Elite open-water swimmer racing in choppy water during a competitive event, illustrating conditions associated with Swimming-Induced Pulmonary Oedema (SIPE).
20 Feb 2026

Swimming-Induced Pulmonary Oedema (SIPE) – Adult, mild

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Understanding Your Condition

You were assessed today for Swimming-Induced Pulmonary Oedema (SIPE).

Though the concept has been suggested as early as 1989, SIPE remains uncommon, and the mechanisms are not well-understood, where fluid leaks from the small blood vessels in the lungs into the air spaces during swimming. This can cause sudden breathlessness, cough, chest tightness, and sometimes pink or blood-stained sputum.

It most often occurs in cold water, during intense effort, or when wearing tight wetsuits. It can affect very fit and experienced swimmers. The exact cause is still being researched.

Symptoms usually improve once you stop swimming and warm up, but careful monitoring is important because breathing problems can worsen in the short term.

The Rottnest Channel Swim, in partnership with the University of Western Australia (UWA) and the WA Department of Health have been heavily involved in researching this phenomenon. You may have seen their research teams at previous Rottnest Channel Swim events!

During your swim, you developed symptoms consistent with SIPE.

You were assessed as having a mild episode, and your oxygen levels were found to be stable enough for discharge.

Over the next 24–72 hours you may notice:

  • Mild shortness of breath on exertion
  • A dry or slightly productive cough
  • Chest tightness
  • Fatigue

These symptoms usually settle over several days.

It is not normal to develop:

  • Increasing breathlessness
  • Persistent low oxygen readings (if monitored)
  • Fever
  • Worsening chest pain

Symptoms can fluctuate slightly. Gradual improvement is expected.

SIPE is thought to occur when:

  • Cold water causes blood to shift from the limbs to the chest
  • Hard exertion increases pressure in the lung circulation
  • Tight wetsuits may further increase central blood volume

This combination can force fluid into the lung air spaces.

Importantly, SIPE is still being actively studied, and there is no single test that confirms it. Diagnosis is based on symptoms and clinical assessment.

  • Rest and avoid strenuous activity
  • Keep warm
  • Stay well hydrated
  • Avoid swimming until fully recovered
  • Do not return to open-water swimming until reviewed

If you were prescribed medication, take it as directed.

SIPE can recur. Recurrence rates reported in the literature vary.

You should arrange medical review before returning to:

  • Open-water swimming
  • Triathlon
  • Cold-water events
  • Military or endurance swim training

A GP or sports physician may consider:

  • Blood pressure assessment
  • Cardiac review
  • Lung imaging if needed

🚨 Call 000 or go to the nearest Emergency Department if…

  • You develop worsening shortness of breath
  • You cannot speak in full sentences
  • Your lips or fingers turn blue or grey
  • You cough up large amounts of blood
  • You develop severe chest pain
  • You feel faint or collapse
  • See your GP within 24–72 hours
  • Earlier review if symptoms persist beyond 3 days
  • Specialist referral if recurrent episodes occur

Do not return to competitive or open-water swimming without medical clearance.

Healthdirect Australia: 1800 022 222

Alternatively, contact your GP or local Emergency Department.

  • Wilmshurst PT, Nuri M, Crowther A, Webb-Peploe MM. Cold-induced pulmonary oedema in scuba divers and swimmers and subsequent development of hypertension. Lancet. 1989 Jan 14;1(8629):62-5. doi: 10.1016/s0140-6736(89)91426-8. PMID: 2562880.
  • Shupak A, Weiler-Ravell D, Adir Y, Daskalovic YI, Ramon Y, Kerem D. Pulmonary oedema induced by strenuous swimming: a field study. Respir Physiol. 2000 Jun;121(1):25-31. doi: 10.1016/s0034-5687(00)00109-2. PMID: 10854620.
  • Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6. doi: 10.1067/mem.2003.69. PMID: 12548277.
  • Adir Y, Shupak A, Gil A, Peled N, Keynan Y, Domachevsky L, Weiler-Ravell D. Swimming-induced pulmonary edema: clinical presentation and serial lung function. Chest. 2004 Aug;126(2):394-9. doi: 10.1378/chest.126.2.394. PMID: 15302723.
  • Moon RE, Martina SD, Peacher DF, Potter JF, Wester TE, Cherry AD, Natoli MJ, Otteni CE, Kernagis DN, White WD, Freiberger JJ. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016 Mar 8;133(10):988-96. doi: 10.1161/CIRCULATIONAHA.115.019464. Epub 2016 Feb 16. PMID: 26882910; PMCID: PMC5127690.

Evidence Base: Based on current Australian sports medicine and emergency medicine guidance, and contemporary literature on swimming-induced pulmonary oedema.

Version 1.0
Review Date: February 2027
Annual review cycle.

NB: This information has been prepared with reference to the most up to date Australian standards and guidance in relevant sports medicine fields. It is prepared in good faith, however is only intended for use as explicitly directed by a DeployED health practitioner. It does not replace medical advice, nor does it purport to be perfect. If you have any doubts about the advice here, please consult your own doctor. If you have not been sent here by us, then this is not for you and DeployED accepts no responsibility for any outcomes which come to pass from your use of this information.

Follow Dr Stuart McLay:

Emergency Physician

Dr Stuart McLay is passionate about the delivery of exceptional care, everywhere. He is the founder of DeployED, a Fellow of the Australasian College of Emergency Medicine (FACEM - an Emergency Physician), a Core trainee of the College for Intensive Care Medicine, and a Mass Gathering Medicine / Expedition Medicine enthusiast. He's also a husband to 1, and father to 3, and a great annoyance to many.