• Health & Fitness

Swimming-Induced Pulmonary Edema

Also known as Immersion Pulmonary Edema, this is a rare, but life-threatening condition that can affect swimmers.

The health benefits of swimming are at the heart of why we swim, yet, did you know that open water swimming can also put your health at risk?

And, no, we’re not talking about sharks.

Swimming-Induced Pulmonary Edema, or ‘SIPE’ as it is commonly called, is a rarely talked about condition that can affect swimmers.

While it is pretty rare, it’s being seen more and more among open water swimmers of all ages and fitness levels each year and it can be potentially life-threatening if not picked up quickly.

What is Swimming-Induced Pulmonary Edema (SIPE)?

SIPE is a potentially life-threatening condition caused when fluids collect and fill the lungs.

The small blood vessels (pulmonary capillaries) that line your lungs leak blood abnormally into the lung’s airspaces (alveoli).

Also known as Immersion Pulmonary Edema, this condition usually occurs during physical activity and exertion in water immersion such as swimming, scuba diving, snorkelling and free diving. However, it has been found that long-distance and cold water swimmers are at a higher risk of developing this condition.

Signs & Symptoms of SIPE

There are many symptoms of SIPE, however, the primary and most obvious symptom is a cough that brings up blood-tinged or frothy sputum (also known as phlegm), a thick type of mucus made in your lungs.

Other symptoms include:

  • Shortness of breath or rapid, heavy or uneven breathing
  • Uncontrollable coughing. This cough is usually distressing and can produce pink, frothy or blood-tinged sputum (originating in the lungs or bronchial tubes)
  • Confusion or irrational behaviour
  • Tightness or pain in the chest
  • Difficulty breathing at the surface
  • Crackles, rattling or junky feelings deep in your chest
  • Wheezing

Research has shown that 30% of people who have suffered from SIPE previously have experienced an episode again in the future. So, it’s important to know the signs and what to do when symptoms do appear.

If you experience any of these symptoms following a swim, it is recommended you visit your GP or emergency department for a diagnosis

Risk factors that can increase the risk of developing SIPE

SIPE can happen to anybody at any time during our much-loved sport of swimming but swimmers with pre-existing conditions or undertaking certain activities are at greater risk of developing SIPE.

  • Cardiac disease and high blood pressure
  • Increased stress and exertion during immersion
  • Immersion in cold water
  • Excessive pre-hydration before immersion
  • Antiplatelet agents such as aspirin or fish oil
  • Using a snorkel

Diagnosing SIPE

SIPE can only be diagnosed by a medical professional, although acute onset breathing problems during or following immersion, especially in cold water, is a major sign of developing SIPE.

Medical professionals will monitor symptoms, measure oxygen saturation and take chest x-rays among a range of tests they use to diagnose whether you have SIPE.

Managing SIPE

Managing symptoms of SIPE is extremely important to ensure it does not turn life-threatening or cause further complications.

Removal from the water immediately after suffering symptoms of SIPE will help start the process of reversing the hydrostatic effect of immersion and reduce the negative filling pressures.

Upon removal from water, if the swimmer is conscious it is recommended to keep them still while sitting in an upright position. This minimises exertion while helping to encourage the return of fluids to the lower extremities of the body.

It is also important to keep warm following removal from the water to help reduce peripheral vasoconstriction.

The majority of SIPE cases resolve rapidly within 48 hours of an episode. Although it is important to seek medical attention to ensure you don’t incur any complications and to gain advice on when it is safe to enter the water again.

  • Written by Ocean Swims on 1 September 2022
  • (Updated on 3 August 2023)

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