When your doctor listens to your chest with a stethoscope, they’re checking for clues about how your heart and lungs are working. If they hear crackles (small popping sounds), it can be worrying.

Crackles do not usually mean your pulmonary hypertension (PH) is getting worse. Most of the time, crackles come from extra fluid in the lungs, often due to left-sided heart problems or a lung issue like pneumonia. People with PH can have crackles too, but crackles are a sign to look for the cause, not proof that PH is progressing.

This article explains what crackles are, common causes, and when to call your care team.

What Are Lung Crackles?

​​Lung crackles can mean you have fluid in the lungs. Liquid blockages in small airways can make crackling sounds. When you breathe in, those blockages or plugs rupture, making a popping or bubbling noise as the air pushes through.

When lung crackles are caused by fluid in the lungs, you may experience symptoms similar to those of pulmonary edema. This is a condition caused by excess fluid in the lungs. You may feel as though you’re running out of air, a condition called dyspnea. You may feel shortness of breath or like you’re suffocating or drowning, especially when lying down.

Crackles may also be produced without fluid in the lungs. In pulmonary fibrosis, scarring and thickening of the lung tissues occur. Crackles are produced when closed portions suddenly open and allow airflow.

“My lungs snap, crackle, and pop like Rice Krispies,” one myPHteam member said.

Lung crackles aren’t a distinct symptom of pulmonary hypertension. However, several diseases and conditions can cause lung crackles, including:

• Heart failure — Reduced heart pumping function causing fluid buildup in the lungs
• Pulmonary fibrosis — Scarring of lung tissue leading to breathing difficulty
• Chronic obstructive pulmonary disease (COPD) — Blocked airflow from conditions like emphysema or chronic bronchitis
• Bronchiectasis — Widened, damaged airways with persistent mucus and infections
• Bronchitis — Airway inflammation, often caused by infection or smoking
• Pneumonia — A lung infection causing fluid or pus in the air sacs
• Cystic fibrosis — An inherited condition causing thick mucus in the lungs and other organs

An experienced doctor can tell the difference between wet and dry lung crackles. The sound’s location helps determine whether the source is heart failure, pulmonary fibrosis, pneumonia, or another heart or lung condition.

A member of myPHteam with pulmonary fibrosis described seeing their primary care provider (PCP) because of lung crackles: “I saw my PCP yesterday about my edema, and he ordered a bunch of blood tests … and ordered a chest X-ray as he heard crackles in both of my lower lung lobes. (I have mild pulmonary fibrosis and lung scarring from interstitial lung disease.)”

Lung Crackles While Lying Down

If your lung crackles appear or get worse when you lie flat, it can reflect fluid shifting toward the lungs — often the same process that causes orthopnea (shortness of breath when lying down). Sitting up or propping yourself on pillows may ease symptoms, but you should tell your doctor, especially if the breathlessness is new or rapidly worse. Orthopnea is commonly linked to heart problems (like heart failure) as well as some lung conditions, so a checkup helps identify and treat the cause.

Do Lung Crackles Mean Your PH Is Getting Worse?

Pulmonary hypertension is high blood pressure in the arteries that bring blood from the right side of the heart to the lungs. PH is diagnosed when the mean pulmonary artery pressure is greater than 20 millimeters of mercury (mm Hg) at rest. Pulmonary hypertension is classified into types, including pulmonary arterial hypertension (PAH), based on what causes the condition.

Lung crackles don’t usually mean your PH is getting worse. Crackles most often point to fluid in the lungs (for example, from left-sided heart failure) or to a lung condition like infection or scarring.

If you have PH and your doctor hears crackles, they will first check for left-sided heart problems or lung disease.

If you have PH and your doctor hears crackles, they will first check for left-sided heart problems or lung disease.

What Your Healthcare Team May Do

Your provider will look at the whole picture of your health, not just a stethoscope finding. They may:

• Check your oxygen level, blood pressure, and weight
• Order tests like a chest X-ray, blood tests, or an echocardiogram
• Adjust medicines (for example, diuretics to remove extra fluid if you’re congested)

If they’re concerned your PH itself is changing, they might order more tests. An echocardiogram is a screening test. A right heart catheterization is the test that confirms PH and shows how severe it is.

When To Call for Help

Contact your care team urgently if you notice any of these signs:

• Sudden or worse shortness of breath, especially when lying flat
• Fast weight gain — for example, 2 to 3 pounds in a day or 5 pounds in a week
• New swelling in the feet, ankles, or belly
• Worsening cough or fever

Call emergency services if you have severe trouble breathing, chest pain, or fainting.

Treating Lung Crackles

Treatment for lung crackles depends on the underlying cause. Treating the cause of crackles — like heart congestion or a lung infection — often makes the sounds go away and helps you feel better. Managing PH with the plan your specialist gave you is still important, but remember, crackles are an indication to look for another problem, not a sure sign of PH progression.

Some common treatments for lung crackles include:

• Oxygen therapy to raise low oxygen levels
• Diuretics to reduce fluid levels
• Bronchodilators to relax the muscles and open the airways in conditions like COPD and asthma
• Inhaled corticosteroids to reduce inflammation in conditions like COPD and asthma
• Antibiotics to treat infections

In some cases, myPHteam members have discovered that their lung crackles go away with time and treatment.

“My pulmonologist didn’t hear any crackling or wheezing in my lungs today,” a myPHteam member shared. “It’s the first time that’s happened since 2016!”

Another member said, “My interstitial lung disease is improving, and there is no more crackling in my lungs.”

“My interstitial lung disease is improving, and there is no more crackling in my lungs.”

— A myPHteam member

If you have difficulty breathing or think you may have lung crackles with PH, talk to your healthcare provider. They can answer your questions, diagnose the underlying cause, and offer treatment suggestions to improve your quality of life.

Join the Conversation

On myPHteam, people share their experiences with pulmonary hypertension, get advice, and find support from others who understand.

Have you experienced lung crackles with PH? What has helped you manage this symptom? Let others know in the comments below.