Table 1 Key considerations for the clinician addressing an athlete with probable swimming-induced pulmonary edema (SIPE)

Was it SIPE?

• Clinical features are non-specific and a variety of features (e.g. cough, crackles, desaturation) are present in two thirds cases.

• Symptoms occur in close temporal association with water immersion.

• Rapid resolution (usually complete < 48 h) appears to be a universal feature and may be of use in differentiating SIPE from aspiration.

• Chest radiograph/ultrasound evidence of pulmonary edema is informative.

• Obtain a full and thorough collateral history, including assessment of timing of onset of symptoms.

• Evaluate any chest imaging and blood results.

• Utilise logical investigations to rule out other differential diagnoses (e.g. bronchoprovocation testing, continuous laryngoscopy during exercise [18]).

Will it recur?

• Recurrence rates are variable (between 13 and 40%) but the condition can definitely recur.

• Counsel the athlete that there is a reasonable chance of recurrence and provide safety advice for both athlete and medical teams.

• Stepwise return to swimming.

What can be done to avoid/treat it?

• Several risk factors are recognised.

• Detection of underlying cardiorespiratory disease is important

• Rule out underlying cardiac or respiratory disease process, e.g. by arranging echocardiogram, blood pressure monitor, lung function + more detailed investigations as indicated.

• Avoid over-hydration, tight fitting wetsuits, fish oil and aspirin.

• Consider the use of oral sildenafil prior to exercise in selected and well-characterised cases. This medication is not prohibited currently.