What are the other Names for this Condition? (Also known as/Synonyms)

• Lung Congestion
• Lung Water
• Pulmonary Congestion

What is Pulmonary Edema? (Definition/Background Information)

• Pulmonary Edema refers to the presence of abnormal fluid in the air sacs of the lungs. The condition may be observed in individuals of all age groups and can occur due to a variety of causes
• Normally, gaseous exchange occurs in the lungs, within the air sacs; but, when there is an abnormal collection of fluid in the air sacs, the exchange of gases cannot take place and the individual feels short of breath and discomforted
• A few risks factors for Pulmonary Edema include uncontrolled diabetes and heart defects. The most common cause of Pulmonary Edema is congestive heart failure
• The signs and symptoms of Pulmonary Edema include difficulty breathing, wheezing, and fatigue. It may be diagnosed through a series of tests such as chest X-rays and blood tests
• Complications with Pulmonary Edema include ascites and swelling of the legs. Supplemental oxygen therapy and medication can be prescribed to help treat Pulmonary Edema. If treated early, individuals with the condition have a typically good prognosis

Who gets Pulmonary Edema? (Age and Sex Distribution)

• Pulmonary Edema may affect a wide range of population age groups - from infants to older adults; though it is more common among older individuals
• Both males and females are affected, and no specific gender predilection is seen
• There is no specific predisposition to any race or ethnicity, and the condition is observed worldwide

What are the Risk Factors for Pulmonary Edema? (Predisposing Factors)

Some risk factors for Pulmonary Edema include:

• Hypertension (high blood pressure)
• High blood cholesterol
• Uncontrolled diabetes
• Lung disease
• Heart defects that may be present congenitally (at birth)
• Aggravating factors in congestive heart failure such as infections and increased physical activities

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pulmonary Edema? (Etiology)

• Most commonly, Pulmonary Edema is caused by a defect in the pumping of heart, called congestive heart failure. If the heart cannot pump out blood, the pressure in the blood vessels carrying the blood from lungs to heart increases. Congestive heart failure in itself can be caused by multiple medical conditions such as a heart attack, defects in the valves of the heart, and high blood pressure
• Pulmonary Edema can also be caused by a variety of other conditions collectively known as non-cardiogenic Pulmonary Edema i.e., Pulmonary Edema that is not due to heart conditions. These may be due to:
  • Certain drugs such as heroin, cocaine, or even aspirin
  • Kidney problems
  • Inhalation of harmful or poisonous gases (chlorine or ammonia)
  • Lung infection or severe infection in the body
  • Near drowning events
  • High altitudes that can cause High-Altitude Pulmonary Edema (HAPE)

What are the Signs and Symptoms of Pulmonary Edema?

Individuals with Pulmonary Edema may have a variety of signs and symptoms that can include, but is not limited to:

• Difficulty breathing
• Cough with bloody or frothy phlegm
• Wheezing
• Leg swelling (pedal edema)
• Decreased consciousness
• Pale skin with sweating
• Anxiety
• Fatigue
• Cyanosis or bluish skin  
• Increased heart rate (tachycardia)

How is Pulmonary Edema Diagnosed?

A good medical history evaluation and complete physical examination is the mainstay for the diagnosis of Pulmonary Edema. The following tests may be used in the diagnosis:

• The physician might be able to listen to abnormal breath sounds due to presence of fluid in the air sacs of the lungs
• Blood tests: To look for the concentration of gases in blood and levels of other metabolites
• Chest X-ray: It is helpful in visualizing the fluid in lungs
• Electrocardiogram: A test to measure the electrical activity of the heart that is useful in assessing any underlying heart disease
• Echocardiogram (ultrasound of the heart): An imaging study that involves taking high-definition pictures of the heart to study blood flow in the heart and across the valves
• Pulmonary artery catheterization: It is used to measure the pressure in the capillaries of the lungs. This is done by introducing a small balloon tipped catheter through the leg vein into the pulmonary artery and measuring the pressure in the artery by inflating and deflating the balloon
• Cardiac catheterization is used to measure the blood flow in the vessels of the heart, and the pressures across the different chambers of the heart

Many clinical conditions can have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pulmonary Edema?

The complications arising from Pulmonary Edema are due to rising pressure in the pulmonary vascular system. Increased pressure in pulmonary artery causes decrease in the pumping of right ventricle, and hence, pressure builds up in the right side of the heart. This causes ineffective emptying of large veins of the body into the right side of the heart.

The following complications can arise as a result of Pulmonary Edema:

• Hepatomegaly and congestion: Increased backpressure from right side of the heart can cause increased stasis of blood in liver resulting in its congestion and increased size
• Ascites: Presence of free fluid in the abdomen due to increased pressure in the pulmonary vascular system
• Pleural effusion: Fluid accumulates between the lungs and its covering (pleura)

Complications may develop from the underlying condition causing Pulmonary Edema.

How can Pulmonary Edema be Treated?

Pulmonary Edema is treated in the emergency setting and may require treatment in intensive care unit (ICU) depending upon the clinical condition of the individual.

• Oxygen therapy is the first and foremost treatment provided. Oxygen is administered through the nasal cannula or mask as required
• The medications administered depend on the cause of Pulmonary Edema and the individual’s clinical status. These may include:
• Diuretics or water pills: These medications help reduce the water in the body thereby reducing the pressure in the vascular compartments. It helps in relieving breathlessness and reducing the fluid in the lungs
• Vasodilators: These medications cause dilatation in the blood vessels
• Morphine may be used to improve anxiety and shortness of breath

How can Pulmonary Edema be Prevented?

Since certain heart conditions are the major cause of Pulmonary Edema, preventive measures for heart disease may help minimize the risk for Pulmonary Edema. Such measures may include:

• Controlling blood pressure
• Controlling cholesterol levels
• Quitting smoking
• Reducing stress levels
• Regular exercise and a healthy diet that is low in fat and sodium.
• If traveling (ascending) to high altitudes, allow time to acclimatize to the altitude

What is the Prognosis of Pulmonary Edema? (Outcomes/Resolutions)

The prognosis of Pulmonary Edema depends upon the underlying cause and the severity of the condition.

• Some individuals are known to get better quickly, while some may require prolonged therapy and support
• The condition can be life-threatening if left untreated

Additional and Relevant Useful Information for Pulmonary Edema:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/healthy-lungs/