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Gatterer H, Villafuerte FC, Ulrich S, Bhandari SS, Keyes LE, Burtscher M. Altitude illnesses. Nat Rev Dis Primers 2024; 10:43. [PMID: 38902312 DOI: 10.1038/s41572-024-00526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/22/2024]
Abstract
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
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Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria.
| | - Francisco C Villafuerte
- Laboratorio de Fisiología del Transporte de Oxígeno y Adaptación a la Altura - LID, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sanjeeb S Bhandari
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Emergency Department, UPMC Western Maryland Health, Cumberland, MD, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Wu Y, Zhao W, Liu B, Zhang J, Zhong Z, Zhou S, Xie J, Gao Y, Li P, Chen J. Assessment of Acute Mountain Sickness: Comparing the Chinese AMS Score to the Lake Louise Score. High Alt Med Biol 2024. [PMID: 38602430 DOI: 10.1089/ham.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Wu, Yu, Wenqi Zhao, Bao Liu, Jianyang Zhang, Zhifeng Zhong, Simin Zhou, Jiaxin Xie, Yuqi Gao, Peng Li, and Jian Chen. Assessment of Acute Mountain Sickness: Comparing the Chinese Ams Score to the Lake Louise Score. High Alt Med Biol 00:000-000, 2024. Objective: To compare the ability of the Chinese AMS Score (CAS) to detect acute mountain sickness (AMS) using the 2018 version of the Lake Louise Score (LLS) as reference. Methods: After flying from Chengdu (altitude: 500 m) to Lhasa (3,658 m), 2,486 young men completed a questionnaire. The questionnaire contained LLS and CAS items. An LLS ≥3 and/or a CAS ≥cutoff were used as the criteria for AMS. Hierarchical cluster analysis and two-step cluster analysis were used to investigate relationships between the symptoms. Results: AMS incidence rates were 33.8% (n = 840) with the LLS and 59.3% (n = 1,473) with the CAS (χ2 = 872.5, p < 0.001). The LLS and CAS had a linear relationship (orthogonal regression, Pearson r = 0.91, p < 0.001). With the LLS as the standard, the CAS had high diagnostic accuracy (area under the curve = 0.95, 95% confidence interval: 0.94-0.96). However, with the CAS, 25.5% (n = 633) more participants were labeled as having AMS than with the LLS (false positives). Two clusters were identified: one with headache only (419 participants, 66.2%) and one without headache but with other symptoms (214 participants, 33.8%). Reducing the weight of headache in the CAS allowed to align CAS and LLS. Conclusion: In comparison to the LLS, the CAS has a sensitivity close to 100% but lacks specificity given the high rate of false positives. The different weight of headaches may be the main reason for the discrepancy.
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Affiliation(s)
- Yu Wu
- Department of High Altitude Operational Medicine College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Wenqi Zhao
- Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Bao Liu
- Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Jianyang Zhang
- Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Zhifeng Zhong
- Department of High Altitude Operational Medicine College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Simin Zhou
- Department of High Altitude Operational Medicine College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Jiaxin Xie
- Department of High Altitude Operational Medicine College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Yuqi Gao
- Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Peng Li
- Department of High Altitude Operational Medicine College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
| | - Jian Chen
- Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, People's Republic of China
- High Altitude Medical Research Center, PLA, Army Medical University, Chongqing, People's Republic of China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education, Army Medical University, Chongqing, People's Republic of China
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Burtscher J, Swenson ER, Hackett PH, Millet GP, Burtscher M. Flying to high-altitude destinations: Is the risk of acute mountain sickness greater? J Travel Med 2023; 30:taad011. [PMID: 36694981 PMCID: PMC10289512 DOI: 10.1093/jtm/taad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/31/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Altitude sojourns increasingly attract individuals of all ages and different health statuses due to the appeal of high-altitude destinations worldwide and easy access to air travel. The risk of acute mountain sickness (AMS) when flying to high-altitude destinations remains underemphasized. Thus, this review aims to evaluate the altitude-dependent AMS incidence depending on the mode of ascending, e.g. by air vs terrestrial travel. METHODS A literature search was performed to identify the observational studies assessing AMS incidence after acute ascent of primarily healthy adults to real high altitude. In addition, placebo arms of interventional trials evaluating the prophylactic efficacy of various drugs have been separately analysed to