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.

What is pulmonary oedema?

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.

What causes pulmonary oedema?

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

Heart-related pulmonary oedema

This form is directly linked to problems with the heart, particularly the left ventricle, which is responsible for pumping oxygen-rich blood to the body. When the left side of the heart becomes weak or stiff, it cannot pump efficiently, causing pressure to increase in the blood vessels of the lungs. This pressure forces fluid into the lung tissue and air sacs.

Key heart-related causes include:

• Heart failure: The most common cause; occurs when the heart cannot pump blood effectively.
• Heart attack (myocardial infarction): Damages heart muscle, weakening its pumping ability.
• Coronary artery disease: Narrowed arteries reduce blood flow and strain the heart.
• Damaged or leaky heart valves: Mitral or aortic valve problems cause blood to back up into the lungs.
• Long-standing high blood pressure: Makes the heart work harder, eventually weakening it.
• Abnormal heart rhythms (arrhythmias): Rapid or irregular rhythms can impair pumping efficiency.

Non-heart-related pulmonary oedema

This type is not caused by heart failure. Instead, it results from damage to the lung tissue or a disruption in how fluid is regulated within the lungs.

Common causes include:

• Severe infections, such as pneumonia, inflammation and infection, can damage lung tissue, causing fluid to leak in.
• Sepsis (blood infection): Triggers widespread inflammation, making the lung’s blood vessels leaky.
• Acute respiratory distress syndrome (ARDS): A severe lung reaction caused by trauma, infection, or illness.
• Kidney failure: Excess fluid builds up in the body, including the lungs.
• Inhalation of toxins or chemicals – Smoke, chlorine gas, and ammonia can irritate the lungs and cause fluid leakage.
• Near-drowning: Water enters the lungs and disrupts normal gas exchange.
• High altitude exposure (above 8,000 feet) – Known as HAPE (High Altitude Pulmonary Oedema), caused by low oxygen levels and increased pressure in lung vessels.

Other contributing factors

• Certain conditions can increase susceptibility to pulmonary oedema or directly trigger it:
• Brain injuries or seizures: Sudden neurological events can increase lung pressure (neurogenic pulmonary oedema).
• Liver failure: Can cause general fluid retention and circulatory problems.

Signs and symptoms of pulmonary oedema

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.

How can I be at risk?

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.

What are my treatment options?

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.

How can I prevent pulmonary oedema?

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.

Just breathe easy

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.

Frequently Asked Questions

1. What are the four stages of pulmonary oedema?

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.

2. Is pulmonary oedema normal?

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.

3. How can water in the lungs be reduced naturally?

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.

4. How long can you survive with pulmonary oedema?

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.

5. Can pulmonary oedema cause sudden death?

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