Everything You Need to Know About Pulmonary Edema

Diagnosing and Treating Pulmonary Edema

Before your healthcare provider can diagnose and treat pulmonary edema, they will need to perform a physical exam, run lab tests and do imaging. Pulse oximetry can be used to assess oxygen levels. An X-ray is often the first imaging step because it can show fluid in the lungs, which can help rule out other causes of breathlessness. An echocardiogram, or an ultrasound of the heart, can check for abnormalities and evaluate the heart function. In severe or uncertain cases, invasive hemodynamic monitoring (e.g., with a pulmonary artery catheter) may be used to distinguish cardiogenic vs non-cardiogenic causes.

Treatment depends on the severity and the underlying cause. “Treatment for pulmonary edema is not difficult but the symptoms will not go away on their own without adjustments to medications and changes to diet,” Dr. Garfield explained. In emergencies, supplemental oxygen is essential and often the first line of treatment. Depending on severity, ventilators or respirators that directly deliver air into your windpipe may be needed. In many patients, diuretics, or water pills, can help remove excess fluid and ease pressure on the lungs. If the pulmonary edema is non-cardiogenic, antibiotics and steroids may be needed. If it is cardiogenic, medications to ease cardiac workload, improve heart function or manage blood pressure may be required.

In all cases, it is crucial to treat whatever triggered the edema to prevent recurrence. “It is important to remember that pulmonary edema is not a progressive disease but a treatable readily reversible condition with the right management.”

Pulmonary Edema vs. Pneumonia vs. Pleural Effusion — What’s the Difference?

Because fluid in or around the lungs can arise from different problems, it’s important to distinguish pulmonary edema from other lung conditions. Pulmonary edema, by definition, is a buildup of fluid inside the lungs, in the interstitial (tissue) and alveolar (air sac) spaces impairing oxygen exchange directly.

Pneumonia is primarily an infection of lung tissue caused by bacteria, viruses or fungi. In this case, the infection causes the lungs’ air sacs (alveoli) to become inflamed and fill up with fluid or mucus which makes it hard for oxygen to get into your bloodstream. Because of this, imaging will pick up a dense, solid-appearing area in a lung lobe rather than a “flooding” of both lungs as in edema.

In contrast, pleural effusion occurs when fluid is collected in the pleural space or the thin layer between the lungs and the chest wall and not inside the lung tissue itself. A pleural effusion can compress the lungs from outside, but it does not flood the alveoli with fluid.

The suggested management and treatments differ greatly among these conditions, so correct diagnosis is critical.

Prevention and Considerations

Preventing pulmonary edema centers largely on managing underlying risk factors and conditions. For those at risk — especially people with heart disease, hypertension, valvular disease or chronic kidney problems — maintaining cardiovascular health is key. This means controlling blood pressure, avoiding salt and fluid overload, managing comorbidities, maintaining a healthy lifestyle and following medical advice closely.

“For example, patients who eat a lot of takeout are at high risk for exacerbating their heart failure and developing pulmonary edema,” Dr. Garfield continued. “Patients at risk for pulmonary edema need to understand the impact of processed foods and added salt on water retention, and they need to understand that blood pressure and heart rate control are paramount to keeping the heart in balance.”

Pulmonary edema can progress quickly to life-threatening respiratory failure, so if you are experiencing symptoms, it is crucial to seek medical attention immediately. Thankfully, if quickly identified and treatment, recovery is possible. Taking care of your heart and lungs, being cautious with altitude or strenuous water activities, and listening to your body — especially when breathing becomes difficult — are among your best defenses against a condition that, without treatment, can rapidly become life-threatening.