Pulmonary Oedema: Symptoms, Diagnosis, Treatment

Pulmonary oedema refers to the abnormal accumulation of fluid in the lungs, making it difficult to breathe. The condition is usually a result of heart disease but can be due to other reasons, such as kidney failure, blood transfusion, or high altitudes.

Pulmonary oedema is characterised by the accumulation of excess fluid in the lungs’ air sacs (alveoli), which leads to difficulty breathing. This fluid buildup can make it hard for oxygen to move from the lungs into the bloodstream. This condition can be life-threatening and should be treated as soon as possible.

High altitude pulmonary oedema (HAPE)

HAPE is a severe form of altitude sickness that occurs at high altitudes or during rapid ascents in such terrains, due to lower oxygen levels at these places. Reduced oxygen intake at high altitudes leads to the narrowing of blood vessels in the lungs, resulting in excess fluid accumulation. HAPE is a medical emergency and can be life-threatening.

Pulmonary oedema vs pleural effusion

Both pulmonary oedema and pleural effusion involve fluid accumulation in the lungs. However, pulmonary oedema refers to the collection of excess fluid in the tissues and air sacs in the lungs, while the fluid buildup in pleural effusion occurs in the pleural cavity which encapsulates the lung.

Pulmonary oedema vs pneumonia

Both pulmonary oedema and pneumonia involve fluid accumulation in the lungs. However, pneumonia occurs due to an infection and could be viral, bacterial, or fungal in origin. An infection does not cause pulmonary oedema, and the fluid tends to be thinner and more diluted.

Pulmonary oedema vs pulmonary embolism

A pulmonary embolism refers to a blood clot from a vein in the leg that travels to the lungs via the bloodstream and lodges itself in the lung’s vascular network. Pulmonary embolism can be fatal and requires immediate medical intervention.

What are the symptoms of pulmonary oedema?

Pulmonary oedema can occur suddenly (acute) or develop slowly over time (chronic).

Symptoms of acute pulmonary oedema include:

Shortness of breath, especially when lying down or moving
Coughing up blood and/or frothy mucus
Wheezing
Chest pain or tightness
Feeling suffocated

The symptoms of chronic pulmonary oedema are similar to the symptoms of acute pulmonary oedema but tend to be milder than an acute attack. Individuals with chronic pulmonary oedema can experience episodes of breathlessness while asleep, causing them to wake up gasping for air. Some also have swelling around their extremities.

What are the risk factors?

Most cases of pulmonary oedema are usually linked to heart disease, especially among individuals who are not compliant with their treatment regime. Conditions that increase the risk for pulmonary oedema include:

Heart failure
Coronary artery disease
Heart valve issues
Irregular heartbeat (arrhythmia)
High blood pressure
Liver disease
Kidney failure
Lung injury

How is pulmonary oedema diagnosed?

Pulmonary oedema is diagnosed through clinical evaluation, medical history, physical examination, and diagnostic tests.

Complete blood count.
Cardiac biomarkers for heart failure.
Blood oxygen levels.
Liver and kidney function tests.
Chest X-ray to look for fluid accumulation in the lungs and shape/size of the heart.
Echocardiogram (heart ultrasound) to check for abnormalities in the structure and/or function of the heart.
Electrocardiogram (ECG) to check for abnormalities in the electrical activity of the heart.
Cardiac catheterisation to look for blockages in the coronary arteries.

How is it treated?

The treatment of pulmonary oedema focuses on addressing the underlying cause, reducing fluid buildup in the lungs, and improving oxygenation. Common treatment options available for individuals with pulmonary oedema include:

Immediate management (emergency treatment)

In cases of acute pulmonary oedema, rapid treatment is critical to stabilise the patient and improve oxygen levels.

Oxygen Therapy: The first step is usually to provide supplemental oxygen to help improve oxygen levels in the blood. Oxygen can be delivered through a mask, nasal cannula, or, in severe cases, through mechanical ventilation.

Positioning: Patients are often positioned upright (sitting up) to help reduce the pressure on the lungs and make breathing easier.

Continuous Positive Airway Pressure (CPAP): In some cases, especially if oxygen therapy alone is insufficient, CPAP or bilevel positive airway pressure (BiPAP) may be used. These methods deliver pressurised air through a mask to keep the airways open and improve oxygenation.

Medications

Medications are used to reduce fluid buildup, manage symptoms, and treat underlying causes.

Diuretics (e.g., furosemide): Diuretics help remove excess fluid from the body by increasing urine production.
Morphine: In some cases, morphine may be used to reduce sympathetic nervous activity, relieve shortness of breath, and decrease the workload on the heart.

Can pulmonary oedema be prevented?

Pulmonary oedema can be prevented by taking several precautions such as:

Being compliant to treatment regime, especially for patients with heart disease.
Seeking medical attention if you have breathing difficulties.
Attending routine checkups as advised by your doctor.
Maintaining a healthy weight.
Consuming low salt diet.
Speaking to your physician before indulging in activities involving high altitudes such as mountain climbing.

Book an appointment at Pantai Hospitals

Stay informed about the symptoms of pulmonary oedema and the steps you can take to prevent it. Speak to your doctor to learn more about pulmonary oedema.

A dedicated and expert team of cardiologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding pulmonary oedema. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.