confirm or refute the findings from the observational studies. Linear regression analyses were used to evaluate the altitude-dependent AMS incidence. RESULTS Findings of 12 observational studies, in which the AMS incidence in 11 021 individuals ascending to 19 different altitudes (2200-4559 m) was evaluated, revealed an impressive 4.5-fold steeper increase in the AMS incidence for air travel as compared with slower ascent modes, i.e. hiking or combined car and/or air travel and hiking. The higher AMS incidence following transportation by flight vs slower means was also confirmed in placebo-treated participants in 10 studies of drug prophylaxis against AMS. CONCLUSIONS Due to the short time span in going from low to high altitude, reduced acclimatization likely is the main reason for a higher AMS risk when travelling to high-altitude destinations by flight. To avoid frustrating travel experiences and health risks, appropriate and timely medical advice on how to prepare for air travel to high altitude is of vital importance. Effective preparation options include the use of modern pre-acclimatization strategies and pharmacological prophylaxis by acetazolamide or dexamethasone, or even considering alternate itineraries with more gradual ascent.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne 1015, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne 1005, Switzerland
| | - Erik R Swenson
- VA Puget Health Care System, University of Washington, Seattle, WA, USA
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne 1015, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne 1005, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Innsbruck A-6020, Austria
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Berendsen RR, Bärtsch P, Basnyat B, Berger MM, Hackett P, Luks AM, Richalet JP, Zafren K, Kayser B. Strengthening Altitude Knowledge: A Delphi Study to Define Minimum Knowledge of Altitude Illness for Laypersons Traveling to High Altitude. High Alt Med Biol 2022; 23:330-337. [PMID: 36201281 DOI: 10.1089/ham.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Berendsen, Remco R., Peter Bärtsch, Buddha Basnyat, Marc Moritz Berger, Peter Hackett, Andrew M. Luks, Jean-Paul Richalet, Ken Zafren, Bengt Kayser, and the STAK Plenary Group. Strengthening altitude knowledge: a Delphi study to define minimum knowledge of altitude illness for laypersons traveling to high altitude. High Alt Med Biol. 23:330-337, 2022. Introduction: A lack of knowledge among laypersons about the hazards of high-altitude exposure contributes to morbidity and mortality from acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) among high-altitude travelers. There are guidelines regarding the recognition, prevention, and treatment of acute-altitude illness for experts, but essential knowledge for laypersons traveling to high altitudes has not been defined. We sought expert consensus on the essential knowledge required for people planning to travel to high altitudes. Methods: The Delphi method was used. The panel consisted of two moderators, a core expert group and a plenary expert group. The moderators made a preliminary list of statements defining the desired minimum knowledge for laypersons traveling to high altitudes, based on the relevant literature. These preliminary statements were then reviewed, supplemented, and modified by a core expert group. A list of 33 statements was then presented to a plenary group of experts in successive rounds. Results: It took three rounds to reach a consensus. Of the 10 core experts invited, 7 completed all the rounds. Of the 76 plenary experts, 41 (54%) participated in Round 1, and of these 41 a total of 32 (78%) experts completed all three rounds. The final list contained 28 statements in 5 categories (altitude physiology, sleeping at altitude, AMS, HACE, and HAPE). This list represents an expert consensus on the desired minimum knowledge for laypersons planning high-altitude travel. Conclusion: Using the Delphi method, the STrengthening Altitude Knowledge initiative yielded a set of 28 statements representing essential learning objectives for laypersons who plan to travel to high altitudes. This list could be used to develop educational interventions.
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Affiliation(s)
- Remco R Berendsen
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter Bärtsch
- Department of Internal Medicine, University Hospital, Heidelberg, Germany
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
| | - Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, Essen University Hospital, University Duisburg-Essen, Duisburg, Germany
| | - Peter Hackett
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Altitude Research Center, University of Colorado, Aurora, Colorado, USA
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine. University of Washington, Seattle, Washington, USA
| | - Jean-Paul Richalet
- INSERM U1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Bobigny, France
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Bengt Kayser
- Institute of Sport Sciences (ISSUL), University of Lausanne, Switzerland
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