Understanding High Altitude Illnesses: Risks and Symptoms

People traveling to high altitudes for work or pleasure are increasing day by day. The rewards of such travel are generally at the risk of developing of one of several forms of acute altitude illnesses and/or worsening of underlying medical problems. The purpose of Physiology in Medicine is to provide physiologically-based information that can be used when counseling patients for these purposes. Symptoms of high altitude pulmonary oedema typically occurs two to three days after arrival at altitude and it comprises of dyspnoea with effort, progressing to dyspnoea at rest, a dry cough, weakness, and poor exercise tolerance.

If the disease worsens without treatment, severe dyspnoea and frank pulmonary oedema are obvious, with coma and death following.

Clinical signs in case the disease is detected early include tachycardia and tachypnoea, mild pyrexia, basal crepitations, and dependent oedema. Patients with high altitude pulmonary oedema tend to have lower oxygen saturations than unaffected people at the same altitude, but the degree of desaturation by itself is not a reliable sign of high altitude pulmonary oedema.

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High altitude pulmonary oedema rarely occurs below 2500 metres. Generally, residents of low altitudes are susceptible to HAPE if acutely exposed to HA. Some suffer from HAPE during the first exposure to HA while others remain unaffected and acclimatize well. The reported incidence of HAPE varies with altitude, rate of ascent, physical activity and altitude of residence. The incidence of HAPE amongst such previously unacclimatized subjects has been variously reported to range between about 0.01% and about 5%. Some of the combatants who had flown above 3300 m had an attack rate of 15%.

Most residents of low altitudes remain healthy on returning to HA after sojourns in the plains, but some suffer from HAPE during the reexposure to hypoxia. Pulmonary edema occurring after a period of adequate acclimatization at a stable altitude can sometimes be attributed to an exacerbating factor, such as sleeping medications, exceptional exertion, cold, pulmonary infection or excessive salt ingestion; these factors have not been studied in a controlled manner. The present study was undertaken in a hospital at 11500ft to get updated information on the wide clinical spectrum of patients of high altitude pulmonary edema.