Medicine.net.comPulmonary edema facts Pulmonary edema is typically caused by filling of alveoli in the lungs by fluid leaking out of the blood. Pulmonary edema may be caused by a number of cardiac or non-cardiac conditions. Breathing difficulty is the main manifestation of pulmonary edema. Treatment of the underlying cause of pulmonary edema is an essential step in themanagement of pulmonary edema.What is pulmonary edema?Edema, in general, means swelling. This typicallyoccurs when fluid from inside blood vessels seeps outside the blood vessel into the surrounding tissues, causing swelling. This can happen either because of too much pressure in the blood vessels or not enough proteins in the bloodstream to hold on to the fluid in the plasma (the part of the blood that does not contain any blood cells.Pulmonary edema is the term used when edema happens in the lungs. The immediate area outside of the small blood vessels in the lungs is occupied by very tiny air sacs called the alveoli. This is where o!ygen from the air is picked up bythe blood passing by, and carbon dio!ide in the blood is passed into the alveoli to be e!haled out."lveoli normally have a thin wall that allows for this air e!change, and fluids are usually kept out of the alveoli unless these walls lose their integrity.Picture of the alveoli and lungPulmonary edema occurs when the alveoli fill up with e!cess fluid seeped out of the blood vesselsin the lung instead of air. This can cause problems with the e!change of gas (o!ygen and carbon dio!ide, resulting in breathing difficulty and poor o!ygenation of blood. #ometimes, this can be referred to as $water in the lungs$ when describing the condition to patients.Pulmonary edema can be caused by many different factors. %t can be related to heart failure, called cardiogenic pulmonary edema, or related to other causes, referred to as non-cardiogenic pulmonary edema. What causes pulmonary edema?"s mentioned earlier, pulmonary edema can be broadly divided into cardiogenic and non-cardiogenic causes. #ome of the common causes are listed below.Cardiogenic causes of pulmonary edema&ardiogenic causes of pulmonary edema resultsfrom high pressure in the blood vessels of the lung due to poor heart function. &ongestive heart failure due to poor heart pumping function (arising from various causes such as arrhythmias and diseases or weakness of the heart muscle, heart attacks, or abnormal heart valves can lead to accumulation of more than the usual amount of blood in the blood vessels of the lungs. This can, in turn, cause the fluid from the blood vessels to be pushed out to the alveoli as the pressure builds up.Non-cardiogenic pulmonary edema'on-cardiogenic pulmonary edema can be commonly caused by the following( "cute respiratory distress syndrome (")*#, a potentially serious condition caused by severe infections, trauma, lung in+ury, inhalation of to!ins, lung infections, cocaine smoking, or radiation to the lungs. %n ")*#, the integrity of the alveoli become compromised as a result of underlying inflammatory response, and this leads to leaky alveoli that can fill up with fluid from the blood vessels. ,idney failure and inability to e!crete fluidfrom the body can cause fluid build-up in theblood vessels, resulting in pulmonary edema. %n people with advanced kidney disease, dialysis may be necessary to remove the e!cess body fluid. -igh altitude pulmonary edema, which can happen due to rapid ascent to high altitudes of more than ./,/// feet. Brain trauma, bleeding in the brain (intracranial hemorrhage, severe sei0ures, or brain surgery can sometimes result in fluid accumulation in the lungs, causing neurogenic pulmonary edema. " rapidly e!panding lung can sometimes cause re-e!pansion pulmonary edema. Thismay happen in cases when the lung collapses (pneumothora! or a large amountof fluid around the lung (pleural effusion is removed, resulting in rapid e!pansion of the lung. This can result in pulmonary edema onthe affected side only (unilateral pulmonary edema. )arely, an overdose on heroin or methadone can lead to pulmonary edema. "spirin overdose or chronic high dose use of aspirin can lead to aspirin into!ication, especially in the elderly, which may cause pulmonary edema. 1ther more rare causes of non-cardiogenic pulmonary edema may include pulmonary embolism (blood clot which has traveled to the lungs, transfusion-related acute lung in+ury (T)"2%, some viral infections, or eclampsia in pregnant women. What are the risk factors for pulmonary edema?The risk factors for pulmonary edema are essentially the underlying causes of the condition. There isn3t any specific risk factor for pulmonary edema other than risk factors for the causative conditions.What are the symptoms of pulmonary edema?The most common symptom of pulmonary edema is shortness of breath or breathlessness. This may be of gradual onset if the process slowly develops, or it can have a sudden onset inthe case of acute pulmonary edema.1ther common symptoms may include easyfatigue, more rapidly developing shortness of breath than normal with usual activity (dyspnea on e!ertion, rapid breathing (tachypnea, di00iness, or weakness.2ow blood o!ygen level (hypo!ia may be detected in patients with pulmonary edema. 