Pulmonary Oedema: When It Feels Like a Flood in Your Lungs

Imagine trying to breathe, but it feels like you’re underwater. That’s what pulmonary oedema can feel like. It happens when fluid builds up in your lungs, making it hard to get enough oxygen. Every year, over 1 million patients are hospitalised with pulmonary oedema resulting from cardiac issues, specifically heart failure. Let’s break down why this happens and what you can do about it.

Pulmonary oedema is a condition where fluid accumulates in the lungs, making it hard to breathe. Normally, your lungs take in air to supply oxygen to your bloodstream, but in this condition, the tiny air sacs (alveoli) fill with fluid instead. This prevents oxygen from reaching your body, leading to shortness of breath. It’s often linked to heart problems, like when the heart can’t pump blood efficiently, causing fluid to back up in the lungs. In extreme cases, it may result in expelling a foamy, pinkish fluid.

Pulmonary oedema can happen because of heart problems or other non-heart-related causes.

Heart-related pulmonary oedema
This type is usually linked to heart issues, especially when the left side of the heart isn’t pumping blood as it should. Problems like heart attacks, heart failure, or damaged heart valves can cause fluid to back up into the lungs, making it harder to breathe. As the heart struggles, blood pools in the lungs, causing fluid to leak into the tiny air sacs where oxygen is absorbed.

Non-heart-related pulmonary oedema
This isn’t related to heart issues. Instead, conditions like severe infections (pneumonia), blood infections (sepsis), kidney failure, or reactions to certain drugs can cause fluid buildup in the lungs. It can also happen if someone is exposed to toxins or chemicals, has a major injury, or is at a high altitude (above 8,000 feet).

Other causes
Brain injuries, serious infections, or drug overdoses can also lead to pulmonary oedema. When fluid fills the lungs, it blocks oxygen from entering the bloodstream, causing shortness of breath. In severe cases, people may cough up a frothy, pink liquid. Quick medical treatment is essential for recovery.

The most common symptom of pulmonary oedema is shortness of breath, which may develop gradually or suddenly, depending on whether it’s a short-term (acute) or long-term (chronic) condition.

Common signs

• Trouble breathing, especially during an activity or when lying down
• Fast, shallow breathing
• Feeling weak or tired
• Dizziness
• Coughing, sometimes with pink or frothy mucus
• Wheezing or chest pain
• Bluish lips or nails (low oxygen)
• Pale skin and heavy sweating
• Swollen feet or ankles (in long-term cases)

Acute pulmonary oedema (sudden onset)

• Sudden difficulty breathing
• Chest tightness
• Pink, frothy mucus
• Feeling anxious or restless

Chronic pulmonary oedema (long-term):

• Breathing problems at night
• Persistent cough
• Unexplained weight gain from fluid retention

High-altitude pulmonary oedema (HAPE):

• Headaches
• Difficulty breathing
• Chest pain
• Fast heartbeat
• Mild fever

If you encounter sudden shortness of breath, confusion, or notice your skin turning blue or grey, seek medical assistance right away.

Pulmonary oedema can be triggered by various risk factors. Cardiovascular problems are the leading cause, encompassing conditions such as heart failure, hypertension, heart attacks, arrhythmias, and issues with heart valves. These conditions make it difficult for the heart to pump blood effectively, leading to fluid buildup in the lungs.

Non-heart-related factors also contribute to pulmonary oedema. These include kidney or liver disease, severe infections like pneumonia or sepsis, lung injuries, and exposure to high altitudes. Additional risks come from inhaling smoke or toxins, certain medications like NSAIDs or chemotherapy drugs, as well as conditions such as obesity, diabetes, and alcohol abuse. Individuals with these risk factors should pay attention to their health and consult a doctor if they experience any symptoms.

