Swelling

What causes swelling in the ankles, legs and feet for people with COPD?

People with chronic obstructive pulmonary disease (COPD) may have swelling in their ankles, legs and feet. This kind of swelling is not caused directly by the COPD patient’s chronic bronchitis or emphysema. Instead, complications of COPD called “pulmonary hypertension” and “cor pulmonale” often cause the swelling.

What are pulmonary hypertension and cor pulmonale? 1,2,3

The right side of the heart pumps blood into the lungs. The blood travels though blood vessels to absorb oxygen from the millions of tiny air sacs in the lungs. The blood then carries the oxygen into the left side of the heart, where it is pumped through to the rest of the body.

Pulmonary hypertension happens when there is high blood pressure in the blood vessels of the lungs. Changes in the blood vessels make it harder for the blood to travel through them. This means that the heart has to work harder to pump blood through the vessels, which causes the blood pressure to be too high.

If it is not treated, this high blood pressure can cause a serious problem for the heart. Because the right side of the heart has to use much more effort to pump the blood into the lungs, that part of the heart can become over-worked, weakened, and enlarged.


Over time, pulmonary hypertension can lead to a kind of heart problem called cor pulmonale. This means that the right side of the heart is no longer able to pump enough blood into the lungs. As a result, the body is not able to absorb enough oxygen from the lungs.

How does cor pulmonale cause swelling in the ankles, legs and feet? 4

People with cor pulmonale do not have enough oxygen flowing through their body in their bloodstreams. Also, the heart is not able to pump the amount of blood through the body that is needed for organs like the liver and kidneys to function well.

In healthy people, the liver and kidneys help remove fluids from the body. But without enough blood supply, those organs are not able to do their usual jobs. This causes too much fluid to collect and build up in areas like the ankles, legs, and feet. These kinds of swelling are common symptoms of cor pulmonale.

How does COPD cause pulmonary hypertension and cor pulmonale? 3

People with COPD often get pulmonary hypertension that leads to cor pulmonale because of lung damage caused by chronic bronchitis and emphysema.

One of the symptoms of COPD is not having enough oxygen in the bloodstream. This can cause the blood vessels to become too narrow. COPD can also destroy the blood vessels that encircle the tiny air sacs in the lungs where oxygen is absorbed.

Both of these effects of COPD can cause pulmonary hypertension. This is because the heart has to work harder to push blood through:

  • Narrower blood vessels, and
  • Fewer blood vessels

If the pulmonary hypertension is not treated and gets worse, then it can cause cor pulmonale for people with COPD.

Pulmonary hypertension and cor pulmonale are common complications for people with all stages of COPD, but they become more common in the later stages of the disease.

Can swelling in the ankles, legs and feet be treated? 1

People with COPD should contact their healthcare providers if they have new or increased swelling in their ankles, legs and feet. It is important to treat pulmonary hypertension before it leads to cor pulmonale. Cor pulmonale can be a very harmful and life-threatening condition.

Pulmonary hypertension and cor pulmonale are commonly treated with oxygen therapy to increase the level of oxygen in the blood. During this kind of treatment, oxygen is often delivered through a soft tube that fits into the nostrils or through a mask over the mouth and nose.

There are also certain types of medicines that can help to:

  • Reduce swelling in the ankles, legs and feet
  • Help the heart beat more strongly
  • Thin the blood and reduced the risk of blood clots
Written by: Anna Nicholson | Last reviewed: July 2015.
View References