COPD An Overview of Leg Swelling in COPD By Deborah Leader, RN Deborah Leader, RN Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD. Learn about our editorial process Updated on March 22, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Sanja Jelic, MD Medically reviewed by Sanja Jelic, MD Sanja Jelic, MD, is board-certified in sleep medicine, critical care medicine, pulmonary disease, and internal medicine. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment With chronic obstructive pulmonary disease (COPD), you may develop peripheral edema (fluid retention), which is swelling of the feet, ankles, and legs. Leg swelling can limit your activity and be physically uncomfortable. It is also a sign of advancing COPD. Jan-Otto / E+ / Getty Images As COPD begins to impair your lungs and heart, your circulation is eventually affected and edema develops. Besides COPD, there are also other causes of 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. Symptoms 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 notice decreased swelling in the morning when waking up. Symptoms of COPD-associated edema include: Puffiness of the feet, ankles, and lower legsItchiness or tenderness of the feet and legsPitting (an indentation of the swelling) from your socks and shoesFeet becoming too large for shoes that used to fitPitting that lasts for up to a minute after you press on the swollen areaDecreased leg swelling when you lift your feet Edema from COPD is typically symmetrical, affecting both legs just about equally. If your lower-extremity edema is unequal, this is a sign that you could have another serious problem—and you should get medical attention promptly. If edema is due to your COPD, you are likely to also have other symptoms of advanced COPD, such as: Shortness of breath during routine activitiesWheezingCoughingFatigueLightheadedness, 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)LethargySevere shortness of breath, even at restA rapid heart rateFluctuating blood pressureChest painFainting Seek urgent medical attention if you develop any of the above symptoms. Causes 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 disease and the extent of leg swelling. For example, 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 interrelated medical conditions that can be caused by this respiratory disease: 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. An Overview of Pulmonary Hypertension Cor pulmonale: Right-sided heart failure may develop due to pulmonary hypertension. With cor pulmonale, 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. Diagnosis Peripheral edema is usually diagnosed with noninvasive examinations. Your healthcare provider 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. Diagnostic Tests Your medical team may order some tests to distinguish COPD-associated edema from other types of swelling. As part of your evaluation, your healthcare provider 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 computed tomography (CT) scan to evaluate your lungs. Your healthcare provider 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 noninvasive evaluation of blood flow in your extremities. Treatment 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 healthcare provider'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. Restrict salt: 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. A Word From Verywell Swelling in your feet, ankles, and legs could be a sign of a serious complication of COPD, and it's important to see your healthcare provider 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Stickel S, Gin-sing W, Wagenaar M, Gibbs JSR. The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension. Eur Heart J Suppl. 2019;21(Suppl K):K46-K53. doi.10.1093/eurheartj/suz207 American Heart Association. Pulmonary Hypertension - High Blood Pressure in the Heart-to-Lung System. Centers for Disease Control and Prevention. Pulmonary Hypertension Fact Sheet. American Academy of Family Physicians, familydoctor.org. What is Edema? Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102–110. Cleveland Clinic Health Essentials. 6 Best Fixes for Pain and Swelling in Your Feet and Ankles. Additional Reading Hurdman J, Condliffe R, Elliot CA, et al. Pulmonary hypertension in COPD: results from the ASPIRE registry. Eur Respir J. 2013;41(6):1292–1301. doi:10.1183/09031936.00079512 Zangiabadi A, De Pasquale CG, Sajkov D. Pulmonary hypertension and right heart dysfunction in chronic lung disease. Biomed Res Int. 2014;2014:739674. doi:10.1155/2014/739674