What is ARDS?

What is the ARDS?

Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill patients. The major complication in ARDS is marked by leakage of fluid into the lungs, making breathing difficult or impossible. Acute lung injury (ALI) is a common condition characterized by acute severe hypoxia that is not due to left atrial hypertension.

The term ALI encompasses a continuum of clinical and radiographic changes that affect the lungs with the acute respiratory distress syndrome (ARDS) representing the more severe end of this continuum. Despite advances in the understanding of the pathophysiology and management of ALI, it is still associated with high mortality.

Out of total COVID-19 cases, the patients who are critically ill—very few and ranging from 1–4%—constitute the potential pool for ARDS.

What are the causes of ARDS?

The causes of ARDS are divided into two categories: direct or indirect injuries to the lung. Some of the direct injuries to the lung include pneumonia, aspiration, trauma, and others. Whereas the indirect injuries to the lung include inflammation of the pancreas, severe infection (also known as sepsis), blood transfusions, burns, and medication reactions.

The few symptoms of ARDS are shortness of breath, cough, and fever; in some cases, fast heart rates and rapid breathing have been reported as well. Occasionally, patients of ARDS experience chest pain, especially during inhalation, and some patients also experience bluish coloring of nails and lips due to the severely decreased oxygen levels in the blood. Several risk factors may escalate the risk of ARDS; this involves obesity, alcohol abuse, chemotherapy, low-protein in blood.

The ARDS market is expected to grow, driven by the factors like increase in the incident pool, expected entry of emerging therapies such as Traumakine, BIO-11006, MultiStem, and Solnatide in the 7MM markets. The increase in market size is also a consequence of a rise in awareness and disease understanding.

Apart from above mentioned molecules, Lenzilumab, tocilizumab (TCZ), aviptadil, ruxolitinib, tradipitant, and remestemcel-L, are the other pipeline therapies, which are expected to enter the market in the forecasted period that will be targeting the COVID-19 associated ARDS.

What is the ARDS Report?

The Acute Respiratory Distress Syndrome (ARDS), a life-threatening condition, was described as a form of respiratory failure that closely resembled respiratory distress syndrome in infants. It can be caused by a variety of pulmonary (such as pneumonia, aspiration) or non-pulmonary (like sepsis, pancreatitis, and trauma) abuses, leading to the development of non-hydrostatic pulmonary edema.

ARDS is characterized by an acute, diffuse, inflammatory lung injury, leading to increased alveolar-capillary permeability, increased lung weight, and loss of aerated lung tissue. Clinically, this establishes as hypoxemia, with bilateral opacities on chest radiography, associated with reduced lung compliance and increased venous admixture and physiological dead space. Morphologically, diffuse alveolar damage is observed in the acute phase of ARDS.

As per the analysis, in terms of severity-specific incidence, a similar trend is observed in all countries, with a majority of the cases witnessed for moderate ARDS, except France, where severe cases of ARDS accounted for a maximum patient population.

What is the ARDS Market Size?

The therapeutic market of Acute Respiratory Distress Syndrome (ARDS) in the seven major markets was USD 917.81 Million in 2017. The United States accounts for the highest market size of Acute Respiratory Distress Syndrome (ARDS), in comparison to the other seven major markets, i.e., EU5 countries and Japan. Among the EU5 countries, Germany contributed the largest market share in EU5 countries, with 52.02%, followed by Italy (15.68%).

What are the ARDS treatment options?

Other treatment options, which the patients with ARDS are generally subjected include supplemental oxygen, prone positioning, use of paralytics, fluid management, and a technique called positive end-expiratory pressure (PEEP) to help push the fluid out of air sacs. These are combined with continuing treatment of the original illness or injury. Because people with ARDS are less able to fight lung infections, they may develop bacterial pneumonia during the illness. Antibiotics are given to fight infection. Also, supportive treatment, such as intravenous fluid or food, may be needed.

Despite decades of research, treatment options for ARDS are restricted. Supportive care with mechanical ventilation remains the mainstay of management. There are relatively few treatments available for ARDS.

Alveolar flooding and pulmonary edema formation are important pathophysiological derangements in patients with ARDS.

Experimental data have shown that β2 agonists can increase sodium transport by activating β2 receptors on alveolar type I. and type II cells, accelerating the resolution of pulmonary edema.

Because injury to the alveolar epithelium is a significant cause of ARDS, the acceleration of alveolar epithelial repair may assist the resolution of pulmonary edema and lung injury. Keratinocyte growth factor (KGF) is important in alveolar epithelial repair, and experimental and human studies support the concept that KGF may be beneficial in patients with ARDS.

Inflammation is an additional pathological hallmark of ARDS and may contribute to both pulmonary and non-pulmonary organ failure. Statins—a class of drugs which is often prescribed by doctors to help decrease cholesterol levels in the blood—can decrease inflammation and development of lung injury in experimental models. By lowering the levels, heart attacks, and stroke can be prevented. Several studies show that, in certain people, statins reduce the risk of heart attack, stroke, and even death from heart disease. However, some studies contradict their use in the management of ARDS because statins neither provide benefit for lowering the morbidity of ARDS in high-risk patients nor improve the clinical outcomes of ALI/ARDS patients. Hence, it may not be appropriate to advocate statin use for the prevention and treatment of ALI/ARDS.

Mechanical ventilation (MV) is the foundation of ARDS management. The use of protective ventilation is a priority in this acute phase of lung inflammation. According to various studies, neuromuscular blocking agents (NMBAs) play an important role in the management of a large number of hospital patients. NMBAs induces reversible muscle paralysis. Their use in patients with ARDS remains controversial but occurs frequently. In addition to their routine use in surgical anesthesia, NMBAs may be valuable in many new and evolving critical care situations. NMBAs exert their pharmacologic effects by modulating signal transmission in skeletal muscle. Action potentials reaching skeletal muscle activates the release of acetylcholine into the motor endplates.