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Pulmonary edema, popularly known as "water in the lung", is an emergency situation, characterized by the accumulation of fluid inside the lungs, which reduces the exchange of respiratory gases and oxygenation of the body, causing difficulty to breathing and feeling of drowning.
Generally, pulmonary edema is more common in people with heart problems, such as heart failure, who are not treated properly and who therefore experience increased pressure in the blood vessels of the lungs, which causes cause blood fluid to enter the pulmonary alveoli. However, it can also happen due to lung infections, for example.
Although it is serious, pulmonary edema is curable, but it is important to immediately call an ambulance or take the person as soon as possible to the hospital, in order to start treatment and eliminate excess fluid from the lung.
Symptoms of pulmonary edema can come on suddenly or develop over time, depending on the cause, and usually include:
1. Acute pulmonary edema
Symptoms of acute pulmonary edema appear suddenly due to the heart's difficulty pumping blood adequately to the body, accumulating in the lungs quickly, causing severe symptoms such as:
- Difficulty breathing or severe shortness of breath that gets worse when lying down or moving around;
- Sensation of suffocation or drowning worse when lying down;
- Cough with frothy or bloody discharge;
- Intense wheezing when breathing;
- Heart racing;
- Blue or purplish fingertips;
- Purple lips;
- Cold sweat;
- Pale, cold or clammy skin;
- Anxiety or agitation.
In the event of symptoms of acute pulmonary edema, medical help should be sought immediately or the nearest emergency room as soon as possible, as it is a medical emergency that requires immediate care, as it can cause cardiorespiratory arrest and put your life at risk.
2. Chronic pulmonary edema
Symptoms of chronic pulmonary edema develop over time, as fluid builds up in the lungs slowly and progressively, and include:
- Difficulty breathing when lying down or when doing some activity;
- Cough or feeling short of breath, especially at night when lying down and which improves when sitting;
- Shortness of breath or intolerance to physical exertion;
- Wheezing when breathing;
- Weight gain for no apparent reason;
- Swelling in the legs or feet;
- Excessive fatigue.
Regardless of whether it really is a situation of pulmonary edema or not, whenever the person has severe difficulty breathing or more than 2 of these symptoms, it is important to go to the hospital, or call for medical help, to confirm the diagnosis and initiate the most appropriate treatment.
3. High altitude pulmonary edema
Symptoms of high- altitude pulmonary edema are usually similar to acute pulmonary edema, and can occur in adults or children who travel or exercise at high altitudes, and include:
- Shortness of breath;
- Difficulty exercising;
- Dry cough initially, which may turn into a cough with frothy or bloody discharge;
- Fast heartbeat and heart palpitation sensation;
- Chest pain;
- Low fever.
Symptoms of acute high- altitude edema usually appear quickly, usually within 1 to 4 days after a rapid ascent to altitudes of 2400 meters or more, and tend to worsen at night, at bedtime.
It is important to seek immediate medical help or the nearest emergency department if these symptoms arise, as they can cause respiratory failure and coma within a few hours, putting life at risk.
How to confirm the diagnosis
The diagnosis of pulmonary edema is made by the doctor in the hospital, through physical examination, analysis of symptoms, history of diseases, such as heart failure or lung diseases, and tests such as complete blood count, blood gas analysis, X-ray of chest, electrocardiogram, or echocardiogram, for example.
These tests can be done so that the doctor can diagnose pulmonary edema, but they can also help to identify the cause of fluid accumulation in the lungs.
The most common cause of pulmonary edema is congestive heart failure, characterized by an inability of the heart to pump blood properly, which results in increased blood pressure in the blood vessels of the lungs in an attempt to promote oxygenation tissue and a release of fluid into the lungs, which makes it difficult for air to enter.
However, there are other situations that can cause the accumulation of water in the lungs and the development of pulmonary edema, such as:
- Coronary diseases;
- Cardiac arrhythmias;
- Heart valve problems;
- High blood pressure;
- Kidney failure;
- Lung infections;
- Pulmonary embolism
- Adult respiratory distress syndrome;
- Anaphylactic reaction to medication or overdose of drugs of abuse;
- Ascend to altitudes above 2400 meters, like climbing a mountain;
- Nervous system problems such as head trauma, subarachnoid hemorrhage, or seizure;
- Smoke inhalation;
- Near drowning, especially when water was inhaled.
Pulmonary edema is usually more frequent in the elderly, as they present more he alth changes, but it can also occur in young people or even in children with congenital heart disease.
How the treatment is done
Treatment for pulmonary edema should be started as soon as possible, in the hospital, using an oxygen mask and diuretic drugs directly into the vein, such as furosemide, to increase the amount of urine and eliminate excess fluids in the lungs.
Furthermore, it is also necessary to take the appropriate treatment for the condition that caused the problem, which may include high blood pressure medication, such as captopril, or lisinopril to treat decompensated heart failure, for example.
Normally, the person needs to stay in the hospital for about 7 days to relieve symptoms, control the problem that caused the onset of pulmonary edema and undergo chest physiotherapy sessions. During this period, it may still be necessary to use a urinary catheter to control the flow of fluids from the body, preventing them from accumulating again.
What is respiratory physiotherapy like
Respiratory physiotherapy for acute pulmonary edema should be performed by a physical therapist and is usually started when the person is hospitalized and with controlled symptoms, serving to gradually improve the oxygen levels in the body.
Learn more about how respiratory physiotherapy is performed.