How Serious is Fluid on the Lungs in the Elderly?
How Serious is Fluid on the Lungs in the Elderly?
You might have heard the phrase ‘fluid on the lungs’ before, as this commonly affects older adults. ‘Fluid on the lungs’ typically refers to a condition called pulmonary oedema, and this can be a serious health concern for older people. Here, we are exploring this condition, what causes it, the symptoms, how it’s diagnosed and treated, potential complications to be aware of, when emergency help is needed, and how caregivers can properly support an older adult with fluid on the lungs.
At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For over 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about fluid on the lungs in older adults, we can help.
What does it mean to have ‘fluid on the lungs’?
The phrase ‘fluid on the lungs’ usually means fluid has built up in the air sacs inside the lungs, which makes it harder to breathe. The real name for this condition is ‘pulmonary oedema’, but it is important to note that this isn’t a disease in itself, but rather a symptom of an underlying issue – most commonly, a heart condition. When the heart struggles to pump blood effectively throughout the body, there could be increased pressure in the blood vessels, which causes fluid to leak into the air sacs in the lungs.
While the severity of this varies, for older adults, pulmonary oedema can signal a serious issue. At this age, the body may struggle to handle the internal stress of having reduced oxygen levels. Pulmonary oedema can come on suddenly (known as acute pulmonary oedema), or it can come on gradually (known as chronic pulmonary oedema). Either way, medical attention is often needed.
What is the difference between pulmonary oedema and pneumonia?
It is important to first distinguish the difference between pulmonary oedema and other similar conditions. Pulmonary oedema and pneumonia can both cause a build-up of fluid in the lungs, however pneumonia is caused by a viral, bacterial or fungal infection. In this case, the fluid in the lungs is infected, and is usually thinner and more watery than the fluid that occurs in pulmonary oedema. Put simply, pulmonary oedema can occur on its own, or it could be a symptom of a pneumonia infection.
What is the difference between pulmonary oedema and pleural effusion?
Pleural effusion is another condition that may be referred to as ‘fluid on the lungs’, although less frequently than pulmonary oedema. Pulmonary oedema and pleural effusion are often confused due to their symptom parallels and similar causes, however there is a difference; pulmonary oedema is when fluid collects in the air sacs inside of the lungs, whereas pleural effusion is when fluid collects in the layers of the pleura that sit outside the lungs, between the chest cavity and the lungs. Usually there is a thin layer of fluid in this area, but when pleural effusion is present, there may be more. Pleural effusion is also commonly caused by pneumonia, heart failure or cancer.
What causes pulmonary oedema in older adults?
A number of conditions can cause pulmonary oedema in older people. According to a 2012 study, the most common reasons may include high blood pressure, arrhythmias (a rapid heart rhythm), unstable angina, infections like pneumonia, and a heart attack.
Heart-related causes
Acute heart failure is a common reason people with pulmonary oedema are admitted to hospital, and this is the case for over 67,000 admissions in England and Wales each year. This is known as cardiogenic pulmonary oedema, and there are several causes for this, including myocardial ischemia, arrhythmias, acute valvular dysfunction (leaking or narrowing of the heart valves), severe high blood pressure, or a heart attack.
Fluid in the lungs builds up as a result of the heart lacking the necessary force to pump blood efficiently around the body, meaning the amount of blood in the veins increases. When this happens in the heart, the pressure on those blood vessels increases, and fluid enters the air sacs in the lungs. A 2021 review found that increased oedema can predict worsening heart failure, so this should always be considered a medical emergency.
Lung-related causes
Some lung injuries or stress on the lungs can also cause pulmonary oedema, such as from infections like pneumonia or smoke inhalation. This causes damage to blood vessels in the lungs, and as a result, those blood vessels fail to clear fluid from the lungs, causing buildup.
Other issues such as acute respiratory distress syndrome (ARDS) can cause pulmonary oedema, and chronic obstructive pulmonary disease (COPD) could indirectly cause this due to associated heart failure, which in turn, can lead to pulmonary oedema.
Kidney issues
The kidneys help to maintain fluid balance within the body, so when older people develop kidney issues such as chronic kidney disease or acute kidney failure, the body might begin to retain fluid, causing a buildup in certain areas. Kidney issues are a common cause of pulmonary oedema in older people as age tends to lead to reduced kidney function.
In one 2023 study of people with chronic kidney disease, 70% of patients had pleural effusion, and 52% had pulmonary oedema.
Other causes
Although heart conditions, lung conditions and kidney conditions are usually the main causes of pulmonary oedema in older people, certain other factors can cause this too. This might be referred to as noncardiogenic pulmonary oedema, and the reasons include:
- High-altitude exposure (known as high-altitude pulmonary oedema)
- Activities like scuba diving
- Getting a major blood transfusion
- Taking certain medications or getting certain treatments, such as chemotherapy or NSAIDs
- Brain injuries (known as neurogenic pulmonary oedema)
- Infections such as pneumonia or sepsis
- Conditions such as pancreatitis or liver disease
Certain lifestyle factors can increase the chance of developing pulmonary oedema, such as eating a poor diet, sedentary behaviour, and not effectively managing pre-existing chronic illnesses.
