Chest
Volume 126, Issue 2, August 2004, Pages 394-399
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Clinical Investigations
AIRWAY EDEMA
Swimming-Induced Pulmonary Edema: Clinical Presentation and Serial Lung Function

https://doi.org/10.1378/chest.126.2.394Get rights and content

Background:

Acute pulmonary edema has been noted in swimmers and divers, and has been termed swimming-induced pulmonary edema (SIPE). The mechanisms and consequences of SIPE are unknown, and there are currently no series of carefully evaluated patients with this condition. Herein we report the clinical presentation, incidence of recurrence, findings on physical examination, chest radiography, and oxygen saturation in 70 trainees with a diagnosis of SIPE. We also report the results of forced spirometry in a subgroup of 37 swimmers.

Methods:

SIPE was diagnosed when severe shortness of breath and cough were reported during or after swimming, and were associated with evidence of pulmonary edema. During the years from 1998 to 2001, 70 cases of SIPE were documented in young healthy male subjects participating in a fitness-training program. Physical examination and pulse oximetry were performed immediately. Chest radiographs were obtained in all cases 12 to 18 h following onset of symptoms. In 37 swimmers, spirometry was performed at the time of chest radiography and again after 7 days.

Results:

All subjects complained of severe shortness of breath. Sixty-seven of the 70 subjects (95.7%) had a prominent cough; in 63 subjects (90%), there was significant sputum production. Hemoptysis was observed in 39 subjects (55.7%). Mean arterial oxygen saturation after swimming was 88.4 ± 6.6% breathing air, compared with 98 ± 1.7% breathing air at rest before the start of the swimming trial (mean ± SD) [p < 0.001]. Chest radiographs obtained 12 to 18 h after swimming were normal in all cases. Sixteen trainees (22.9%) had a recurrence of SIPE. Spirometry demonstrated restrictive lung function, which persisted for a week.

Conclusions:

In our trainee population, SIPE is a not uncommon, often recurrent phenomenon that significantly influences performance. It is not clear what predisposes to its occurrence or recurrence and what, if any, are its long-term effects.

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Materials and Methods

We prospectively examined participants in a swimming fitness-training program. The subjects were healthy, nonsmoking men aged 18 to 19 years. All were in good physical condition, and periodically took part in a swimming time trial over 2.4 to 3.6 kilometers in the open sea. The swimming trials were conducted while the sea was calm, and the average duration of the trial was usually between 30 min and 45 min. Subjects swam in the supine position wearing only a bathing suit, and using swim fins in

Results

Seventy cases of SIPE were diagnosed during a 3-year period (Table 1), an incidence of 1.8% for all the swimming trials performed by the trainees. All 70 subjects complained of severe shortness of breath, 67 subjects (95.7%) had a prominent cough, and 63 subjects (90%) had sputum production. Pink froth or hemoptysis was observed in 39 subjects (55.7%). Six subjects (8.6%) complained of substernal chest pain. Although 13 subjects (18.8%) reported a considerable amount of seawater in their mouths

Discussion

The occurrence of exercise-induced pulmonary hemorrhage in galloping thoroughbred racehorses is a well-known phenomenon18 that has been attributed to extremely high pulmonary vascular pressures. Alveolar hemorrhage in this setting is most likely due to stress failure of the pulmonary capillaries.5678910

In contrast with the findings in animal studies, such events are very rarely reported in athletes during or after intense exercise. Previous reports1920 described acute pulmonary edema or

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