An Overview of Leg Swelling in COPD

With chronic obstructive pulmonary disease (COPD), you may develop peripheral edema, which is swelling of the feet, ankles, and legs. Leg swelling can limit your activity and it can be physically uncomfortable. It is also a sign of advancing COPD.

As COPD begins to impair your lungs and heart, your circulation is eventually affected—and edema (fluid retention) develops. Besides COPD, there are also other causes of leg edema, so you will need a medical evaluation for your leg swelling even if you have already been diagnosed with COPD.

Medications and lifestyle strategies can help reduce leg edema. And since edema is a sign that your COPD may be progressing, you could also need your COPD treatments adjusted.

Leg swelling in COPD can start gradually, and it is more noticeable after you have been sitting with your legs down or walking for a while. Leg edema may improve when you raise your feet or lie down, so some people with COPD-associated edema notice decreased swelling in the morning when waking up.

Symptoms of COPD-associated edema include:

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

If you have edema due to your COPD, you are likely to also have other symptoms of advanced COPD such as:

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

While it isn't common, COPD can also cause edema in the hands, arms, or abdomen. This is a sign of severe COPD-associated right heart failure. As with leg edema, the swelling should be symmetrical if it is caused by COPD.

Edema can also rapidly worsen. Life-threatening 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
• Severe shortness of breath, even at rest
• A rapid heart rate
• Fluctuating blood pressure
• Chest pain
• Fainting

Seek urgent medical attention if you develop any of the above symptoms.

Leg swelling in COPD is a complex process associated with several factors involving your lungs, heart, oxygen level, kidneys, and fluid balance. In general, edema is associated with advanced COPD, but there isn't necessarily a strict correlation between the severity of your COPD and the extent of leg swelling—you can have end-stage COPD without leg swelling and you can have leg swelling with mild COPD (especially if you also have kidney disease).

Among the contributors to peripheral edema in COPD are pulmonary hypertension and cor pulmonale, medical conditions that can be caused by COPD.

Pulmonary hypertension occurs when lung disease causes high pressure in the blood vessels of the lungs. As a consequence, the right side of your heart (which moves blood between the heart and lungs) has to work a lot harder to pump.

Right heart failure, described as cor pulmonale, may develop due to pulmonary hypertension. With right heart failure, blood can get backed up in the veins throughout your body. As fluid leaks into the surrounding tissues, edema develops. Due to the effects of gravity, fluid starts to pool in the lowest parts of your body—your feet, ankles, and legs—and makes them swell.

When you have COPD, you can develop hypoxemia (low blood oxygen level). Your kidneys, which balance fluid in the body, detect the low oxygen level and mistakenly sense that you are deficient in body fluid. The kidneys respond by retaining fluid to compensate for the low blood oxygen levels. The excess fluid pools in your legs due to the effects of gravity—causing peripheral edema.

Peripheral edema is usually diagnosed with noninvasive examinations. Your doctor will look to see if the skin is swollen. If a dimple or pit forms after lightly pressing on the area for 15 seconds, this is described as pitting edema.

Pitting edema can be caused by other conditions, however. For example, venous insufficiency can cause pitting edema in both legs, resembling the leg edema associated with COPD.

If you are not able to maintain regular physical activity because of your COPD, you might also gain weight. Oftentimes, it can be difficult to distinguish edema from weight gain.

And a deep vein thrombosis (DVT) can cause pitting or non-pitting edema on one side of the body.

If the edema is non-pitting, it could be caused by other illnesses, such as thyroid disease or lymph node drainage issues. And asymmetric edema is typically caused by physical pressure, which may occur due to a tumor or an injury.

Your medical team may order some tests to distinguish COPD-associated edema from other types of swelling.

As part of your evaluation, your doctor will take your blood pressure and measure your blood oxygen saturation level to assess your heart and lung function. You may also need a chest x-ray or computerized tomography (CT) to evaluate your lungs. Your doctor may order an echocardiogram to assess your heart function.

And if there is concern about the blood flow in your legs (or arms), you may also have a venous ultrasound, which is a non-invasive evaluation of blood flow in your extremities.

While there is not a cure for COPD, pulmonary hypertension, or cor pulmonale, medical and surgical treatments may prevent worsening. Fluid management is an important part of the treatment for leg edema in COPD, and it involves lifestyle strategies as well as medication.

Medications that can help reduce edema include diuretic prescriptions, which trigger the elimination of fluid in the urine.

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

• Rest with your feet up: You might notice the swelling going down when you lift your feet up at the same level as your heart (or higher).
• Wear compression stockings: These supportive socks may also help reduce the pooling of blood in your feet and ankles. You can usually purchase a pair at your local drugstore.
• Keep up with hydration: Your fluid intake is a tricky thing when you have COPD-associated leg edema, so you need to closely follow your doctor's instructions when it comes to fluids. Excess fluid can cause edema if your kidneys can't catch up with urine production. But not drinking enough water may also promote swelling if your kidneys retain excess fluid to prevent dehydration.
• Salt restriction: Your salt intake can affect the edema in your legs. 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 and heart function in COPD, and maintain healthier circulation.

Swelling in your feet, ankles, and legs could be a sign of a serious complication of COPD, and it's important to see your doctor about it. There are, however, other causes of leg edema, and a full diagnostic evaluation is necessary.

You might need to make some adjustments to your dietary salt and fluid. With proper treatment, you can stay active and reduce leg swelling caused by COPD.