ARDS (acute respiratory distress syndrome): what it is, treatment and recovery

In ARDS the lungs become very inflamed and stop working properly. Asthma + Lung UK explains that the inflammation harms the blood vessels around the airways, which makes it very difficult to breathe because the body cannot get enough oxygen. The tiny air sacs become inflamed and leaky, so oxygen cannot pass properly into the blood.

The NHS calls it a life-threatening illness and stresses that it is usually a complication of other serious conditions and is treated in hospital. It is not a condition people usually develop while otherwise well. It follows a trigger that injures the lungs directly or through widespread inflammation in the body.

The word acute matters. ARDS is a sudden, serious change in how the lungs work, and is different from long-term lung diseases such as COPD or pulmonary fibrosis.

The NHS says ARDS is treated in hospital, usually in an intensive care unit, and that treatment may include oxygen through a mask, ventilation where a machine breathes for you, medicines such as antibiotics to treat infection, and fluids given through a vein. The underlying trigger must be treated at the same time.

Asthma + Lung UK says the main treatment is oxygen. If someone is very unwell they may be given oxygen through a tube in the mouth using a ventilator, and are given general anaesthetic so that they are asleep while on it. Treatment may also include lying face down (prone positioning), which may help take bigger breaths and get more oxygen into the healthy areas of the lungs, and fluids to manage the body's liquid levels.

Intensive care teams in the UK also follow a guideline from the Faculty of Intensive Care Medicine and the Intensive Care Society, published in July 2018 and supported by the British Thoracic Society. For patients who need a ventilator it recommends low tidal volumes (under 6 ml/kg ideal body weight) and limited airway pressures.

For moderate to severe ARDS, the guideline recommends prone positioning for at least 12 hours per day and suggests a conservative approach to fluids. It does not recommend high-frequency oscillation, and suggests inhaled nitric oxide is not used. ECMO, which oxygenates blood outside the body, is suggested as an add-on for very severe ARDS. These details are for professionals; they are here so families hearing unfamiliar terms on the unit can recognise them.

The NHS lists two symptoms: shortness of breath, and taking short, fast breaths. Asthma + Lung UK adds skin that looks blue or grey (cyanosis), which can be easier to see on the palms, soles, lips, gums and inside the eyelids on black or brown skin. It says symptoms develop quickly, usually within a week of the initial cause.

The NHS says to call 999 or go to A&E if you or someone else has severe difficulty breathing, such as being unable to get words out, choking or gasping. The same applies to sudden breathlessness with pain in the arms, back, neck or jaw, a tight or heavy chest, sickness, coughing up blood, or pain or swelling in one leg. Do not drive yourself.

The NHS says ARDS usually affects people who are already unwell. Asthma + Lung UK divides the causes into direct causes, where the lungs are harmed, and indirect causes, where other parts of the body are harmed. Direct causes include a serious lung infection such as pneumonia, COVID-19 or bronchiolitis (especially in children), inhaling vomit or food, a serious lung or chest injury, lung transplant, breathing in smoke and drowning. Indirect causes include sepsis, acute pancreatitis and blood transfusion.

• Sepsis, a serious reaction to infection.

• Infections such as pneumonia.

• Acute pancreatitis.

• Accidentally inhaling vomit or food.

• Drowning and smoke inhalation.

• Severe injuries.

• Having blood transfusions.

• Having a lung transplant.

NHS Wales, adapting NHS content, says there is no specific test to diagnose ARDS. A full assessment identifies the cause and rules out other conditions. It lists the following parts of that assessment.

• A physical examination.

• Blood tests to measure oxygen in the blood and check for infection.

• Pulse oximetry, a fingertip, ear or toe sensor that measures how much oxygen the blood is absorbing.

• A chest X-ray and a CT scan to look for evidence of ARDS.

• An echocardiogram, an ultrasound of the heart and nearby blood vessels.

The NHS is direct: ARDS is life-threatening, cannot always be cured, and there is a chance that someone who has it may die. Asthma + Lung UK says treatment can help most people, that about 6 in 10 people survive, and that deaths most often happen because of the underlying illness or injury. Recovery depends on how serious the ARDS was, what caused it, age and other health conditions.

People with ARDS usually stay in hospital for 2 to 3 weeks, according to the charity, with follow-up appointments afterwards. Some people's lungs recover to work almost as well as before. For others, the NHS lists shortness of breath, muscle weakness and pain as possible long-term effects, and Asthma + Lung UK says pulmonary rehabilitation can help manage breathlessness.

Asthma + Lung UK also notes that some people develop mental health problems after intensive care, such as post-traumatic stress disorder, depression and anxiety, and that a healthcare professional can help. Raise ongoing symptoms, including breathlessness, weakness or pain, with your GP or follow-up team.

ARDS itself is not described by the NHS or Asthma + Lung UK as an infection that passes from person to person. It is a response of the lungs to another serious illness or injury. However, some of the conditions that can trigger it, such as pneumonia, COVID-19 or other infections, can spread, so ward staff may use infection-control precautions for those underlying causes.

If you are visiting someone with ARDS, follow the hospital's guidance on hand hygiene, masks and visiting arrangements, and ask the nursing team if you are unsure.

ARDS is managed through hospital critical care, and emergency admission is through the NHS in most cases. There is no meaningful self-referral route for the acute illness, and the treatments are delivered by intensive care teams.

Where private care may feature is after recovery: respiratory follow-up, breathing tests, a CT scan, or rehabilitation with a physiotherapist. Check that anything arranged privately links back to your GP and discharge summary.