What are the symptoms of pulmonary oedema?
The symptoms of pulmonary oedema often depend on the underlying cause, but the NHS states that some of the most common are:
- Shortness of breath, particularly when lying down or exercising
- A persistent cough
- A rapid heartbeat
- Waking in the night with breathlessness
- Wheezing or gasping
- Fatigue
- Anxiety
- Confusion
- Swelling in the lower limbs, ankles or abdomen
- Loss of appetite
- Weight gain or weight loss
Some other reported signs of pulmonary oedema include dizziness, excessive sweating, clammy skin, blue colouring on lips or fingers, and frothy mucus from the mouth, which might also contain blood.
How is pulmonary oedema diagnosed?
Pulmonary oedema is most commonly diagnosed using a combination of physical examinations, imaging tests and testing to identify the underlying cause. Doctors will typically ask about the person’s medical history, check their heart rate, and listen for abnormal sounds in the lungs to confirm the presence of fluid. If found, they may order imaging tests such as chest X-rays or ultrasound scans to confirm this. Depending on the person’s symptoms and what the suspected underlying causes are, patients may also undergo tests such as an ECG (electrocardiogram) to determine the severity of any heart issues, or blood tests to evaluate things like kidney function.
It is thought that the one-year mortality rate for people admitted to hospital with acute pulmonary oedema could be as high as 40%, so prompt and accurate diagnosis is important to identify the underlying cause.
How is pulmonary oedema treated?
Pulmonary oedema must be treated quickly in order to prevent serious issues, and the exact treatment used will depend on the underlying cause. In an emergency where a person cannot breathe easily, oxygen may be given to increase the amount of oxygen in their blood and help them to breathe, which could immediately ease some of their discomfort.
The underlying cause must be identified and treated as soon as possible, and it is vital to get things like high blood pressure and heart arrhythmia under control. If an infection such as pneumonia is present, treatment for this will begin promptly, such as antibiotics.
If heart failure is found to be the cause, medications may be quickly administered intravenously to slow down the effects, such as ACE inhibitors, beta-blockers or diuretics to reduce fluid build-up. Devices such as pacemakers can also be implanted into the chest to help control the heart rhythm, or in severe cases, heart surgery may be required.
If pleural effusion turns out to be the cause, then other draining procedures (such as thoracentesis) might be carried out to manually relieve this pressure from the chest cavity.
Regardless of the underlying cause or treatment method, lifestyle changes will usually be needed to manage symptoms, such as adopting a balanced diet, stopping smoking, reducing alcohol intake, managing blood pressure, and moving your body more with doctor-approved exercises to improve heart, kidney and lung health.
What are the potential complications of untreated pulmonary oedema?
Prompt treatment of pulmonary oedema is vital, as certain complications can arise if this condition is not dealt with immediately. These might include things like respiratory distress that leads to high stress and anxiety, and respiratory failure.
If a heart condition is the cause, then untreated pulmonary oedema could lead to increased pressure on the heart, and heart failure, which can be fatal.
When should you seek emergency help for pulmonary oedema?
If you notice gradual signs of pulmonary oedema such as a persistent cough, and are unsure of the severity, speak to your GP as soon as possible to get their advice on how best to treat the situation.
If, however, you notice any of the aforementioned symptoms arising suddenly in yourself or a loved one, such as shortness of breath, a rapid heartbeat or swelling in the lower limbs, this should be considered a medical emergency. For around 25% of hospitalised people with cardiogenic pulmonary oedema, this is fatal, so taking action straight away is crucial and could save a life. Any sudden or severe shortness of breath, chest pain or rapid swelling should be checked immediately – call 999 straight away to get prompt medical attention.
What support can caregivers offer to older people with pulmonary oedema?
Managing acute pulmonary oedema means getting urgent medical assistance, so caregivers may need to help by recognising the signs early, taking prompt action to address the issues, and accessing treatment.
For chronic pulmonary oedema, caregivers may need to help older adults by:
- Managing their medications to prevent further episodes
- Attending regular follow-up appointments
- Improving the comfort and accessibility of the home environment to enhance recovery (such as adjusting bed positioning to help with breathing)
- Supporting necessary lifestyle changes such as monitoring a healthy diet and safe physical activity
- Keeping GPs and doctors informed of the progression of symptoms, such as breathing difficulties or swelling – any changes in symptoms could indicate a worsening of their condition and require immediate medical attention
- Helping with strenuous daily tasks that are impacted by symptoms like fatigue or breathlessness, such as personal care, housekeeping and running errands, in order to maintain their safety and improve their comfort
- Providing emotional support to address the emotional distress that symptoms like breathlessness can cause
- Offering regular companionship so older adults always feel safe at home with a familiar, trusted face around
With care providers like Home Instead, families can effectively manage the symptoms of pulmonary oedema with either visiting care or live-in care options. Respite care can also take over for families who need a break for any reason, including due to carer’s burnout.
Our experienced, supportive Care Professionals can provide the help needed to manage the symptoms of pulmonary oedema effectively within an older person’s own home, where they feel safe and at ease. For the support you need, reach out to your local Home Instead office to discuss your options.
We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.
