Overview of Leg Swelling in COPD

If you have chronic obstructive pulmonary disease (COPD) and notice that your feet, ankles, and legs start swelling, you may be experiencing a serious but common complication of the condition, known as pulmonary hypertension.

Pulmonary hypertension is fairly common in people who have COPD. It occurs when there is high blood pressure in the blood vessels within and between the lungs. Changes in these blood vessels make it harder for blood to move through them, which makes it much more difficult for the right side of your heart (the part of the heart responsible for moving blood between your heart and your lungs) to pump, which may result in fluid building up in your lower extremities, as your body has a harder time keeping blood moving efficiently.

Pulmonary hypertension may lead to cor pulmonale, also known as right-sided heart failure or dysfunction, in which the right side of the heart becomes enlarged and does not pump as efficiently. In this situation, the heart is unable to pump enough blood into the lungs, and thus the body is unable to absorb adequate oxygen from the lungs. If left untreated, cor pulmonale may result in a higher risk of COPD exacerbation and a lower rate of survival.

In addition to the swelling of your feet, ankles, and legs, pulmonary hypertension can cause the following symptoms:

• Shortness of breath during routine activities
• A faster or racing heartbeat
• Fatigue
• Chest pain or pain in your upper right abdomen
• Decreased appetite
• Bluish-colored lips (shows your blood isn't carrying enough oxygen)

In the majority of people with COPD, pulmonary hypertension is mild to moderate. Only in a small group of people does it become severe. People with pulmonary hypertension that is bad enough to cause significant swelling in their lower extremities may find it difficult to perform many daily tasks.

Pulmonary hypertension can be caused by damage resulting from the chronic bronchitis or emphysema that are characteristic of COPD.

As COPD causes a lack of sufficient oxygen in the bloodstream, this can result in narrower and smaller blood vessels that make it more difficult for blood to pass through, forcing blood pressure to increase in your heart and lungs.

This increased pressure causes damage to important blood vessels. Because of this, blood backs up in the veins in your body, and fluid can leak into the surrounding tissues.

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. In medical terms, this swelling is known as edema.

Swelling or edema is usually diagnosed by a noninvasive examination. Your doctor will look to see if the skin over the swollen area is shiny and/or stretched and if a dimple or pit forms after lightly pressing on the area for 15 seconds.

Your practitioner will also take your blood pressure and blood oxygen saturation level and may perform other scans and tests to see what could be causing the swelling, such as an echocardiogram, which uses sound waves to show your heart function.

There's no treatment that's specific for leg and ankle swelling when it comes to pulmonary hypertension and COPD. Instead, treating the underlying conditions that caused the swelling in the first place may help take some of the stress off your heart and lungs, and ultimately reduce the swelling. Keeping the fluid levels in your body balanced is also a strategy to minimize symptoms from pulmonary hypertension. ​

Specifically, you should follow your doctor's instructions regarding the treatment of your COPD and pulmonary hypertension, including medication, exercise, salt and water restrictions, and physical therapy, if prescribed or recommended.

If your swelling and other symptoms seem to be getting worse, your doctor may decide to make changes in your medication regimen, including oxygen therapy or vasodilators, which help to open narrowed blood vessels, or diuretic therapy, which encourages your body to eliminate unnecessary fluids.

There are a few things that you can do at home to help reduce swelling:

• Rest with your feet up: Keeping your feet higher than your heart as often as possible can help reduce the edema in your lower extremities.
• Compression stockings: These supportive socks may also help increase circulation to your feet and ankles—you can usually purchase a pair at your local drugstore.
• Keep up with hydration: Drinking less water actually promotes more swelling. Aim for eight to 10 glasses per day.

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 doctor about it quickly. Any pooling of fluid in the lower extremities means that your heart and lungs are having difficulty doing their jobs, and swift treatment can help get to the root of the problem.

But it's also never too early to start making healthier changes in your diet and lifestyle, such as limiting your intake of processed and packaged foods to cut back on sodium, keeping up with hydration goals, and staying lightly active.