4urthermore, upon e!amination of the lungs with a stethoscope, the doctor may listen for abnormal lung sounds, such as rales or crackles (discontinuous short bubbling sounds corresponding to the splashing of the fluid in the alveoli during breathing.When should I seek medical care for pulmonary edema?5edical attention should be sought for anyone who is diagnosed with pulmonary edema of any cause. 5any causes of pulmonary edema re6uire hospitali0ation, especially if they are caused acutely. %n some cases of chronic (long term pulmonary edema, for e!ample, with congestive heart failure, routine follow-up visits with the treating doctor may be recommended.5ost cases of pulmonary edema are treated by internal medicine doctors (internists, heart specialists (cardiologists, or lung doctors (pulmonologists. How is pulmonary edema diagnosed?Pulmonary edema is typically diagnosed by a chest 7-ray. " normal chest radiograph (7-ray consists of a central white area pertaining to the heart and its main blood vessels plus the bones of the vertebral column, with the lung fields showing as darker fields on either side, enclosed by the bony structures of the chest wall." typical chest 7-ray with pulmonary edema may show a more white appearance over both lung fields than usual. 5ore severe cases of pulmonary edema can demonstrate significant opacification (whitening over the lungs with minimal visuali0ation of the normal lung fields. This whitening represents filling of the alveoli as a result of pulmonary edema, but it may give minimal information about the possible underlying cause.To identify the cause of pulmonary edema, a thorough assessment of the patient3s clinical picture is essential. " careful medical history and physical e!amination often provide invaluable information regarding the cause.1ther diagnostics tools used in assessing the underlying cause of pulmonary edema include the measurement of plasma B-type natriuretic peptide (B'P or '-terminal pro-B'P. This is a protein marker (a hormone that will rise in the blood due to the stretch of the chambers of the heart. Elevation of the B'P nanogram (one billionth of a gram per liter greater than a few hundred (8// or more is highly suggestive of cardiac pulmonary edema. 1n the other hand, values less than .// essentially rule out heart failure as the cause.5ore invasive methods are occasionally necessary to distinguish between cardiac and noncardiac pulmonary edema in more complicated and critical situations. " pulmonary artery catheter (#wan-9an0 is a thin, long tube (catheter inserted into the large veins of the chest or the neck and advanced through the right-sided chambers of the heart and lodged intothe pulmonary capillaries (small branches of the blood vessels of the lungs. This device has the capability of directly measuring the pressure in the pulmonary vessels, called the pulmonary artery wedge pressure. " wedge pressure of .: mm-g or higher is consistent withcardiogenic pulmonary edema, whereas a wedge pressure of less than .: mm-g usually favors anon-cardiogenic cause of pulmonary edema." #wan-9an0 catheter placement and data interpretation is done only in the intensive care unit (%&; setting.What is the treatment for pulmonary edema?The treatment of pulmonary edema largely depends on its cause and severity.5ost cases of cardiac pulmonary edema are treated by using diuretics (water pills along with other medications for heart failure. %n some situations, appropriate treatment can be achieved as an outpatient by taking oral medications. %f the pulmonary edema is more severe or it is not responsive to oral medications,then hospitali0ation and the use of intravenous diuretic medications may be necessary.The treatment for noncardiac causes of pulmonary edema varies depending on the cause. 4or e!ample, severe infection (sepsis is treated with antibiotics and other supportive measures, or kidney failure needs to be properly evaluated and managed.1!ygen supplementation is necessary if the measured o!ygen level in the blood is too low. %n serious conditions, such as ")*#, placing a patient on a mechanical breathing machine is necessary to support their breathing while other measures are taken to treat pulmonary edema and its underlying cause.What are the complications of pulmonary edema?5ost complications of pulmonary edema may arise from the complications associated with the underlying cause. 5ore specifically, pulmonary edema can cause severely compromised o!ygenation of the blood by the lungs. This poor o!ygenation (hypo!ia can potentially lead to diminished o!ygen delivery to different body organs, such as the brain.How can pulmonary edema be prevented?%n terms of preventive measures, depending on the cause of pulmonary edema, some steps can be taken. 