Dr  Sai Praveen Haranath, Senior Consultant Physician and Pulmonary & Critical Care Medicine expert at Apollo Hospital, Hyderabad, emphasises that treatment for pulmonary oedema depends on its underlying causes. “One effective approach is to remove excess fluid from the body, which can be achieved using various medications designed to aid fluid removal,” he states.
He further elaborates on the importance of addressing the root causes, such as heart conditions. “For instance, when a patient has a low pumping function of the heart, it's essential to balance fluid levels to prevent pulmonary oedema. If the heart's pumping function is impaired, it can lead to fluid backflow into the lungs.”
Regarding patient survival, Dr Haranath stresses that outcomes vary widely. "The survival time depends on the severity of the condition. If pulmonary oedema is acute, with very low heart function and an irregular heartbeat, it can be life-threatening and requires immediate intervention." With appropriate treatment, some patients can manage the condition over the long term, provided the underlying issues are controlled.

Preventing pulmonary oedema largely involves managing the underlying conditions that increase the risk, such as heart failure, high blood pressure, and respiratory infections. Key lifestyle changes include eating a heart-healthy diet, cutting down salt intake, exercising regularly, and maintaining a healthy weight. Quitting smoking and monitoring cholesterol levels are also important steps to reduce the risk. 

For those at high risk, it’s essential to get regular check-ups, including blood pressure and cholesterol monitoring. Gradually ascending to higher altitudes and using medications can help prevent altitude-induced pulmonary oedema. Although pulmonary oedema cannot be entirely prevented, taking care of heart health and adhering to a doctor's recommendations can greatly lower the risk of developing or exacerbating the condition.

While finding out so much about pulmonary oedema can feel overwhelming, the good news is that with quick medical treatment, many people recover and learn how to manage the condition.

Pulmonary oedema can be categorised into four stages based on how it develops:

1. Hydrostatic pressure oedema: This is a common form of pulmonary oedema often caused by left heart failure or excessive fluid volume in the body.
2. Permeability oedema with Diffuse Alveolar Damage (DAD): This type of oedema occurs when there is damage to the alveoli, leading to increased permeability of the lung tissue.
3. Permeability oedema without DAD: In this stage, increased permeability of the lung membranes occurs, but without the accompanying damage to the alveoli seen in the previous type.
4. Mixed oedema: This stage involves a combination of both increased hydrostatic pressure and increased membrane permeability, contributing to the development of pulmonary oedema.

Pulmonary oedema is considered a serious medical issue, marked by an accumulation of excess fluid in the lungs that hinders the ability to breathe. This condition may arise from several underlying issues, with heart problems like heart failure being the most common. It can also result from other factors like lung infections, high altitude, or exposure to toxins. 

Here are some natural ways to help remove excess water from your lungs:

• Postural drainage: Change your body position to encourage fluid movement, such as lying on your side with your chest lower than your hips or leaning forward over a chair.
• Chest percussion: Have someone gently tap your back while you lie down with your head lowered to help loosen mucus.
• Steam therapy: Breathe in steam from a hot shower or a pot of boiling water to help open your airways and clear mucus.
• Healthy drinks: Consume herbal teas, green tea, honey, and ginger to help loosen mucus and reduce inflammation.
• Eat sulfur-rich foods: Incorporate foods like onions, broccoli, and garlic to help reduce toxins.
• Vitamins and supplements: Take vitamins C and E, along with omega-3 fatty acids, to support lung health.
• Deep breathing: Practice deep breathing exercises in clean environments to improve lung capacity.
• Stay hydrated: Drink enough water to aid in detoxification and overall health.

It's vital to consult a healthcare practitioner if you're worried about any fluid buildup in your lungs.

Survival with pulmonary oedema varies based on its cause and the speed of treatment. Acute pulmonary oedema requires immediate medical attention, and while many people recover with prompt care, about 20% may not survive, often due to complications. For those who do recover, lung function typically returns to normal within six months to a year, sometimes even sooner.

Urgent medical intervention is necessary in severe cases of pulmonary oedema to avoid serious complications.