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Pulmonary oedema

Pulmonary oedema occurs when there is an excess of fluid in the air sacs in the lungs. 

Pulmonary oedema

In most cases, the causes of pulmonary oedema are related to heart problems, such as congestive heart failure.

However, fluid can accumulate in the lungs for other reasons too, for example:

  • Pneumonia
  • Kidney failure
  • Exposure to certain toxins and medications
  • Trauma/injury to the chest wall
  • Living at high altitudes. 

When the condition develops quickly it is known as acute pulmonary oedema, a medical emergency that needs to be treated immediately. 

What are its symptoms?

Symptoms of acute (sudden) pulmonary oedema include:

  • Difficulty breathing or severe shortness of breath that worsens when lying down
  • A suffocating or ‘drowning’ feeling
  • Wheezing and gasping for breath
  • Anxiety
  • A cough that produces frothy saliva and mucous that may be streaked with blood
  • Heart palpitations
  • Chest pain (if the cause is heart disease)

Seek medical assistance as soon as possible, as acute pulmonary oedema will be fatal if not treated.

Symptoms of chronic (long-term) pulmonary oedema include:

  • More than normal shortness of breath during physical activity
  • Difficulty breathing during exertion
  • Difficulty breathing when lying down
  • Wheezing
  • Fatigue
  • Swelling in the lower extremities (not directly related to pulmonary oedema)
  • Rapid weight gain if the cause of pulmonary oedema is congestive heart failure (when the heart pumps too little blood to satisfy the body’s needs).

Symptoms of high-altitude pulmonary oedema (HAPE) include:

  • Shortness of breath, initially from exertion, then at rest
  • Cough
  • Fever
  • Heart palpitations
  • A cough that produces frothy saliva and mucous that may be streaked with blood
  • A headache
  • Discomfort in the chest

How is it diagnosed? 

Pulmonary oedema requires prompt treatment, so a diagnosis will usually be done based on symptoms, a physical examination, a chest X-ray and an electrocardiogram (ECG). 

Other tests may be performed once the patient is stable to confirm the diagnosis and establish why there was a fluid build-up in the lungs. 

Your blood may be checked for levels of B-type natriuretic peptide (BNP), as increased levels may indicate a heart condition as the underlying cause. Kidney function, thyroid function and blood count tests may also be performed. 

What are your treatment options? 

The first step with regards to treatment is usually to stabilise breathing, so oxygen will be administered through a mask or two thin flexible tubes that deliver oxygen to each nostril (a nasal cannula). Oxygen levels will be monitored, and if necessary a ventilator may be used to assist with your breathing.

Further treatment will depend on your condition and the reason for the pulmonary oedema. Medications include preload reducers that decrease the volume of fluid going into the lungs and heart. Afterload reducers dilate the blood vessels, taking pressure off your heart. 

Blood pressure medication may also be considered if too high (hypertension) or two low blood pressure (hypotension) is present. 

Can it be prevented? 

Cardiovascular (heart) disease is the leading cause of pulmonary oedema, so reducing your risk of heart problems is key. The following is suggested:

  • Control blood pressure
  • Check blood cholesterol levels
  • Avoid smoking
  • Eat a heart-healthy diet
  • Limit salt
  • Maintain a healthy weight and exercise regularly
  • Manage stress levels

To prevent HAPE: If you travel or climb at a high altitude familiarise yourself with acclimatisation, ascending only the recommended amount per day and resting when necessary. Speak to your doctor about prescription medication for HAPE.

For more info

The Heart and Stroke Foundation South Africa

IMAGE CREDIT: 123rf.com

The accuracy of this information was checked and approved by physician Dr Thomas Blake in May 2016