# Symptoms and Phases of Chronic Respiratory Failure
Chronic respiratory failure usually does not develop suddenly. It occurs when the lungs slowly lose their ability to take in enough oxygen and release carbon dioxide. This happens in different phases, each with its own characteristics and consequences for how someone feels and what they can do. This tab describes how the disease usually develops and which symptoms occur in which phase.
Early phase: mild airway control
In this phase, someone usually notices that something changes for the first time. The lungs are still working reasonably, but are starting to become difficult.
**Symptoms:**
- Shortness of breath that mainly occurs during exercise — for example when walking fast or climbing stairs
- Chronic cough, sometimes with phlegm
- Feeling tired, especially after physical activity
- In some cases: whistling or wheezing when breathing
- Chest pain or pressure, especially after exercise
**In daily life:**
Many people modify their activities without experiencing it as serious. They take the stairs slower or opt for the elevator. Walking is still possible, but maybe a little shorter or slower. Work can still be fully done, although breaks are sometimes welcome. Sleep is usually still normal, but some notice slight snoring or restless sleep at night.
**Figures about this phase: **
This is not a formal medical phase with fixed survival data. Rather, it is a harbinger. How much time someone spends in this condition varies widely — from months to years — and depends on the underlying cause (COPD, pulmonary fibrosis, neuromuscular disorders, etc.).
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Moderate phase: clear exercise restrictions
In this phase, the symptoms become more noticeable and clearly influence what someone can do.
**Symptoms:**
- Shortness of breath even with less effort — for example, just walking at a normal pace
- Tiredness and exhaustion after short activities
- Chronic cough gets worse or happens more often
- Coughing up phlegm; sometimes with a change in color (yellow, green)
- Swelling in the legs and feet may start (because the heart has to work harder to pump blood)
- Sleep problems are increasing — for example interruptions, muffled snoring, waking up with the feeling of not breathing properly
- Headaches or blurred vision in the morning after sleep (sign of nocturnal oxygen deficiency)
- Difficulty concentrating, memory feels less sharp
**In daily life:**
This is when people really need to adjust their lives. Heavy housework is becoming difficult — vacuuming, cleaning windows, gardening becomes exhausting. Work can become more difficult; some people have to work fewer hours or ask for breaks. Social activities are planned more carefully. Shopping requires breaks. Many people feel afraid or become cautious because they don't know how far they can go before they get short of breath. This can lead to isolation.
**Medical monitoring: **
In this phase, a therapist usually checks the oxygen level in the blood regularly. For many patients, this is where the need for oxygen therapy begins during certain activities or during the day.
**Figures about this phase: **
This varies greatly depending on the underlying cause. In COPD, this phase can last for years. Progressive diseases such as pulmonary fibrosis sometimes progress more quickly. Precise survival rates for “moderate phase” do not exist separately from the specific diagnosis.
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Severe phase: oxygen deficiency even at rest
This is the point where chronic respiratory failure really becomes clear. The lungs can no longer provide enough oxygen, even when someone is sitting still.
**Symptoms:**
- Shortness of breath even at rest — it feels like having trouble breathing even without doing anything
- Deep bluing (cyanosis): lips, fingers, toes or face get a blue-purple hue due to low oxygen levels
- Severe tiredness; many people can only walk short distances
- Chest feels more swollen; cough intensifies
- Feet and legs swell markedly (oedema)
- Sleep is severely disrupted: many nighttime awakenings, feels like you cannot breathe at night
- Confusion, dizziness or concentration problems (due to lack of oxygen to the brain)
- Stomach complaints, nausea, poor appetite
- Depression, anxiety, feelings of despair are very common
**In daily life:**
Independent functioning is severely limited. Showering, dressing, eating can already be exhausting. Many people can no longer independently do shopping or housework. They feel confined to home, sometimes to one room. The psychological impact is significant: loss of independence, fear of the future, grief over what is lost. Relationships change — much dependence on partners or caregivers.
**Medical adjustments:**
In this phase people almost always receive oxygen therapy — at home during the day and sometimes also at night. Some receive non-invasive ventilation (NIPPV), where a mask and machine help with breathing, especially at night. These aids can help relieve symptoms and improve sleep.
**Figures about this phase: **
The median survival in this phase varies greatly depending on the underlying cause and individual circumstances. With COPD with severe deficits, the median expectation is a few years, but this can be much shorter or longer (source: various lung researchers, 2024-2025). With more aggressive diseases such as certain forms of pulmonary fibrosis this can be months. With neuromuscular disorders it heavily depends on which muscles are affected. **These figures say nothing about one person** — much depends on additional diseases, the health of the heart and kidneys, and how well someone responds to treatment.
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Very severe phase: respiratory support needed
In this phase the body can barely breathe on its own, or can only do so for short periods.
**Symptoms:**
- Rapid, shallow breathing
- Continuous shortness of breath, even at rest and with oxygen supply
- Severe cyanosis (lips and face are distinctly blue-purple)
- Confusion, drowsiness or unresponsiveness (very low oxygen level and high carbon dioxide in the blood)
- Rattling or gurgling sound when breathing
- Extreme fatigue — many people cannot even feed themselves
- Continuous feeling of anxiety or panic
- Possible unconsciousness
**In daily life:**
Complete dependence on care and medical aids. Many people are at home or admitted to a hospital/nursing home. Communication with family becomes difficult. The focus shifts to comfort and dignity. Many patients and families think more deeply in this phase about what wellbeing still means and what they do or do not want.
**Medical support:**
Non-invasive ventilation (NIPPV) is used intensively — possibly almost continuously. Some can still stay at home with professional 24-hour care. Others require intensive admission, especially if complications arise (infections, heart problems, other organ failure). Medicines help relieve symptoms (anxiety, shortness of breath, coughing), but cannot stop the underlying disease.
**Figures about this phase: **
For many diseases this is the last stage before someone dies from the disease. Survival duration varies from weeks to months, sometimes longer. This depends on many factors: what the disease is, how well someone responds to support, whether infections occur, and how well the heart and other organs still function. **No number predicts what applies to one person.**
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Hospital admission and acute exacerbations
Many patients with chronic respiratory failure experienced one or more acute exacerbations — a sudden worsening. This often happens due to infection (pneumonia, flu), but can also arise from other causes.
**What happens:**
- Suddenly much more short of breath
- Fever, or conversely feeling cold
- Coughing with more mucus, sometimes bloody
- Chest pain
- Confusion
- Possibly no longer able to breathe independently
In this situation, hospitalization is usually necessary. There, patients receive intensive oxygen, sometimes ventilation via mouthpiece or ventilator, medications for infection, and medications to keep the lungs open. Many hospitalizations of patients with chronic respiratory failure progress well and someone goes home, although they feel weaker afterwards than before. Others stay longer or die in the hospital.
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When to contact your doctor
You should contact your doctor or lung specialist if:
- Your shortness of breath suddenly worsens, even at rest
- You develop blue lips or fingers
- You cough up blood
- You develop severe chest or abdominal pain
- You become confused or feel very sleepy
- You develop fever together with coughing or shortness of breath
- You feel a rapid heartbeat, especially with shortness of breath
- Your oxygen device (if you have one) seems to work less well
- Your feet and legs swell more quickly
- You can no longer eat or drink
Many of these symptoms can be treated, especially if they are noticed early. That is why regular contact with your care team is important.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._