Expert Answers: Relief for Swollen Ankles

It can be common for people with COPD to experience ankle swelling. In fact, we've had several community member ask the following question, so we decided to ask our experts for their answers:

"Is there anything I can do to relieve my swollen ankles?"

Pulmonary hypertension?

COPD does not cause ankle edema, this is often caused by a condition known as cor pulmonale. Cor pulmonale is caused by long-term pulmonary hypertension. What is pulmonary hypertension? It is high blood pressure in the arteries of the lungs.

Pulmonary hypertension and cor pulmonale are fairly common in people who have COPD and occurs because the blood vessels in the lungs become constricted and narrowed causing the right side of the heart to work a lot harder. Over time, the right heart muscle becomes enlarged and thickened and loses its ability to contract normally.

Because of this fluid backs up in the veins of your body and fluid can leak into the surrounding tissues. Our friend gravity causes this fluid to pool in the lowest parts of your body- your feet, ankles, and legs - and causes them to swell up. What can you do if you have swelling or edema? While there is no specific treatment, you can treat the symptoms which can take the stress off your heart and lungs, and may help to reduce the swelling.

Some of the things that can help are:

• Following your COPD treatment plan
• Taking all of your medications as prescribed
• If you have oxygen, using it for the number of hours prescribed
• Using your CPAP machine regularly if you have been prescribed one.
• Regular exercise/pulmonary rehab helps to move the fluid around
• At home you can put your feet up higher than your heart when possible will help to reduce the edema in your lower extremities.
• Sometimes a diuretic or “water pill” is prescribed to get rid of the excess fluid, only take this if it has been prescribed by your physician.

If you are finding that the swelling is worse than usual, talk with your doctor.

Common COPD comorbidities

Chronic Obstructive Pulmonary Disease (COPD) is often accompanied by comorbidities. Comorbidities are defined as other chronic medical conditions that are generally associated with the primary diagnosis, in this case, COPD. Sometimes these other conditions can make the COPD get worse. Cardiovascular conditions which can affect COPD may include high blood pressure (including hypertension and pulmonary hypertension), coronary artery disease, and atrial fibrillation, to name a few.^1-4

Pulmonary hypertension is fairly common and serious in people who have COPD. It means that blood pressure is higher than normal in the heart and in the lungs. The increased pressure in the heart and lungs causes damage to those blood vessels. Because of this, blood can back up and pool in the veins of the body. When this happens, the increased pressure causes fluid to leak into the surrounding tissues. Due to gravity, this usually occurs in the lower extremities; namely, your feet, ankles, and legs, which accounts for the swelling you refer to in the question above. People with pulmonary hypertension which is bad enough to cause significant swelling in their lower extremities may find it difficult to perform many of their usual daily physical activities.^1-4

There is no treatment that's specific for leg and ankle swelling in pulmonary hypertension with COPD. Instead, treating the underlying condition(s) that caused the swelling in the first place may help take some of the stress off the heart and lungs, and ultimately reduce the swelling.^1-4

Specifically, you should follow your doctor's instructions regarding treatment of your COPD and pulmonary hypertension, including medications, exercise, and physical therapy, when prescribed. If the swelling and other symptoms seem to be getting worse, your doctor may decide to make changes in your medication regimen, which can include supplemental oxygen therapy.^1-4

There are a few things that can be done at home to help reduce the swelling as well. Elevate your feet and make sure they are at a level that is higher than your heart. Doing this as often as possible will help reduce the edema in the lower extremities. If your extremities swell and the swelling doesn’t go down after you put your feet up, or after a night’s sleep while elevated, it would be prudent to contact your health care provider for additional treatment.^1-4

How to treat it

Swollen ankles are quite common for people with COPD – and are actually a symptom of a larger problem. Put simply, it’s due to a condition known as Pulmonary Hypertension in which the vessels going to the heart and lungs narrow, causing the blood pressure in these areas to raise and the blood to back up in the veins throughout the body. In turn, this causes fluid to leak into the tissues around the veins. The fluid often settles in your feet and ankles.

Some relief can be achieved by elevating your feet whenever you sit and sleep. When lying down your feet should be above the level of your heart.
If the symptom persists, you should certainly speak to your doctor about it. He or she may prescribe a diuretic to alleviate the swelling.

It’s very important the underlying issue be treated and not just the symptoms. So, be persistent about following all your doctors orders regarding exercise, medication, and diet. You may be put on a low sodium diet to help and a regimen of moderate, low-impact exercise.