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Treatments and drugs
By Mayo Clinic staffGiving oxygen is the first step in the treatment for pulmonary edema. You usually receive oxygen through a face mask or nasal cannula — a flexible plastic tube with two openings that deliver oxygen to each nostril. This should ease some of your symptoms. Sometimes it may be necessary to assist your breathing with a machine.
Depending on your condition and the reason for your pulmonary edema, you may also receive one or more of the following medications:
- Preload reducers. Doctors commonly use nitroglycerin and diuretics, such as furosemide (Lasix), to treat pulmonary edema. These medications dilate the veins in your lungs and elsewhere in your body, which decreases fluid pressure going into your heart and lungs. Diuretics may make you urinate so much initially that you may temporarily need a urinary catheter while you're in the hospital.
- Morphine (Astramorph, Roxanol). This narcotic may be used to relieve shortness of breath and anxiety. But some doctors believe that the risks of morphine may outweigh the benefits and are more apt to use other, more effective, drugs.
- Afterload reducers. These drugs dilate the peripheral vessels and take a pressure load off the left ventricle. Some examples of afterload reducer medications include nitroprusside (Nitropress), enalapril (Vasotec) and captopril (Capoten).
- Blood pressure medications. If you have high blood pressure when you develop pulmonary edema, you'll be given medications to control it. On the other hand, if your blood pressure is too low, you're likely to be given drugs to raise it.
Treating high-altitude pulmonary edema (HAPE)
If you're climbing or traveling at high altitudes and experience mild symptoms of HAPE, descending a few thousand feet (about 600 to 900 meters) should relieve your symptoms. Oxygen also is helpful. When symptoms are more severe, you'll likely need help in your descent. A helicopter rescue may be necessary for the most serious cases, because HAPE can be life-threatening.
Some climbers take the prescription medication acetazolamide (Diamox) to help treat or prevent symptoms of HAPE. To prevent HAPE, acetazolamide is started as long as three days before ascent. Acetazolamide can occasionally have side effects — including tingling or burning in the hands and feet, confusion, diarrhea, nausea, loss of appetite, and hearing problems.
- Pulmonary edema. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec07/ch074/ch074b.html. Accessed June 4, 2009.
- Schwartzstein RM. Dyspnea and Pulmonary Edema. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y. Mc-Graw Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2863220. Accessed June 4, 2009.
- Ware LB, et al. Acute pulmonary edema. New England Journal of Medicine. 2005;353:2788.
- Signs and symptoms of heart failure. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=339. Accessed June 6, 2009.
- Harris MD, et al. High-altitude medicine. American Academy of Family Physicians. http://www.aafp.org/afp/AFPprinter/980415ap/harris.html?print=yes. Accessed June 6, 2009.
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- What causes cardiomyopathy? National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/cm/cm_causes.html. Accessed June 6, 2009.
- What is ARDS? National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards_All.html. Accessed June 4, 2009.
- Givertz MM. Noncardiogenic pulmonary edema. http://www.uptodate.com/home/index.html. Accessed June 5, 2009.
- Swenson ER. Pathogenesis of high-altitude pulmonary edema: Inflammation is not an etiologic factor. Journal of the American Medical Association. 2002; 287: 2295
- Mattu A, et al. Modern management of cardiogenic pulmonary edema. Emergency Medicine Clinics of North America. 2005;23:1105
- Acetazolamide (Prescribing information). Haifa Bay, Israel. Taro Pharmaceuticals, Inc. http://www.taro.com/media/oMedia/Acetazolamide%20Tablets%20%200305-1.pdf. Accessed June 6, 2009.
- ABCs of Preventing Heart Disease, Stroke and Heart Attack. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=3035374. Accessed June 6, 2009.
- How do I know if I have high blood pressure. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=219. Accessed June 6, 2009.
- About high blood pressure. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=468. Accessed June 6, 2009.
- How can I reduce high blood pressure? American Heart Association. Accessed June 6, 2009.
- Cigarette smoking and cardiovascular disease. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=4545. Accessed June 6, 2009.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. June 12, 2009.
- Grogan M (expert opinion). Mayo Clinic. Rochester, Minn. June 12, 2009.
