase in fat mass to worse health outcomes, including a lower tolerance for exercise and an increased risk of early mortality.[6] The extra weight around the chest wall causes compression and reduces air capacity.
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Even in the absence of COPD, research suggests that obesity is associated with greater fatigue.[8]
Pulmonary rehab or a healthcare provider can provide nutritional counseling and a plan to increase activity, shed weight, and boost energy with COPD.
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