August 11th 2025
By Ari Parker
Learn about pulmonary edema causes in elderly patients, including heart failure, pneumonia, and kidney disease.
By Ari Parker
As we age, the risk of excessive fluid in the lungs increases. This condition, referred to as pulmonary edema, not only makes breathing difficult but can be life-threatening if left untreated. With timely detection and treatment, however, most people recover from too much fluid in their lungs.
Here are the signs to look out for, the most common causes of pulmonary edema, and ways to treat and/or prevent fluid buildup in the lungs.
Pulmonary edema occurs when there’s excessive fluid buildup in the lungs, making it difficult to breathe. Since our lungs, immune system, and nervous system weaken as we age, those over 65 have a higher risk of developing pulmonary edema.
The main causes of fluid in the lungs in the elderly are congestive heart failure, lung infections like pneumonia, and kidney or liver failure.
Fluid in the lungs could be life-threatening if left untreated. If you or a loved one is experiencing severe shortness of breath, you should seek immediate medical attention.
Our lungs are the primary organs involved in breathing. To reduce friction when breathing, we naturally have a small amount of fluid in the lining around our lungs. Pulmonary edema occurs when there is an abnormal accumulation of fluid in the air sacs within the lungs, making it difficult to breathe.
When we inhale, we breathe in oxygen that is carried by the blood to tissues and organs all over the body. When we exhale, we discard carbon dioxide, a byproduct of energy production in the body cells.
The oxygen taken in during inhalation is stored in air sacs inside the lungs called alveoli and absorbed into the bloodstream. If there’s fluid buildup in the air sacs, however, the lungs cannot supply sufficient oxygen to the blood.
In the short term, this could lead to shortness of breath, coughs, or wheezing. Over time, it may also lead to other complications as the body doesn’t receive sufficient oxygen for normal functioning or isn’t able to properly eliminate carbon dioxide, resulting in symptoms like fatigue and swollen legs.
As we age, our lungs change due to changes in:
The nervous system: Nerves in the airways become less sensitive as we age, making it harder to control how we breathe and how much liquid is in the lungs.
Our immune system: Usually, the immune system weakens with age, meaning our bodies can’t fight complications in the lungs as easily.
Tissues and muscles: As we age, muscles and tissues around the lungs grow weaker, making it difficult to open and shut the airways as intended.
Together, these three changes negatively impact the lungs, resulting in a higher likelihood of pulmonary edema and other lung complications, like more severe cases of RSV and pneumonia among the elderly.
Aging also increases the risk of heart disease, and pulmonary edema is often a complication of various heart conditions.
In addition, organ failures, specifically of the kidneys and liver, and stroke or brain injury, can result in pulmonary edema.
There are a few potential reasons for abnormal fluid buildup in the lungs, including heart-related causes, lung and respiratory conditions, and other medical reasons.
The most common cause of pulmonary edema is congestive heart failure. According to Yale Medicine, up to 80% of people who experience heart failure develop pulmonary edema.
Heart failure occurs when the heart can’t pump blood efficiently, which can result in a backup in the blood vessels carrying blood to the heart. When the left side of the heart is weak, it isn’t able to sufficiently move the blood, causing the blood to pool in the left side of the heart. This increases pressure in the blood vessels of the lungs. That pressure forces fluid (not blood) out of the vessels and into the tiny air sacs of the lungs, called alveoli. This fluid buildup, known as pulmonary edema, makes it harder to breathe.
The following conditions may cause heart muscles to become weaker, resulting in congestive heart failure and fluid buildup in the lungs:
Heart attack
Stroke
Coronary artery disease (heart disease)
Cardiomyopathy (damage to heart muscles)
Arrhythmia (abnormal heart rhythm)
Heart valve problems
Severe damage to the lungs can cause fluid buildup. That damage could be a result of inhaling toxins, severe trauma, a blood clot in the lungs, or, more commonly, a viral infection in the lungs, such as pneumonia.
An array of other medical conditions can damage either the lungs or the heart, increasing the risk of pulmonary edema. These include:
Kidney failure
Sepsis
Pancreatitis
Liver cirrhosis
Recurring blood transfusions
Trauma to or around the lungs with shock
Certain medicines, such as chemotherapy drugs, immunotherapy drugs, select heart medications, and some antibiotics, may also lead to abnormal fluid buildup. Exposure to higher altitudes than someone is used to may also cause pulmonary edema.
Pulmonary edema isn’t the only respiratory condition that becomes more common with age. Others include:
RSV: A virus that causes infections in the respiratory tract.