2ong-term prevention of heart disease and heart attacks, slow elevation to high altitudes, or avoidance of drug overdose can be considered preventive.1n the other hand, some causes may not completely avoidable or preventable, such as ")*# due to an overwhelming infection or a trauma.www.aaaai.orgAsthma OverviewAsthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs.If you have asthma your airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggersyour symptoms. This makes it difficult for air to move inand out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightness.For many asthma sufferers, timing of these symptoms isclosely related to physical activity. And, some otherwise healthy people can develop asthma symptoms only when eercising. This is called eercise!induced bronchoconstriction "#I$%, or eercise!induced asthma "#IA%. &taying active is an important way to stay healthy, so asthma shouldn't keep you on the sidelines. (our physician can develop a management plan to keep your symptoms under control before, during and after physicial activity.)eople with a family history of allergies or asthma are more prone to developing asthma. *any people with asthma also have allergies. This is called allergic asthma.+ccupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the ,ob.-hildhood asthma impacts millions of children and their families. In fact, the ma,ority of children who develop asthma do so before the age of five.There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place you will be able to manage your condition, and your .uality of life will improve.An allergist / immunologistis the best .ualified physician in diagnosing and treating asthma. /ith the help of your allergist, you can take control of your condition and participate in normal activities.Asthma Symptoms & DiagnosisAsthma SymptomsAccording to the leading eperts in asthma, the symptoms of asthma and best treatment for you or yourchild may be .uite different than for someone else with asthma.The most common symptom is wheezing. This is a scratchy or whistling sound when you breathe. +ther symptoms include01&hortness of breath1-hest tightness or pain1-hronic coughing1Trouble sleeping due to coughing or wheezingAsthma symptoms, also called asthma flare!ups or asthma attacks, are often caused by allergies and eposure to allergens such as pet dander, dust mites, pollen or mold. 2on!allergic triggers include smoke, pollution or cold air or changes in weather.Asthma symptoms may be worse during eercise, when you have a cold or during times of high stress.-hildren with asthma may show the same symptoms as adults with asthma0 coughing, wheezing and shortness of breath. In some children chronic cough may be the only symptom.If your child has one or more of these common symptoms, make an appointment with an allergist / immunologist01-oughing that is constant or that is made worse by viral infections, happens while your child is asleep, or is triggered by eercise and cold air1/heezing or whistling sound when your child ehales1&hortness of breath or rapid breathing, which may be associated with eercise1-hest tightness "a young child may say that his chest 3hurts4 or 3feels funny4%1Fatigue "your child may slow down or stop playing%1)roblems feeding or grunting during feeding "infants%1Avoiding sports or social activities1)roblems sleeping due to coughing or difficulty breathing)atterns in asthma symptoms are important and can help your doctor make a diagnosis. )ay attention to when symptoms occur01At night or early morning15uring or after eercise15uring certain seasons1After laughing or crying1/hen eposed to common asthma triggersAsthma DiagnosisAn allergist diagnoses asthma by taking a thorough medical history and performing breathing tests to measure how well your lungs work.+ne of these tests is called spirometry. (ou will take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or ehale. This test diagnoses asthma severity and measures how well treatment is working.*any people with asthma also have allergies, so your doctor may perform allergy testing. Treating the underlying allergic triggers for your asthma will help youavoid asthma symptoms.Asthma Treatment & ManagementThere is no cure for asthma, but symptoms can be controlled with effective asthma treatment andmanagement. This involves taking your medications as directed and learning to avoid triggers that cause your asthma symptoms. (our allergist will prescribe the best medications for your condition and provide you with specific instructions for using them.-ontroller medications are taken daily and includeinhaled corticosteroids "fluticasone "Flovent 5iskus, Flovent 6FA%, budesonide ")ulmicort Flehaler%, mometasone "Asmane%, ciclesonide "Alvesco%, flunisolide "Aerobid%, beclomethasone "7var% and others%.-ombination inhalers contain an inhaled corticosteroid plus a long!acting beta!agonist "8A$A%. 8A$As are symptom!controllers that are helpful in opening your airways. 6owever, in certain people they may carry some risks.8A$As should never be prescribed as the sole therapy for asthma. -urrent recommendations arefor them to be used only along with inhaled corticosteroids. -ombination medications include fluticasone and salmeterol "Advair 5iskus, Advair 6FA%, budesonide and formoterol "&ymbicort%, and mometasone and formoterol "5ulera%.8eukotriene modifiers are oral medications that include montelukast "&ingulair%, zafirlukast "Accolate% and zileuton "9yflo, 9yflo -:%.7uick!relief or rescue medications are used to .uickly rela and open the airways and relieve symptoms during an asthma flare!up, or are taken before eercising if prescribed. These include0 short!acting beta!agonists. These inhaledbronchodilator "brong!koh!5I#!lay!tur% medications include albuterol ")roAir 6FA, ;entolin 6FA, others%, levalbuterol "