Altitude Illness: Pulmonary Symptoms

Altitude Illness is a condition developed after having to ascent in a high altitude area. This illness is composed of variety of syndromes that results from loss of oxygen or hypoxia.  Altitude Illness can present with either cerebral or pulmonary symptoms. High – Altitude Cerebral Edema (HACE) and Acute Mountain Sickness (AMS) demonstrates cerebral symptoms or those that affect the brain. On the other hand, High – Altitude Pulmonary Edema (HAPE) presents pulmonary symptoms or that of the lung. There is no specific risk factor; anyone who is travelling in an altitude can be affected. No matter what the individual’s age, level of physical fitness, medical history or altitude experience is, one can acquire the illness.

Level of Altitude

High altitude – elevations over 1500 m (4900 ft)

  • Arterial oxygen saturation is maintained but with low PO2 that results in mild tissue hypoxia

Moderate altitude – elevations of 2000-3500 m (6600-11,500 ft)

  • Arterial oxygen saturation is maintained but with low PO2 that results in mild tissue hypoxia

Very high altitude – elevations of 3500-5500 m (11,500-18,000 ft)

  • Arterial oxygen saturation is not maintained and extreme hypoxemia can occur, especially during sleeping hours exercise
  • High – Altitude Pulmonary Edema (HAPE) is common in this altitude height

Extreme altitude – elevations over 5500 m

  • Body system declines and deteriorates

Manifestations

High – Altitude Pulmonary Edema (HAPE) takes place 2-4 days after a travel or rise in a high altitude area, and usually worsens at night. The Lake Louise Consensus definition of HAPE necessitates at least 2 of the following symptoms (in the context of a current elevation increase):

  1. Weakness
  2. Decreased exercise
  3. Cough (cough worsens and be productive)
  4. Dyspnea at rest (can be severe and harsh)
  5. Chest tightness or congestion
  6. Tachypnea
  7. Tachycardia
  8. Low-grade fever
  9. Drowsiness or other CNS symptoms

Assessment and Diagnosis

The following test and diagnostic procedures may confirm the presence of altitude illness or may rule out such.

  • Chest radiographs show patchy unilateral or bilateral fluffy infiltrates with a normal cardiac silhouette
  • Gram stain and culture (G/S, C/S) evaluate for conditions requiring antibiotic therapy

Management

The following regimen are the management available to treat altitude illness.

High – Altitude Pulmonary Edema (HAPE) can be treated when the symptoms become severe enough that it hampers the individual’s daily and accustomed activities.

Medications may include:

  • Carbonic anhydrase inhibitors
  • Calcium channel blockers (nifedipine)
  • Phosphodiesterase (type 5) enzyme inhibitor
  • Antitussives
  • Analgesics
  • Corticosteroid (dexamethasone)
  • Beta agonists

The following symptoms are indications of admission:

  • Arterial oxygen desaturation at rest
  • Dyspnea at rest
  • Inability to move down

For moderate-to-severe High – Altitude Pulmonary Edema (HAPE)

  • Rest
  • Oxygen
  • Medications as ordered

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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