Pneumonia: An infection that fills the air sacs in one or both lungs with fluid or pus.
Pleural effusion: Fluid buildup around the lungs but not inside them.
Many of these conditions cause shortness of breath and may require immediate medical attention. Due to similarities in their symptoms, it is essential to consult a healthcare provider to correctly diagnose the underlying cause and start the appropriate course of treatment.
With prompt diagnosis, pulmonary edema is treatable. Here are the signs to look out for and how a healthcare provider can help.
The most common symptom is difficulty breathing, which worsens when lying down or exercising. Many with pulmonary edema describe their difficulty breathing as the sensation of drowning or suffocation.
Other common symptoms include:
Wheezing
Gasping for breath
Anxiety
Racing heartbeat
Cold or clammy skin
Persistent cough, often bloody
Difficulty speaking
Leg or foot swelling
Pale skin
Excessive sweating
Fatigue
If a loved one is experiencing the above symptoms, take them to the nearest emergency room or hospital. There, a healthcare provider will conduct a physical exam, searching for signs of pulmonary edema, like an irregular heartbeat, wheezing, or higher respiratory rate.
Often, they’ll order tests to check for fluid buildup in the lungs. Commonly ordered tests include a lung ultrasound, chest x-ray, and/or bloodwork. Since excessive fluid in the lungs is often related to heart conditions, they may also run tests to assess the functioning of the heart, such as an electrocardiogram or echocardiogram.
Excessive fluid buildup is treated in an emergency room or hospital. Treatment often includes providing supplemental oxygen through a face mask or, in severe cases, a breathing tube connected to a ventilator. They may provide medications to ease anxiety and drain excess body fluids.
The provider will also diagnose and treat any underlying causes, such as a heart attack or kidney disease.
When it comes to paying for treatment, most private insurance plans and Medicare help cover costs. Medicare Part A helps pay for any inpatient hospital services for pulmonary edema, while follow-up appointments and any other care deemed medically necessary fall under Part B. Those with a Medicare Part D plan are also covered for prescribed medications.
Since pulmonary edema can be life-threatening, it requires immediate care. That said, many recover from the condition, and their lungs work as usual within six months to a year.
The steps to recover from pulmonary edema and to prevent it are the same:
Take medications as prescribed
Attend annual wellness check-ups to detect any medical conditions that increase the risk of pulmonary edema
Eat a diet that’s low in salt and fat
Don’t smoke
Exercise regularly to maintain lung function and heart health
Pulmonary edema is a medical condition that occurs when air sacs in our lungs fill up with fluid, causing shortness of breath and other symptoms. The elderly are at a higher risk of developing pulmonary edema as a complication of other conditions, such as heart failure, stroke, or kidney failure.
If you or a loved one is experiencing difficulty breathing and other symptoms associated with pulmonary edema, seek immediate medical attention. A healthcare provider can diagnose the underlying cause and design an appropriate treatment plan.
The most common cause of excessive fluid in the lungs for those over 65 is congestive heart failure.
Abnormal levels of fluid in the lungs can be life-threatening for elderly patients. If you or a loved one is experiencing extreme difficulty breathing, seek immediate medical care.
Excessive fluid in the lungs that causes shortness of breath cannot be treated at home. Instead, it must be treated by a healthcare provider, typically in a hospital or emergency room. However, there are steps to take at home to prevent abnormal fluid in the lungs, including taking any medication as prescribed and eating a healthy diet low in fat and salt.
National Lung, Heart, and Blood Institute. (2022). The respiratory system. https://www.nhlbi.nih.gov/health/lungs/respiratory-system
National Library of Medicine. (2024). Pulmonary edema. https://medlineplus.gov/ency/article/000140.htm
Mayo Clinic. (2022). Pulmonary edema. https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009
National Library of Medicine. (2024). Aging changes in the lungs. https://medlineplus.gov/ency/article/004011.htm
National Institute on Aging. (2024). Heart health and aging. https://www.nia.nih.gov/health/heart-health/heart-health-and-aging
Centers for Disease Control and Prevention. (2024). RSV in older adults. https://www.cdc.gov/rsv/older-adults/index.html
National Library of Medicine. (2023). Pneumonia. https://medlineplus.gov/pneumonia.html
Yale Medicine. (n.d.). Pulmonary edema. https://www.yalemedicine.org/conditions/pulmonary-edema
National Library of Medicine. (2023). Pulmonary edema. https://www.ncbi.nlm.nih.gov/books/NBK557611/
Cleveland Clinic. (2022). Pulmonary edema. https://my.clevelandclinic.org/health/diseases/24218-pulmonary-edema
