Pulmonary Oedema following Exercise in Humans

Abstract

Pulmonary physiologists have documented many transient changes in the lung and the respiratory system during and following exercise, including the incomplete oxygen saturation of arterial blood in some subjects, possibly due to transient pulmonary oedema. The large increase in pulmonary arterial pressure during exercise, leading to either increased pulmonary capillary leakage and/or pulmonary capillary stress failure, is likely to be responsible for any increase in extravascular lung water during exercise. The purpose of this article is to summarise the studies to date that have specifically examined lung water following exercise. A limited number of studies have been completed with the specific purpose of identifying pulmonary oedema following exercise or a similar intervention. Of these, approximately 50% have observed a positive change and the remaining have provided results that are either inconclusive or show no change in extravascular lung water. While it is difficult to draw a firm conclusion from these studies, we believe that pulmonary oedema does occur in some humans following exercise. As such, this is a phenomenon of significance to pulmonary and exercise physiologists. This possibility warrants further study in the area with more precise measurement tools than has previously been undertaken.

The Evaluation of Cardiac Complaints in Marathon Runners

“…Noncardiogenic pulmonary edema has been described in the setting of marathon running. This entity has been linked to post-marathon adult respiratory distress syndrome and hyponatremia, although the true mechanism and significance is unknown (24,25).…”

Intense hypoxic cycle exercise does not alter lung density in competitive male cyclists

“…Alternatively, protocols of 2 h of treadmill running at 75% of _ VO 2max (Manier et al 1999), 1 h cycling at 60-65% _ VO 2max (Hodges et al, unpublished data) and an incremental exercise test to maximum (Gallagher et al 1988) were all insufficient to induce a change in lung density, as measured by CT, MRI and radiography, respectively. The insensitivity and/or subjectivity of the various measurement techniques and tradeoffs between exercise intensity and duration have been criticised (Manier et al 1999) and interpretation of the mixed results is complex (Hodges et al 2006).…”

“…Lung densities were calculated with CT, which is unbiased and sensitive enough to detect small changes in EVLW (Coxson et al 1995). An important aspect of this study was the addition of a hypoxic stressor throughout the exercise session, a stimulus that would increase the likelihood of extravascular water accumulation by heterogeneously increasing pulmonary artery pressure via the hypoxic vasoconstriction response (Hodges et al 2006;West 2004).…”

Evidence of pulmonary oedema triggered by exercise in healthy humans and detected with various imaging techniques

“…This review will not discuss the pathophysiology of oedema, as it is discussed in review papers elsewhere (West & Mathieu-Costello 1995, West 2000, 2004, Hodges et al 2006, Mairbaurl 2006. Furthermore, this review aims to shed light on whether different imaging methods used, level of hypoxia, timing of the post-exercise imaging, varied fitness levels of the subjects, and/or sex differences influence the diagnosis and occurrence of pulmonary oedema.…”