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Lung diseases

FLUID BUILD UP IN LUNGS AT NIGHT

10/05/2005

Question:

MY 48 YEAR OLD HUSBAND, WHO HAS BEEN A SMOKER FOR ALMOST 30 YEARS, AND IS ALSO A CONSTRUCTION CONTRACTOR, HAS BEGUN TO EXPERIENCE A BUILD UP OF FLUID IN HIS LUNGS AT NIGHT. IT HAS BEGUN WAKING HIM UP AT LEAST 3 TIMES PER NIGHT WITH COUGHING FITS. WHEN HE WAKES UP IN THE MORNING, HE HAS LIMITED LUNG CAPACITY UNTIL HE COUGHS UP WHAT HE DESCRIBES AS CLEAR, FROTHY FLUID. HE HAS NO PROBLEMS WITH BREATHING DURING THE DAY. ARE THERE ANY CONDITIONS WHICH WOULD CAUSE FLUID BUILD UP IN THE LUNGS ONLY AT NIGHT?

Answer:

Awakening at night due to accumulation of fluid within the lungs is call paroxysmal nocturnal dyspnea.  It may be associated with orthopnea, breathless while lying flat or need to use several pillows at night as well as swelling in the feet or ankles.  It is usually due to congestive heart failure.  It is caused by edema fluid translocating from the lower extremities into the lungs on changing position from standing to lying down.

Other conditions that might mimic paroxysmal nocturnal dyspnea include chronic bronchitis due to cough and sputum production at night as well as obstructive sleep apnea with snoring and episodes of holding or stopping breathing at night and awakening with snorts or gasps.

It is very important that you see your primary care physician and discuss these symptoms in detail with your doctor.  In addition, to a careful history, your doctor will perform a thorough physical examination and may order addition tests such as an ECHO, an ultrasonographic study to assess heart function and size, an electrocardiogram, a chest x-ray, and possibly laboratory studies.  You may be referred to a cardiologist, a heart doctor.

Treatment will depend upon the exact cause of these episodes; if they are due to heart failure, the usual treatment includes diuretics (fluid pills) and medications to improve heart function.

Because these episodes strongly suggest heart failure and because heart failure is serious illness that can be treated, it is very important that you do not hesitate to discuss these symptoms with your primary care physician and undergo further evaluation.

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Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati