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Ma J, Ma Y, Yi J, Lei P, Fang Y, Wang L, Liu F, Luo L, Zhang K, Jin L, Yang Q, Sun D, Zhang C, Wu D. Rapid altitude displacement induce zebrafish appearing acute high altitude illness symptoms. Heliyon 2024; 10:e28429. [PMID: 38590888 PMCID: PMC10999933 DOI: 10.1016/j.heliyon.2024.e28429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
Rapid ascent to high-altitude areas above 2500 m often leads to acute high altitude illness (AHAI), posing significant health risks. Current models for AHAI research are limited in their ability to accurately simulate the high-altitude environment for drug screening. Addressing this gap, a novel static self-assembled water vacuum transparent chamber was developed to induce AHAI in zebrafish. This study identified 6000 m for 2 h as the optimal condition for AHAI induction in zebrafish. Under these conditions, notable behavioral changes including slow movement, abnormal exploration behavior and static behavior in the Novel tank test. Furthermore, this model demonstrated changes in oxidative stress-related markers included increased levels of malondialdehyde, decreased levels of glutathione, decreased activities of superoxide dismutase and catalase, and increased levels of inflammatory markers IL-6, IL-1β and TNF-α, and inflammatory cell infiltration and mild edema in the gill tissue, mirroring the clinical pathophysiology observed in AHAI patients. This innovative zebrafish model not only offers a more accurate representation of the high-altitude environment but also provides a high-throughput platform for AHAI drug discovery and pathogenesis research.
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Affiliation(s)
- Jiahui Ma
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
- National and Local Joint Engineering Research Center of Ecological Treatment Technology of Urban Water Pollution, College of Life and Environmental Science, Wenzhou University, Wenzhou, 325035, China
| | - Yilei Ma
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Jia Yi
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Pengyu Lei
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Yimeng Fang
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Lei Wang
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, China
| | - Fan Liu
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Li Luo
- Affiliated Dongguang Hospital, Southern Medical University, Dongguang, 523059, China
| | - Kun Zhang
- Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Libo Jin
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
| | - Qinsi Yang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, China
| | - Da Sun
- Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou, 325000, China
- Zhejiang Provincial Key Laboratory for Water Environment and Marine Biological Resources Protection, College of Life and Environmental Science, Wenzhou University, Wenzhou, 325000, China
| | - Chi Zhang
- Department of Clinical Translational Research, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, China
| | - Dejun Wu
- Emergency Department, Quzhou People's Hospital, Quzhou, 324000, China
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Shen TC, Lin MC, Lin CL, Lin WH, Chuang BK. Acute mountain sickness on Jade Mountain: Results from the real-world practice (2018-2019). J Formos Med Assoc 2024:S0929-6646(24)00083-4. [PMID: 38331638 DOI: 10.1016/j.jfma.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/24/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
Acute mountain sickness (AMS) is initiated in response to a hypoxic and hypobaric environment at a high altitude. The precise prevalence of AMS in Jade Mountain climbers remained largely unknown, particularly data obtained from real medical consultations. An overnight stay at the Pai-Yun Lodge (3402 m) is usually required before an ascent of the Jade Mountain. Since 2004, a Pai-Yun Clinic has been established in the Pai-Yun Lodge. The Pai-Yun Clinic provided regular and emergency medical service every weekend. We conducted a retrospective study by using medical records from the Pai-Yun Clinic between 2018 and 2019. A total of 1021 patients were enrolled, with 56.2 % males. Different age groups were 3.2 %, 54.5 %, 37.9 %, and 4.4 % in <20, 20-39, 40-59, and ≥60 years, respectively. There were 582 (57.0 %) patients diagnosed to have AMS (230 [39.5 %] were mild type and 352 [60.5 %] were severe type). The factors associated with AMS development included young age, absence of climbing history (>3000 m) within the last 3 months, first climbing (>3000 m) experience, taking preventive medication, low oxygen saturation, and a high Lake Louise AMS score (LLAMSS). The factors associated with AMS severity included absence of taking preventive medication, low oxygen saturation, and a high LLAMSS. Approximately 15 % of Jade Mountain climbers needed medical service, of which 60 % had AMS. 60 % of patients with AMS must require oxygen supply or medication prescription. Oxygen saturation measure and LLAMSS evaluation are reasonable tools to predict the occurrence and severity of AMS on Jade Mountain.
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Affiliation(s)
- Te-Chun Shen
- Division of Critical Care Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Mei-Chen Lin
- Department of Nursing, Chu Shang Show Chwan Hospital, Nantou, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Ho Lin
- Management Office, Jade Mountain National Park, Nantou, Taiwan
| | - Bi-Kun Chuang
- Department of Otorhinolaryngology, Chu Shang Show Chwan Hospital, Nantou, Taiwan.
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Ramchandani R, Florica IT, Zhou Z, Alemi A, Baranchuk A. Review of Athletic Guidelines for High-Altitude Training and Acclimatization. High Alt Med Biol 2024. [PMID: 38207236 DOI: 10.1089/ham.2023.0042] [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: 01/13/2024] Open
Abstract
Ramchandani, Rashi, Ioana Tereza Florica, Zier Zhou, Aziz Alemi, and Adrian Baranchuk. Review of athletic guidelines for high-altitude training and acclimatization. High Alt Med Biol. 00:000-000, 2024. Introduction: Exposure to high altitude results in hypobaric hypoxia with physiological acclimatization changes that are thought to influence athletic performance. This review summarizes existing literature regarding implications of high-altitude training and altitude-related guidelines from major governing bodies of sports. Methods: A nonsystematic review was performed using PubMed and OVID Medline to identify articles regarding altitude training and guidelines from international governing bodies of various sports. Sports inherently involving training or competing at high altitude were excluded. Results: Important physiological compensatory mechanisms to high-altitude environments include elevations in blood pressure, heart rate, red blood cell mass, tidal volume, and respiratory rate. These responses can have varying effects on athletic performance. Governing sport bodies have limited and differing regulations for training and competition at high altitudes with recommended acclimatization periods ranging from 3 days to 3 weeks. Discussion: Physiological changes in response to high terrestrial altitude exposure can have substantial impacts on athletic performance. Major sport governing bodies have limited regulations and recommendations regarding altitude training and competition. Existing guidelines are variable and lack substantial evidence to support recommendations. Additional studies are needed to clarify the implications of high-altitude exposure on athletic ability to optimize training and competition.
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Affiliation(s)
- Rashi Ramchandani
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ioana Tereza Florica
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Zier Zhou
- Atherosclerosis, Genomics and Vascular Biology Division, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aziz Alemi
- Department of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
- Department of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
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Berger MM, Luks AM. High Altitude. Semin Respir Crit Care Med 2023; 44:681-695. [PMID: 37816346 DOI: 10.1055/s-0043-1770063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
With ascent to high altitude, barometric pressure declines, leading to a reduction in the partial pressure of oxygen at every point along the oxygen transport chain from the ambient air to tissue mitochondria. This leads, in turn, to a series of changes over varying time frames across multiple organ systems that serve to maintain tissue oxygen delivery at levels sufficient to prevent acute altitude illness and preserve cognitive and locomotor function. This review focuses primarily on the physiological adjustments and acclimatization processes that occur in the lungs of healthy individuals, including alterations in control of breathing, ventilation, gas exchange, lung mechanics and dynamics, and pulmonary vascular physiology. Because other organ systems, including the cardiovascular, hematologic and renal systems, contribute to acclimatization, the responses seen in these systems, as well as changes in common activities such as sleep and exercise, are also addressed. While the pattern of the responses highlighted in this review are similar across individuals, the magnitude of such responses often demonstrates significant interindividual variability which accounts for subsequent differences in tolerance of the low oxygen conditions in this environment.
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Affiliation(s)
- Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
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Small E, Juul N, Pomeranz D, Burns P, Phillips C, Cheffers M, Lipman GS. Predictive Capacity of Pulmonary Function Tests for Acute Mountain Sickness. High Alt Med Biol 2021; 22:193-200. [PMID: 33601996 DOI: 10.1089/ham.2020.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Small, Elan, Nicholas Juul, David Pomeranz, Patrick Burns, Caleb Phillips, Mary Cheffers, and Grant S. Lipman. Predictive capacity of pulmonary function tests for acute mountain sickness. High Alt Med Biol. 22: 193-200, 2021. Background: Pulmonary function as measured by spirometry has been investigated at altitude with heterogenous results, though data focused on spirometry and acute mountain sickness (AMS) are limited. The objective of this study was to investigate the capacity of pulmonary function tests (PFTs) to predict the development of AMS. Materials and Methods: This study was a blinded prospective observational study run during a randomized controlled trial comparing acetazolamide, budesonide, and placebo for AMS prevention on White Mountain, CA. Spirometry measurements of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow were taken at a baseline altitude of 1,250 m, and the evening of and morning after ascent to 3,810 m. Measurements were assessed for correlation with AMS. Results: One hundred three participants were analyzed with well-matched baseline demographics and AMS incidence of 75 (73%) and severe AMS of 48 (47%). There were no statistically significant associations between changes in mean spirometry values on ascent to high altitude with incidence of AMS or severe AMS. Lake Louise Questionnaire scores were negatively correlated with FVC (r = -0.31) and FEV1 (r = -0.29) the night of ascent. Baseline PFT had a predictive accuracy of 65%-73% for AMS, with a receiver operating characteristic of 0.51-0.65. Conclusions: Spirometry did not demonstrate statistically significant changes on ascent to high altitude, nor were there significant associations with incidence of AMS or severe AMS. Low-altitude spirometry did not accurately predict development of AMS, and it should not be recommended for risk stratification.
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Affiliation(s)
- Elan Small
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Juul
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder, Colorado, USA
| | - Mary Cheffers
- Department of Emergency Medicine, Keck School of Medicine, Los Angeles, California, USA
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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García I, Drobnic F, Javierre C, Pons V, Viscor G. Severe Hypoxic Exercise Does Not Impair Lung Diffusion in Elite Swimmers. High Alt Med Biol 2021; 22:90-95. [PMID: 33605802 DOI: 10.1089/ham.2020.0178] [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: 11/13/2022] Open
Abstract
García, Iker, Franchek Drobnic, Casimiro Javierre, Victoria Pons, and Ginés Viscor. Severe hypoxic exercise does not impair lung diffusion in elite swimmers. High Alt Med Biol. 22:90-95, 2021. Background: Exercise performed at high altitude may cause a subclinical pulmonary interstitial edema that can worsen gas exchange function. This study aimed to evaluate whether there are changes in alveolar-capillary diffusion after exercise during a short-term exposure to hypobaric hypoxia in elite swimmers. Materials and Methods: Seven elite swimmers (age: 20.4 ± 1.4 years, height: 1.78 ± 10.8 m, body mass: 69.7 ± 11.1 kg) participated in the study. Diffusing capacity of the lungs for carbon monoxide (DLCO), transfer coefficient of carbon monoxide, pulse oximeter oxygen saturation (SpO2), and heart rate (HR) were measured at sea level at rest (SL-R), and after a short-term hypobaric hypoxia exposure (4,000 m), both at rest (HA-R) and at the end of moderate interval exercise (HA-E). Results: The combined exposure to high altitude and exercise did not change DLCO from SL-R to HA-R, or HA-E (43.8 ± 9.8 to 41.3 ± 10.5 to 42.4 ± 8.6 ml minutes-1 mmHg-1, p = 0.391). As expected, elite swimmers showed large decrease in SpO2 (72 ± 5; p < 0.001) and increase in HR (139 ± 9 beats minutes-1; p < 0.003) after HA-E. Conclusions: An acute high-altitude exposure combined with submaximal exercise does not change alveolar-capillary diffusion in elite swimmers.
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Affiliation(s)
- Iker García
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Barcelona, Spain.,Departament de Fisiologia i Nutrició, Centre d'Alt Rendiment (CAR), Sant Cugat del Vallés, Barcelona, Spain
| | | | - Casimiro Javierre
- Departament de Ciències Fisiològiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Barcelona, Spain
| | - Victoria Pons
- Departament de Fisiologia i Nutrició, Centre d'Alt Rendiment (CAR), Sant Cugat del Vallés, Barcelona, Spain
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Barcelona, Spain
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Berger MM, Hackett PH, Bärtsch P. No Relevant Analogy Between COVID-19 and Acute Mountain Sickness. High Alt Med Biol 2020; 21:315-318. [PMID: 32970479 DOI: 10.1089/ham.2020.0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Berger, Marc Moritz, Peter H. Hackett, and Peter Bärtsch. No relevant analogy between COVID-19 and acute mountain sickness. High Alt Med Biol. 21:315-318, 2020.-Clinicians and scientists have suggested therapies for coronavirus disease-19 (COVID-19) that are known to be effective for other medical conditions. A recent publication suggests that pathophysiological mechanisms underlying acute mountain sickness (a syndrome of nonspecific neurological symptoms typically experienced by nonacclimatized individuals at altitudes >2500 m) may overlap with the mechanisms causing COVID-19. In this short review, we briefly evaluate this mistaken analogy and demonstrate that this concept is not supported by scientific evidence.
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Affiliation(s)
- Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter Bärtsch
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
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Sulaiman X, Xu WF, Cai LH, Huang XY, Cheng LF, Zhang YP. Hematologic and spirometric characteristics of Tajik and Kyrgyz highlanders in the Pamir Mountains. Am J Hum Biol 2020; 33:e23459. [PMID: 32643228 DOI: 10.1002/ajhb.23459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES In this study, we measured the hematologic and spirometric parameters of native Tajik and Kyrgyz highlanders in the Pamir Mountains to investigate adaptations to high altitude stressors. METHODS Hematological parameters including arterial oxygen saturation (SaO2 ), red blood cell (RBC) counts, and hemoglobin (Hb) concentration were measured on Sarikoli Tajik (n = 80; 3100 m), Wakhi Tajik (n = 48; 3500 m), and Kyrgyz (n = 64; 3250 m) in comparison to lowland Uyghurs (n = 50; 1300 m). Spirometric parameters including forced vital capacity (FVC), the first second of forced expiration (FEV1), and forced expiratory flow between 25% and 75% (FEF25-75) were measured. We also reported mountain sickness symptoms in these highlanders and conducted a multivariate regression analysis to analyze the association between these symptoms and the measured parameters. RESULTS SaO2 of Sarikoli Tajik, Wakhi Tajik, and Kyrgyz (91%-93.5%) are significantly lower than lowland Uyghurs, yet are comparable to other native highlanders at a similar altitude. RBC counts and Hb concentrations of all three highland populations are significantly increased compared to Uyghurs. FVC is lower in Sarikoli Tajik, Wakhi Tajik, and Kyrgyz (male: 3.48-3.86 L, female: 2.47-2.78 L) compared to Uyghurs. Combined with normal FEV1, elevated FEV1/FVC ratio, and FEF25-75, the spirometric patterns of these highlanders indicate restrictive lung disease. A high prevalence of mountain sickness symptoms such as headache and nausea was found in all three highland populations, and are attributed to low FVC and aging by regression analysis. CONCLUSION Tajik and Kyrgyz highlanders showed adaptation in SaO2 , RBC, and Hb level, but poor performance in spirometry, which causes mountain sickness.
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Affiliation(s)
- Xierzhatijiang Sulaiman
- Department of Pharmacology, School of Pharmacy, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wei-Fang Xu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | | | - Xiao-Yang Huang
- The People's Hospital of Shawan County, Shawan, Xinjiang, China
| | - Lu-Feng Cheng
- Department of Pharmacology, School of Pharmacy, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ya-Ping Zhang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,State Key Laboratory for Conservation and Utilization of Bio-Resources, Yunnan University, Kunming, Yunnan, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China.,KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, Yunnan, China
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Lung Diffusion in a 14-Day Swimming Altitude Training Camp at 1850 Meters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103501. [PMID: 32429560 PMCID: PMC7277217 DOI: 10.3390/ijerph17103501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
Abstract
Swimming exercise at sea level causes a transient decrease in lung diffusing capacity for carbon monoxide (DLCO). The exposure to hypobaric hypoxia can affect lung gas exchange, and hypoxic pulmonary vasoconstriction may elicit pulmonary oedema. The purpose of this study is to evaluate whether there are changes in DLCO during a 14-day altitude training camp (1850 m) in elite swimmers and the acute effects of a combined training session of swimming in moderate hypoxia and 44-min cycling in acute normobaric severe hypoxia (3000 m). Participants were eight international level swimmers (5 females and 3 males; 17–24 years old; 173.5 ± 5.5 cm; 64.4 ± 5.3 kg) with a training volume of 80 km per week. The single-breath method was used to measure the changes in DLCO and functional gas exchange parameters. No changes in DLCO after a 14-day altitude training camp at 1850 m were detected but a decrease in alveolar volume (VA; 7.13 ± 1.61 vs. 6.50 ± 1.59 L; p = 0.005; d = 0.396) and an increase in the transfer coefficient of the lung for carbon monoxide (KCO; 6.23 ± 1.03 vs. 6.83 ± 1.31 mL·min−1·mmHg−1·L−1; p = 0.038; d = 0.509) after the altitude camp were observed. During the acute hypoxia combined session, there were no changes in DLCO after swimming training at 1850 m, but there was a decrease in DLCO after cycling at a simulated altitude of 3000 m (40.6 ± 10.8 vs. 36.8 ± 11.2 mL·min−1·mmHg−1; p = 0.044; d = 0.341). A training camp at moderate altitude did not alter pulmonary diffusing capacity in elite swimmers, although a cycling session at a higher simulated altitude caused a certain degree of impairment of the alveolar–capillary gas exchange.
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Lim R, Ma IWY, Brutsaert TD, Nysten HE, Nysten CN, Sherpa MT, Day TA. Transthoracic sonographic assessment of B-line scores during ascent to altitude among healthy trekkers. Respir Physiol Neurobiol 2019; 263:14-19. [PMID: 30794965 DOI: 10.1016/j.resp.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
Sonographic B-lines can indicate pulmonary interstitial edema. We sought to determine the incidence of subclinical pulmonary edema measured by sonographic B-lines among lowland trekkers ascending to high altitude in the Nepal Himalaya. Twenty healthy trekkers underwent portable sonographic examinations and arterial blood draws during ascent to 5160 m over ten days. B-lines were identified in twelve participants and more frequent at 4240 m and 5160 m compared to lower altitudes (P < 0.03). There was a strong negative correlation between arterial oxygen saturation and the number of B-lines at 5160 m (ρ = -0.75, P = 0.008). Our study contributes to the growing body of literature demonstrating the development of asymptomatic pulmonary edema during ascent to high altitude. Portable lung sonography may have utility in fieldwork contexts such as trekking at altitude, but further research is needed in order to clarify its potential clinical applicability.
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Affiliation(s)
- Rachel Lim
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Irene W Y Ma
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tom D Brutsaert
- Department of Exercise Science and Anthropology, Syracuse University, New York, USA
| | | | - Cassandra N Nysten
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | | | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
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Furian M, Flueck D, Latshang TD, Scheiwiller PM, Segitz SD, Mueller-Mottet S, Murer C, Steiner A, Ulrich S, Rothe T, Kohler M, Bloch KE. Exercise performance and symptoms in lowlanders with COPD ascending to moderate altitude: randomized trial. Int J Chron Obstruct Pulmon Dis 2018; 13:3529-3538. [PMID: 30464436 PMCID: PMC6208550 DOI: 10.2147/copd.s173039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective To evaluate the effects of altitude travel on exercise performance and symptoms in lowlanders with COPD. Design Randomized crossover trial. Setting University Hospital Zurich (490 m), research facility in mountain villages, Davos Clavadel (1,650 m) and Davos Jakobshorn (2,590 m). Participants Forty COPD patients, Global Initiative for Obstructive Lung Disease (GOLD) grade 2–3, living below 800 m, median (quartiles) age 67 y (60; 69), forced expiratory volume in 1 second 57% predicted (49; 70). Intervention Two-day sojourns at 490 m, 1,650 m, and 2,590 m in randomized order. Outcome measures Six-minute walk distance (6MWD), cardiopulmonary exercise tests, symptoms, and other health effects. Results At 490 m, days 1 and 2, median (quartiles) 6MWD were 558 m (477; 587) and 577 m (531; 629). At 2,590 m, days 1 and 2, mean changes in 6MWD from corresponding day at 490 m were −41 m (95% CI −51 to −31) and −40 m (−53 to −27), n=40, P<0.05, both changes. At 1,650 m, day 1, 6MWD had changed by −22 m (−32 to −13), maximal oxygen uptake during bicycle exercise by −7% (−13 to 0) vs 490 m, P<0.05, both changes. At 490 m, 1,650 m, and 2,590 m, day 1, resting PaO2 were 9.0 (8.4; 9.4), 8.1 (7.5; 8.6), and 6.8 (6.3; 7.4) kPa, respectively, P<0.05 higher altitudes vs 490 m. While staying at higher altitudes, nine patients (24%) experienced symptoms or adverse health effects requiring oxygen therapy or relocation to lower altitude. Conclusion During sojourns at 1,650 m and 2,590 m, lowlanders with moderate to severe COPD experienced a mild reduction in exercise performance and nearly one quarter required oxygen therapy or descent to lower altitude because of adverse health effects. The findings may help to counsel COPD patients planning altitude travel. Registration ClinicalTrials.gov: NCT01875133
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Affiliation(s)
- Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Deborah Flueck
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Tsogyal D Latshang
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Philipp M Scheiwiller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | | | | | - Christian Murer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Adrian Steiner
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Thomas Rothe
- Zuercher RehaZentrum Davos, Davos Clavadel, Switzerland
| | - Malcolm Kohler
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland,
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Cross TJ, Wheatley C, Stewart GM, Coffman K, Carlson A, Stepanek J, Morris NR, Johnson BD. The influence of thoracic gas compression and airflow density dependence on the assessment of pulmonary function at high altitude. Physiol Rep 2018; 6:e13576. [PMID: 29595881 PMCID: PMC5875542 DOI: 10.14814/phy2.13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022] Open
Abstract
The purpose of this report was to illustrate how thoracic gas compression (TGC) artifact, and differences in air density, may together conflate the interpretation of changes in the forced expiratory flows (FEFs) at high altitude (>2400 m). Twenty-four adults (10 women; 44 ± 15 year) with normal baseline pulmonary function (>90% predicted) completed a 12-day sojourn at Mt. Kilimanjaro. Participants were assessed at Moshi (Day 0, 853 m) and at Barafu Camp (Day 9, 4837 m). Typical maximal expiratory flow-volume (MEFV) curves were obtained in accordance with ATS/ERS guidelines, and were either: (1) left unadjusted; (2) adjusted for TGC by constructing a "maximal perimeter" MEFV curve; or (3) adjusted for both TGC and differences in air density between altitudes. Forced vital capacity (FVC) was lower at Barafu compared with Moshi camp (5.19 ± 1.29 L vs. 5.40 ± 1.45 L, P < 0.05). Unadjusted data indicated no difference in the mid-expiratory flows (FEF25-75% ) between altitudes (∆ + 0.03 ± 0.53 L sec-1 ; ∆ + 1.2 ± 11.9%). Conversely, TGC-adjusted data revealed that FEF25-75% was significantly improved by sojourning at high altitude (∆ + 0.58 ± 0.78 L sec-1 ; ∆ + 12.9 ± 16.5%, P < 0.05). Finally, when data were adjusted for TGC and air density, FEFs were "less than expected" due to the lower air density at Barafu compared with Moshi camp (∆-0.54 ± 0.68 L sec-1 ; ∆-10.9 ± 13.0%, P < 0.05), indicating a mild obstructive defect had developed on ascent to high altitude. These findings clearly demonstrate the influence that TGC artifact, and differences in air density, bear on flow-volume data; consequently, it is imperative that future investigators adjust for, or at least acknowledge, these confounding factors when comparing FEFs between altitudes.
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Affiliation(s)
- Troy J. Cross
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | | | - Glenn M. Stewart
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | - Kirsten Coffman
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| | - Alex Carlson
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| | - Jan Stepanek
- Preventive, Occupational and Aerospace MedicineMayo ClinicScottsdaleArizona
| | - Norman R. Morris
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Bruce D. Johnson
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
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Berger MM, Macholz F, Schmidt P, Fried S, Perz T, Dankl D, Niebauer J, Bärtsch P, Mairbäurl H, Sareban M. Inhaled Budesonide Does Not Affect Hypoxic Pulmonary Vasoconstriction at 4559 Meters of Altitude. High Alt Med Biol 2018; 19:52-59. [PMID: 29298124 DOI: 10.1089/ham.2017.0113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Berger, Marc Moritz, Franziska Macholz, Peter Schmidt, Sebastian Fried, Tabea Perz, Daniel Dankl, Josef Niebauer, Peter Bärtsch, Heimo Mairbäurl, and Mahdi Sareban. Inhaled budesonide does not affect hypoxic pulmonary vasoconstriction at 4559 meters of altitude. High Alt Med Biol 19:52-59, 2018.-Oral intake of the corticosteroid dexamethasone has been shown to lower pulmonary artery pressure (PAP) and to prevent high-altitude pulmonary edema. This study tested whether inhalation of the corticosteroid budesonide attenuates PAP and right ventricular (RV) function after rapid ascent to 4559 m. In this prospective, randomized, double-blind, and placebo-controlled trial, 50 subjects were randomized into three groups to receive budesonide at 200 or 800 μg twice/day (n = 16 and 17, respectively) or placebo (n = 17). Inhalation was started 1 day before ascending from 1130 to 4559 m within 20 hours. Systolic PAP (SPAP) and RV function were assessed by transthoracic echocardiography at low altitude (423 m) and after 7, 20, 32, and 44 hours at 4559 m. Ascent to high altitude increased SPAP about 1.7-fold (p < 0.001), whereas RV function was preserved. There was no difference in SPAP and RV function between groups at low and high altitude (all p values >0.10). Capillary partial pressure of oxygen (PO2) and carbon dioxide as well as the alveolar to arterial PO2 difference were decreased at high altitude but not affected by budesonide. Prophylactic inhalation of budesonide does not attenuate high-altitude-induced pulmonary vasoconstriction and RV function after rapid ascent to 4559 m.
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Affiliation(s)
- Marc Moritz Berger
- 1 Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University , Salzburg, Austria .,2 Department of Anesthesiology, University Hospital Heidelberg , Heidelberg, Germany
| | - Franziska Macholz
- 1 Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University , Salzburg, Austria
| | - Peter Schmidt
- 1 Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University , Salzburg, Austria
| | - Sebastian Fried
- 3 Division of Sports Medicine, Department of Internal Medicine VII, University Hospital Heidelberg , Heidelberg, Germany
| | - Tabea Perz
- 4 University Institute of Sports Medicine, Prevention and Rehabilitation; Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University , Salzburg, Austria
| | - Daniel Dankl
- 1 Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University , Salzburg, Austria
| | - Josef Niebauer
- 4 University Institute of Sports Medicine, Prevention and Rehabilitation; Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University , Salzburg, Austria
| | - Peter Bärtsch
- 3 Division of Sports Medicine, Department of Internal Medicine VII, University Hospital Heidelberg , Heidelberg, Germany
| | - Heimo Mairbäurl
- 3 Division of Sports Medicine, Department of Internal Medicine VII, University Hospital Heidelberg , Heidelberg, Germany .,5 Translational Lung Research Center (TLRC), German Center for Lung Research (DZL) , Heidelberg, Germany
| | - Mahdi Sareban
- 4 University Institute of Sports Medicine, Prevention and Rehabilitation; Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University , Salzburg, Austria
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14
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Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev 2017; 26:26/143/160096. [PMID: 28143879 PMCID: PMC9488514 DOI: 10.1183/16000617.0096-2016] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/23/2016] [Indexed: 12/28/2022] Open
Abstract
At any point 1–5 days following ascent to altitudes ≥2500 m, individuals are at risk of developing one of three forms of acute altitude illness: acute mountain sickness, a syndrome of nonspecific symptoms including headache, lassitude, dizziness and nausea; high-altitude cerebral oedema, a potentially fatal illness characterised by ataxia, decreased consciousness and characteristic changes on magnetic resonance imaging; and high-altitude pulmonary oedema, a noncardiogenic form of pulmonary oedema resulting from excessive hypoxic pulmonary vasoconstriction which can be fatal if not recognised and treated promptly. This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, we describe the current pharmacological and nonpharmacological approaches to the prevention and treatment of these diseases. Lack of acclimatisation is the main risk factor for acute altitude illness; descent is the optimal treatmenthttp://ow.ly/45d2305JyZ0
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Affiliation(s)
- Andrew M Luks
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Erik R Swenson
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA.,Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Peter Bärtsch
- Dept of Internal Medicine, University Clinic Heidelberg, Heidelberg, Germany
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15
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Soria R, Egger M, Scherrer U, Bender N, Rimoldi SF. Pulmonary artery pressure and arterial oxygen saturation in people living at high or low altitude: systematic review and meta-analysis. J Appl Physiol (1985) 2016; 121:1151-1159. [PMID: 27660297 DOI: 10.1152/japplphysiol.00394.2016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/02/2016] [Accepted: 09/21/2016] [Indexed: 02/08/2023] Open
Abstract
More than 140 million people are living at high altitude worldwide. An increase of pulmonary artery pressure (PAP) is a hallmark of high-altitude exposure and, if pronounced, may be associated with important morbidity and mortality. Surprisingly, there is little information on the usual PAP in high-altitude populations. We, therefore, conducted a systematic review (MEDLINE and EMBASE) and meta-analysis of studies published (in English or Spanish) between 2000 and 2015 on echocardiographic estimations of PAP and measurements of arterial oxygen saturation in apparently healthy participants from general populations of high-altitude dwellers (>2,500 m). For comparison, we similarly analyzed data published on these variables during the same period for populations living at low altitude. Twelve high-altitude studies comprising 834 participants and 18 low-altitude studies (710 participants) fulfilled the inclusion criteria. All but one high-altitude studies were performed between 3,600 and 4,350 m. The combined mean systolic PAP (right ventricular-to-right atrial pressure gradient) at high altitude [25.3 mmHg, 95% confidence interval (CI) 24.0, 26.7], as expected was significantly (P < 0.001) higher than at low altitude (18.4 mmHg, 95% CI 17.1,19.7), and arterial oxygen saturation was significantly lower (90.4%, 95% CI 89.3, 91.5) than at low altitude (98.1%; 95% CI 97.7, 98.4). These findings indicate that at an altitude where the very large majority of high-altitude populations are living, pulmonary hypertension appears to be rare. The reference values and distributions for PAP and arterial oxygen saturation in apparently healthy high-altitude dwellers provided by this meta-analysis will be useful to future studies on the adjustments to high altitude in humans.
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Affiliation(s)
- Rodrigo Soria
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Urs Scherrer
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Switzerland.,Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile; and
| | - Nicole Bender
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.,Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Switzerland;
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16
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Luks AM. Physiology in Medicine: A physiologic approach to prevention and treatment of acute high-altitude illnesses. J Appl Physiol (1985) 2014; 118:509-19. [PMID: 25539941 DOI: 10.1152/japplphysiol.00955.2014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
With the growing interest in adventure travel and the increasing ease and affordability of air, rail, and road-based transportation, increasing numbers of individuals are traveling to high altitude. The decline in barometric pressure and ambient oxygen tensions in this environment trigger a series of physiologic responses across organ systems and over a varying time frame that help the individual acclimatize to the low oxygen conditions but occasionally lead to maladaptive responses and one or several forms of acute altitude illness. The goal of this Physiology in Medicine article is to provide information that providers can use when counseling patients who present to primary care or travel medicine clinics seeking advice about how to prevent these problems. After discussing the primary physiologic responses to acute hypoxia from the organ to the molecular level in normal individuals, the review describes the main forms of acute altitude illness--acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema--and the basic approaches to their prevention and treatment of these problems, with an emphasis throughout on the physiologic basis for the development of these illnesses and their management.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington Seattle, Washington
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17
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Zheng CR, Chen GZ, Yu J, Qin J, Song P, Bian SZ, Xu BD, Tang XG, Huang YT, Liang X, Yang J, Huang L. Inhaled budesonide and oral dexamethasone prevent acute mountain sickness. Am J Med 2014; 127:1001-1009.e2. [PMID: 24784698 DOI: 10.1016/j.amjmed.2014.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND This double-blind, randomized controlled trial aimed to investigate inhaled budesonide and oral dexamethasone compared with placebo for their prophylactic efficacy against acute mountain sickness after acute high-altitude exposure. METHODS There were 138 healthy young male lowland residents recruited and randomly assigned to receive inhaled budesonide (200 μg, twice a day [bid]), oral dexamethasone (4 mg, bid), or placebo (46 in each group). They traveled to 3900 m altitude from 400 m by car. Medication started 1 day before high-altitude exposure and continued until the third day of exposure. Primary outcome measure was the incidence of acute mountain sickness after exposure. RESULTS One hundred twenty-four subjects completed the study (42, 39, and 43 in the budesonide, dexamethasone, and placebo groups, respectively). Demographic characteristics were comparable among the 3 groups. After high-altitude exposure, significantly fewer participants in the budesonide (23.81%) and dexamethasone (30.77%) groups developed acute mountain sickness compared with participants receiving placebo (60.46%) (P = .0006 and P = .0071, respectively). Both the budesonide and dexamethasone groups had lower heart rate and higher pulse oxygen saturation (SpO2) than the placebo group at altitude. Only the budesonide group demonstrated less deterioration in forced vital capacity and sleep quality than the placebo group. Four subjects in the dexamethasone group reported adverse reactions. CONCLUSIONS Both inhaled budesonide (200 μg, bid) and oral dexamethasone (4 mg, bid) were effective for the prevention of acute mountain sickness, especially its severe form, compared with placebo. Budesonide caused fewer adverse reactions than dexamethasone.
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Affiliation(s)
- Cheng-Rong Zheng
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guo-Zhu Chen
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Jie Yu
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Jun Qin
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Pan Song
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Zhu Bian
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Bai-Da Xu
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xu-Gang Tang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yong-Tao Huang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiao Liang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China.
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18
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The lungs in acute mountain sickness: victim, perpetrator, or both? Am J Med 2014; 127:899-900. [PMID: 24950487 DOI: 10.1016/j.amjmed.2014.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/23/2022]
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Abstract
High-altitude pulmonary edema (HAPE), a not uncommon form of acute altitude illness, can occur within days of ascent above 2500 to 3000 m. Although life-threatening, it is avoidable by slow ascent to permit acclimatization or with drug prophylaxis. The critical pathophysiology is an excessive rise in pulmonary vascular resistance or hypoxic pulmonary vasoconstriction (HPV) leading to increased microvascular pressures. The resultant hydrostatic stress causes dynamic changes in the permeability of the alveolar capillary barrier and mechanical injurious damage leading to leakage of large proteins and erythrocytes into the alveolar space in the absence of inflammation. Bronchoalveolar lavage and hemodynamic pressure measurements in humans confirm that elevated capillary pressure induces a high-permeability noninflammatory lung edema. Reduced nitric oxide availability and increased endothelin in hypoxia are the major determinants of excessive HPV in HAPE-susceptible individuals. Other hypoxia-dependent differences in ventilatory control, sympathetic nervous system activation, endothelial function, and alveolar epithelial active fluid reabsorption likely contribute additionally to HAPE susceptibility. Recent studies strongly suggest nonuniform regional hypoxic arteriolar vasoconstriction as an explanation for how HPV occurring predominantly at the arteriolar level causes leakage. In areas of high blood flow due to lesser HPV, edema develops due to pressures that exceed the dynamic and structural capacity of the alveolar capillary barrier to maintain normal fluid balance. This article will review the pathophysiology of the vasculature, alveolar epithelium, innervation, immune response, and genetics of the lung at high altitude, as well as therapeutic and prophylactic strategies to reduce the morbidity and mortality of HAPE.
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Affiliation(s)
- Erik R Swenson
- VA Puget Sound Health Care System, Department of Medicine, University of Washington, Seattle, Washington, USA.
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20
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van Ooij PJAM, Hollmann MW, van Hulst RA, Sterk PJ. Assessment of pulmonary oxygen toxicity: relevance to professional diving; a review. Respir Physiol Neurobiol 2013; 189:117-28. [PMID: 23886638 DOI: 10.1016/j.resp.2013.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/07/2023]
Abstract
When breathing oxygen with partial oxygen pressures PO₂ of between 50 and 300 kPa pathological pulmonary changes develop after 3-24h depending on the PO₂. This kind of injury (known as pulmonary oxygen toxicity) is not only observed in ventilated patients but is also considered an occupational hazard in oxygen divers or mixed gas divers. To prevent these latter groups from sustaining irreversible lesions adequate prevention is required. This review summarizes the pathophysiological effects on the respiratory tract when breathing oxygen with PO₂ of 50-300 kPa (hyperoxia). We discuss to what extent the most commonly used lung function parameters change after exposure to hyperoxia and its role in monitoring the onset and development of pulmonary oxygen toxicity in daily practice. Finally, new techniques in respiratory medicine are discussed with regard to their usefulness in monitoring pulmonary oxygen toxicity in divers.
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Affiliation(s)
- P J A M van Ooij
- Diving Medical Center, Royal Netherlands Navy, The Netherlands; Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.
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21
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Bouzat P, Walther G, Rupp T, Doucende G, Payen JF, Levy P, Verges S. Time course of asymptomatic interstitial pulmonary oedema at high altitude. Respir Physiol Neurobiol 2013; 186:16-21. [DOI: 10.1016/j.resp.2012.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/20/2012] [Accepted: 12/11/2012] [Indexed: 12/21/2022]
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Clarenbach CF, Senn O, Christ AL, Fischler M, Maggiorini M, Bloch KE. Lung function and breathing pattern in subjects developing high altitude pulmonary edema. PLoS One 2012; 7:e41188. [PMID: 22829927 PMCID: PMC3400591 DOI: 10.1371/journal.pone.0041188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/18/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction The purpose of the study was to comprehensively evaluate physiologic changes associated with development of high altitude pulmonary edema (HAPE). We tested whether changes in pulmonary function and breathing pattern would herald clinically overt HAPE at an early stage. Methods In 18 mountaineers, spirometry, diffusing capacity, nitrogen washout, nocturnal ventilation and pulse oximetry were recorded at 490 m and during 3 days after rapid ascent to 4559 m. Findings were compared among subjects developing HAPE and those remaining well (controls). Results In 8 subjects subsequently developing radiographically documented HAPE at 4559 m, median FVC declined to 82% of low altitude baseline while closing volume increased to 164% of baseline (P<0.05, both instances). In 10 controls, FVC decreased slightly (to 93% baseline, P<0.05) but significantly less than in subjects with HAPE and closing volume remained unchanged. Sniff nasal pressure was reduced in both subjects with and without subsequent HAPE. During nights at 4559 m, mean nocturnal oxygen saturation dropped to lower values while minute ventilation, the number of periodic breathing cycles and heart rate were higher (60%; 8.6 L/min; 97 cycles/h; 94 beats/min, respectively) in subjects subsequently developing HAPE than in controls (73%; 5.1 L/min; 48 cycles/h; 79 beats/min; P<0.05 vs. HAPE, all instances). Conclusion The results comprehensively represent the pattern of physiologic alterations that precede overt HAPE. The changes in lung function are consistent with reduced lung compliance and impaired gas exchange. Pronounced nocturnal hypoxemia, ventilatory control instability and sympathetic stimulation are further signs of subsequent overt HAPE. Registration ClinicalTrials.gov identifier: NCT00274430
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Affiliation(s)
| | - Oliver Senn
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | | | - Manuel Fischler
- Medical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland
| | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland
- Center for Human Integrative Physiology, University of Zurich, Zurich, Switzerland
| | - Konrad E. Bloch
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
- Center for Human Integrative Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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23
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Seccombe LM, Rogers PG, Jenkins CR, Peters MJ. Maintenance of vital capacity during repetitive breath-hold in a spearfishing competition. Respirology 2012; 17:350-3. [PMID: 22008376 DOI: 10.1111/j.1440-1843.2011.02090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cough and a reduction in vital capacity have recently been reported following breath-hold dives to depths of 25-75 m. We sought to investigate whether repetitive dives to depths of less than 30 m would elicit similar effects. METHODS Participants in a single-day spearfishing competition were recruited. Subjects performed spirometry before and after the 5-h event. Demographics, medical and diving history, respiratory symptoms and competition diving statistics were collected. RESULTS Twenty-five subjects (two females), age 33 years (11) (mean (SD)), were studied. During the competition each subject completed 76 (33) dives, to 10 (3) m depth, with each dive lasting 0.9 (0.3) min. Maximum depth was 17 (4) m. No respiratory symptoms were reported. There was no difference in spirometry before and after competition except for FEF(25-75%), which increased by 0.16(0.34) L (P < 0.05). CONCLUSIONS Pulmonary oedema or lung injury is not common after repetitive breath-hold diving to depths to 25 m, or is too mild to be reflected in symptoms or spirometry.
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Affiliation(s)
- Leigh M Seccombe
- Australian School of Advanced Medicine, Macquarie University, Australia.
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24
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Latshang TD, Turk AJ, Hess T, Schoch OD, Bosch MM, Barthelmes D, Merz TM, Hefti U, Hefti JP, Maggiorini M, Bloch KE. Acclimatization improves submaximal exercise economy at 5533 m. Scand J Med Sci Sports 2011; 23:458-67. [PMID: 22093058 DOI: 10.1111/j.1600-0838.2011.01403.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 11/28/2022]
Abstract
We tested whether the better subjective exercise tolerance perceived by mountaineers after altitude acclimatization relates to enhanced exercise economy. Thirty-two mountaineers performed progressive bicycle exercise to exhaustion at 490 m and twice at 5533 m (days 6-7 and day 11), respectively, during an expedition to Mt. Muztagh Ata. Maximal work rate (W(max)) decreased from mean ± SD 356 ± 73 watts at 490 m to 191 ± 49 watts and 193 ± 45 watts at 5533 m, days 6-7 and day 11, respectively; corresponding maximal oxygen uptakes (VO2max ) were 50.7 ± 9.5, 26.3 ± 5.6, 24.7 ± 7.0 mL/min/kg (P = 0.0001 5533 m vs 490 m). On days 6-7 (5533 m), VO(2) at 75% W(max) (152 ± 37 watts) was 1.75 ± 0.45 L/min, oxygen saturation 68 ± 8%. On day 11 (5533 m), at the same submaximal work rate, VO(2) was lower (1.61 ± 0.47 L/min, P < 0.027) indicating improved net efficiency; oxygen saturation was higher (74 ± 7%, P < 0.0004) but ratios of VO(2) to work rate increments remained unchanged. On day 11, mountaineers climbed faster from 4497 m to 5533 m than on days 5-6 but perceived less effort (visual analog scale 50 ± 15 vs 57 ± 20, P = 0.006) and reduced symptoms of acute mountain sickness. We conclude that the better performance and subjective exercise tolerance after acclimatization were related to regression of acute mountain sickness and improved submaximal exercise economy because of lower metabolic demands for non-external work-performing functions.
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Affiliation(s)
- T D Latshang
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
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25
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Swenson ER. CON: Most Climbers Do Not Develop Subclinical Interstitial Pulmonary Edema. High Alt Med Biol 2011; 12:125-8; discussion 129-30. [DOI: 10.1089/ham.2011.0005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erik R. Swenson
- VA Puget Sound Health Care System, University of Wasington, Seattle, Washington
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Agostoni P, Swenson ER, Bussotti M, Revera M, Meriggi P, Faini A, Lombardi C, Bilo G, Giuliano A, Bonacina D, Modesti PA, Mancia G, Parati G. High-altitude exposure of three weeks duration increases lung diffusing capacity in humans. J Appl Physiol (1985) 2011; 110:1564-71. [DOI: 10.1152/japplphysiol.01167.2010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: high-altitude adaptation leads to progressive increase in arterial PaO2. In addition to increased ventilation, better arterial oxygenation may reflect improvements in lung gas exchange. Previous investigations reveal alterations at the alveolar-capillary barrier indicative of decreased resistance to gas exchange with prolonged hypoxia adaptation, but how quickly this occurs is unknown. Carbon monoxide lung diffusing capacity and its major determinants, hemoglobin, alveolar volume, pulmonary capillary blood volume, and alveolar-capillary membrane diffusion, have never been examined with early high-altitude adaptation. Methods and Results: lung diffusion was measured in 33 healthy lowlanders at sea level (Milan, Italy) and at Mount Everest South Base Camp (5,400 m) after a 9-day trek and 2-wk residence at 5,400 m. Measurements were adjusted for hemoglobin and inspired oxygen. Subjects with mountain sickness were excluded. After 2 wk at 5,400 m, hemoglobin oxygen saturation increased from 77.2 ± 6.0 to 85.3 ± 3.6%. Compared with sea level, there were increases in hemoglobin, lung diffusing capacity, membrane diffusion, and alveolar volume from 14.2 ± 1.2 to 17.2 ± 1.8 g/dl ( P < 0.01), from 23.6 ± 4.4 to 25.1 ± 5.3 ml·min−1·mmHg−1 ( P < 0.0303), 63 ± 34 to 102 ± 65 ml·min−1·mmHg−1 ( P < 0.01), and 5.6 ± 1.0 to 6.3 ± 1.1 liters ( P < 0.01), respectively. Pulmonary capillary blood volume was unchanged. Membrane diffusion normalized for alveolar volume was 10.9 ± 5.2 at sea level rising to 16.0 ± 9.2 ml·min−1·mmHg−1·l−1 ( P < 0.01) at 5,400 m. Conclusions: at high altitude, lung diffusing capacity improves with acclimatization due to increases of hemoglobin, alveolar volume, and membrane diffusion. Reduction in alveolar-capillary barrier resistance is possibly mediated by an increase of sympathetic tone and can develop in 3 wk.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Dipartimento di Scienze Cardiovascolari, Università di Milano, Milan, Italy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, Washington
| | - Erik R. Swenson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, Washington
| | - Maurizio Bussotti
- Cardiologia Riabilitativa, Fondazione S. Maugeri, IRCCS, Milan, Italy
| | - Miriam Revera
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- Department Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
| | - Paolo Meriggi
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- Department Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Giuliano
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Daniele Bonacina
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Pietro A. Modesti
- Dipartimento di Area Critica Medico Chirurgica, Università di Firenze, Firenze, Italy and Fondazione Don C. Gnocchi, IRCCS Centro di Santa Maria degli Ulivi Pozzolatico, Italia
| | - Giuseppe Mancia
- Department Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
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27
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Affiliation(s)
- Annalisa Cogo
- Centro Studi Biomedici Applicati allo Sport, Università di Ferrara, Ferrara, Italy
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Cogo A, Miserocchi G. Pro: Most Climbers Develop Subclinical Pulmonary Interstitial Edema. High Alt Med Biol 2011; 12:121-4; discussion 131-2. [DOI: 10.1089/ham.2011.0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Annalisa Cogo
- Centro Studi Biomedici Applicati allo Sport, Università di Ferrara, Italy
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29
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Affiliation(s)
- Annalisa Cogo
- Clinica Pneumologica e Centro Studi Biomedici Applicati allo Sport, Università di Ferrara, Ferrara, Italy.
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Yuan JXJ, Garcia JG, West JB, Hales CA, Rich S, Archer SL. High-Altitude Pulmonary Edema. TEXTBOOK OF PULMONARY VASCULAR DISEASE 2011. [PMCID: PMC7122766 DOI: 10.1007/978-0-387-87429-6_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
High-altitude pulmonary edema (HAPE) is an uncommon form of pulmonary edema that occurs in healthy individuals within a few days of arrival at altitudes above 2,500–3,000 m. The crucial pathophysiology is an excessive hypoxia-mediated rise in pulmonary vascular resistance (PVR) or hypoxic pulmonary vasoconstriction (HPV) leading to increased microvascular hydrostatic pressures despite normal left atrial pressure. The resultant hydrostatic stress can cause both dynamic changes in the permeability of the alveolar capillary barrier and mechanical damage leading to leakage of large proteins and erythrocytes into the alveolar space in the absence of inflammation. Bronchoalveolar lavage (BAL) and pulmonary artery (PA) and microvascular pressure measurements in humans confirm that high capillary pressure induces a high-permeability non-inflammatory-type lung edema; a concept termed “capillary stress failure.” Measurements of endothelin and nitric oxide (NO) in exhaled air, NO metabolites in BAL fluid, and NO-dependent endothelial function in the systemic circulation all point to reduced NO availability and increased endothelin in hypoxia as a major cause of the excessive hypoxic PA pressure rise in HAPE-susceptible individuals. Other hypoxia-dependent differences in ventilatory control, sympathetic nervous system activation, endothelial function, and alveolar epithelial sodium and water reabsorption likely contribute additionally to the phenotype of HAPE susceptibility. Recent studies using magnetic resonance imaging in humans strongly suggest nonuniform regional hypoxic arteriolar vasoconstriction as an explanation for how HPV occurring predominantly at the arteriolar level can cause leakage. This compelling but not yet fully proven mechanism predicts that in areas of high blood flow due to lesser vasoconstriction edema will develop owing to pressures that exceed the structural and dynamic capacity of the alveolar capillary barrier to maintain normal alveolar fluid balance. Numerous strategies aimed at lowering HPV and possibly enhancing active alveolar fluid reabsorption are effective in preventing and treating HAPE. Much has been learned about HAPE in the past four decades such that what was once a mysterious alpine malady is now a well-characterized and preventable lung disease. This chapter will relate the history, pathophysiology, and treatment of HAPE, using it not only to illuminate the condition, but also for the broader lessons it offers in understanding pulmonary vascular regulation and lung fluid balance.
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Affiliation(s)
- Jason X. -J. Yuan
- Departments of Medicine, COMRB Rm. 3131 (MC 719), University of Illinois at Chicago, 909 South Wolcott Avenue, Chicago, 60612 Illinois USA
| | - Joe G.N. Garcia
- 310 Admin.Office Building (MC 672), University of Illinois at Chicago, 1737 W. Polk Street, Suite 310, Chicago, 60612 Illinois USA
| | - John B. West
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093-0623 California USA
| | - Charles A. Hales
- Dept. Pulmonary & Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114 Massachusetts USA
| | - Stuart Rich
- Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., Chicago, 60637 Illinois USA
| | - Stephen L. Archer
- Department of Medicine, University of Chicago School of Medicine, 5841 S. Maryland Ave., Chicago, 60637 Illinois USA
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