Respiratory-Lymphatic Coupling in Edema: A Mechanism-Based Narrative Review and Clinical Framework

Background: Edema is a multifactorial clinical condition traditionally attributed to disturbances in vascular and lymphatic fluid dynamics. However, the contribution of respiratory mechanics to fluid regulation remains underrecognized. Objective: This narrative review explores the concept of respiratory-lymphatic coupling and its relevance to edema formation and persistence. Methods: Keyphysiological mechanisms linking breathing dynamics with lymphatic transport are examined, including the role of respiratory-induced pressure gradients and the thoracoabdominal pump in facilitating venous return and lymphatic flow. Disruption of these processes is discussed across clinical conditions where respiratory dysfunction and edema frequently coexist, such as chronic obstructive pulmonary disease, postoperative states and cardiorespiratory disorders. Results: Across these contexts, impaired respiratory mechanics may reduce lymphatic transport efficiency and contribute to fluid accumulation. Rather than representing a primary cause of edema, respiratory-lymphatic coupling is proposed as a modulatory mechanism influencing the severity and progression of fluid imbalance. Conclusions: Based on this conceptual framework, a mechanism-based approach to clinical decision-making is presented. This approach emphasizes identification of dominant pathophysiological drivers, assessment of physiological stability and individualized prioritization of therapeutic interventions. The integration of respiratory and lymphatic strategies is highlighted as a key component of management. These findings support a more integrated understanding of fluid homeostasis and suggest that incorporating respiratory considerations into edema management may enhance clinical outcomes.