Why COPD Causes Swollen Feet and Legs

Chronic obstructive pulmonary disease (COPD) can lead to swelling, particularly in the feet, ankles, and legs (known as peripheral edema). As COPD impairs your lungs and heart, it affects your circulation, which leads to fluid retention. This swelling can be uncomfortable and limit your activity.

Edema is often a sign of advancing disease and is particularly prevalent in those with end-stage COPD. However, the correlation between swelling and the severity of COPD isn't necessarily a strict one. For example, you may also experience swelling with mild COPD (especially if you also have kidney disease).

This article looks at the symptoms and causes of peripheral swelling in COPD and why it's important to call to your healthcare provider's attention. It also explains how edema is diagnosed and treated.

Symptoms of COPD-Related Swelling

Leg swelling in COPD can start gradually. It's usually more noticeable after you've been walking or sitting with your legs hanging down for a while. It may improve when you raise your feet or lie down, so it's common to notice decreased swelling in the morning.

Symptoms of COPD-associated peripheral edema include:

• Puffiness of the feet, ankles, and lower legs (non-pitting edema)
• Itchiness or tenderness of the feet and legs
• An indentation of the swelling from your socks and shoes (pitting edema)
• Pitting that lasts for up to a minute after you press on the swollen area
• Feet becoming too big for your shoes
• Decreased leg swelling when you lift your feet

If peripheral edema is due to advanced COPD, you're likely to also have other symptoms, such as:

• Shortness of breath during routine activities
• Wheezing
• Coughing
• Fatigue
• Lightheadedness, especially during exertion

When to Seek Emergency Care

There are several cases in which COPD-related swelling is considered a medical emergency. This is true when swelling is only on one side of the body, it rapidly worsens, or it occurs in both hands, both arms, or the abdomen.

If any of these apply to you, call 911 or go to an emergency room right away.

Asymmetrical Swelling

Edema from COPD is typically symmetrical, affecting both legs about equally. If you have foot or leg swelling that is more pronounced on one side versus the other, it may be a sign of another serious problem.

Rapid Progression of Swelling

Edema that rapidly gets worse can indicate a life-threatening situation. COPD symptoms that can occur along with progressive edema include:

• Bluish-colored lips or skin (a sign your blood isn't carrying enough oxygen)
• Lethargy (lack of energy)
• Severe shortness of breath, even at rest
• A rapid heart rate
• Fluctuating blood pressure
• Chest pain
• Fainting

Symmetrical Swelling in Certain Areas

While it isn't common, COPD can also cause symmetrical edema in the hands, arms, and abdomen.

This is a sign of severe COPD-associated right heart failure.

Causes of Leg Swelling in COPD

Leg swelling in COPD is a complex process associated with several factors involving your lungs, heart, oxygen level, kidneys, and fluid balance.

Among the contributors to peripheral edema in COPD are interrelated medical conditions that can be caused by this respiratory disease. These include:

• Pulmonary hypertension: Occurs when lung disease causes high pressure in the blood vessels of the lungs. That makes the right side of your heart—which moves blood between the heart and lungs—have to work a lot harder. This can lead to right-sided heart failure.
• Cor pulmonale: Blood gets backed up in the veins throughout your body. That makes fluid leak into nearby tissues. Gravity then makes the fluid pool in the lowest parts of your body, leading to edema.

Other Causes of Pitting Edema

Pitting edema also can be caused by other conditions, including:

• Venous insufficiency: This problem with the valves in your blood vessels can lead to edema that is pitting and symmetrical, so it can look much the same as COPD edema.
• Deep vein thrombosis (DVT): These blood clots in large veins (often in the lower legs) can cause pitting or non-pitting edema on one side of the body.

Other Causes: Non-Pitting Edema

If the edema is non-pitting, it could be caused by other illnesses, such as:

• Thyroid disease (myxedema)
• Lymph node drainage issues (lymphedema)
• Allergic reactions, with edema in the face, tongue, throat, abdomen, arms, or legs (angioedema)
  

Diagnosis of Leg Swelling in COPD

COPD isn't the only cause of leg and foot edema. You should always talk to your healthcare provider about it.

Peripheral edema is usually diagnosed with noninvasive examinations. Your healthcare provider will look to see if the skin is swollen. They may press lightly on an area to see if it's pitting edema.

Diagnostic Tests

Your medical team may order some tests to distinguish COPD-associated edema from other types of swelling. This may involve a variety of tests to evaluate your heart, lungs, and blood flow in your extremities. This may include:

• Checking blood pressure and blood oxygen saturation
• Chest X-ray
• Computed tomography (CT) scan
• Echocardiogram
• Venous (vein) ultrasound

Treatment of Edema in COPD

COPD can't be cured. Neither can pulmonary hypertension or cor pulmonale. However, medical and surgical treatments can keep these conditions from getting worse.

Fluid management is an important part of the treatment for leg edema in COPD. It involves lifestyle strategies as well as medication. This includes prescription diuretics ("water pills"), which help your body pass more fluid in the urine.

A few things that you can do at home to help reduce leg swelling in COPD:

• Rest with your feet up: The swelling may go down when your feet are level with or higher than your heart.
• Wear compression stockings: These supportive socks may also help reduce blood in your feet and ankles. You can buy these at your local drugstore or online.
• Stay hydrated: Ask your healthcare provider about the right fluid intake for you. Too much fluid can overwhelm your kidneys and make edema worse, but too little promotes swelling because your kidneys start retaining fluid to prevent dehydration.
• Restrict salt: Salt concentration is very carefully managed by your kidneys, so too little or too much salt can result in swelling or dehydration.
• Get regular exercise: Staying active can help your lung, heart, and circulatory function in COPD.

Summary

COPD, especially in advanced cases, can cause peripheral edema, or fluid retention. This may make your legs, ankles, and feet swell. The swelling is usually about the same on both sides of your body. It may be pitting, which means pressure causes it to stay indented.

The edema of COPD comes from problems with the heart, lungs, oxygen levels, kidneys, and fluid balance. Not everyone with end-stage COPD has it, and some people have it with mild COPD.

COPD edema is usually diagnosed based on how it looks, combined with a prior diagnosis of COPD. Tests are used to check for other possible causes, such as venous insufficiency and DVT. Treatments for leg and foot swelling in COPD may include diuretics, salt restrictions, and regular exercise.