Have you ever felt a little short of breath, just a feeling of tightness in your chest, when you go to a high altitude area like Nuwara Eliya, or when you climb a big mountain? Sometimes, even though you think these things are normal, they can turn into a serious condition. Today, we are going to talk about such a dangerous, but preventable condition. This is called 'High-Altitude Pulmonary Edema' or HAPE for short.
What is HAPE (High-Altitude Pulmonary Edema)? Simply put...
Simply put, HAPE is when you go to high altitude and your lungs fill with fluid. This is the most severe form of altitude sickness, also known as mountain sickness. When this happens, it becomes very difficult to breathe, and the lungs can sometimes bleed as fluid builds up in them. This deprives the rest of the body's tissues and organs of oxygen.
HAPE occurs when you suddenly move from a low altitude to a high altitude and your body doesn't have enough time to acclimatize to the low oxygen levels. It usually starts at night, within two to four days of moving to a higher altitude.
HAPE often occurs at altitudes of 8,200 feet (2,500 meters) or higher. You don't have to climb the world's highest mountain to reach this altitude. Some countries even have ski resorts at this altitude. Several of the world's most populous cities are located at this altitude.
The most important thing is that HAPE is a potentially life-threatening condition. If you have symptoms of HAPE, you should seek immediate medical attention and get to a lower altitude as soon as possible.
There are two main types of HAPE:
Let's see what types of HAPE there are. There are mainly two types:
1. Classic HAPE: This is the most common type. This condition can occur if someone who usually lives in a low-lying area suddenly goes to a height of more than 8,200 feet, that is, if they ascend too quickly without giving their body time to acclimatize. Imagine, you are trying to climb a mountain much higher than Nuwara Eliya from Colombo in a day or two.
2. Re-entry HAPE: This is a little different. This usually happens when someone who lives at high altitudes goes to a lower altitude for a while and then returns to their usual altitude without reacclimatizing. Just like someone who goes up from a lower altitude, they can also develop HAPE.
How common is HAPE?
Research has found that about 6% of people who ascend to an altitude of 14,800 feet (4,500 meters) within a day or two develop HAPE. If you have had HAPE before, you are more likely to develop it again. This means that if you ascend at the same rate (4,500 meters in 1-2 days), about 60% of people who have had HAPE before will develop it again.
What are the symptoms of HAPE?
Now let's look at the symptoms of HAPE. It is very important to be aware of these.
- Cough: It may start as a dry cough, then progress to a cough with pink, frothy phlegm.
- Difficulty breathing (dyspnea): At first, you may feel tired and short of breath only when doing light work or walking. Later, it becomes difficult to breathe even when just standing still.
- Tachycardia: The heart rate increases.
- Increased breathing rate (tachypnea): You start breathing quickly.
- Low fever.
- Blue discoloration of the skin, lips, or fingernails (cyanosis): This means that the body is not getting enough oxygen.
In addition to these symptoms, you may also have symptoms of another form of altitude sickness, called high-altitude cerebral edema, which is a condition in which the brain fills with water.
What causes HAPE?
As we go up in altitude, the air pressure and oxygen levels in the air become lower than they are at sea level. Your body can gradually adjust to these lower oxygen levels, but it takes time. If you suddenly gain altitude too quickly, your blood, and hence your tissues and organs, will not get enough oxygen. This can make you sick and can even be life-threatening.
When a part of your lungs doesn't get enough oxygen, the blood vessels in your lungs constrict. This is in an effort to push blood to other parts of your lungs that are working well. This causes the pressure in the blood vessels to increase, causing fluid to leak out. This fluid builds up in your lungs, making it difficult to breathe. Eventually, blood can leak into your lungs, and you may cough up blood -tinged mucus.
Who is at higher risk of developing HAPE?
Remember, no matter how physically fit you are, it doesn't protect you from HAPE. The biggest risk factor is gaining height too quickly, no matter how healthy and strong you are. This condition is also seen more commonly in men.
Other risk factors are:
- Having previously developed HAPE.
- Pre-existing high blood pressure in the lungs, known as pulmonary hypertension.
- There are some changes in the structure of the heart, for example, intracardiac shunts and blood vessel abnormalities.
- Cold weather.
- Having respiratory infections.
How do you find out if you have HAPE?
A doctor will determine if you have HAPE based on your symptoms. They will check your breathing, blood pressure, blood oxygen level, and heart rate. If you are taken to a medical facility, a chest X-ray may be done to check for fluid in your lungs. Other tests and scans may also be done to rule out other conditions.
How is HAPE treated?
The first treatment for HAPE is supplemental oxygen. Also, you need to get to lower altitude as quickly as possible. This means going down to at least 1,000 feet (300 meters), and preferably 3,300 feet (1,000 meters). You may need emergency medical help to get you down. Stay warm and drink plenty of water.
After you go down, or while you are waiting to go down, a doctor may give you a treatment called hyperbaric therapy. This may be done in a portable hyperbaric chamber, such as a Gamow Bag®. Sometimes doctors use drugs called nifedipine or phosphodiesterase (PDE) inhibitors (such as sildenafil or tadalafil). However, these drugs are usually used less often if you are able to go down and provide oxygen.
What happens if HAPE develops?
If not treated immediately, HAPE can be fatal. You should seek emergency medical attention immediately, and expect to be taken to a lower altitude for medical treatment. Once you have recovered, your doctor will tell you if it is safe to continue your journey. In general, it is not recommended to go back up again immediately, due to the high recurrence rate.
It can take about two weeks for HAPE symptoms to fully resolve.
If left untreated, 50% of people who develop HAPE will die, so don't take this lightly.
When should you seek medical advice?
You should seek medical advice as soon as you experience the first symptoms of altitude sickness. Tell someone traveling with you about your symptoms, as you may not be able to tell them later. If you have symptoms of HAPE, seek help immediately.
What should I ask the doctor?
It may be helpful to ask your doctor questions like these:
- How long will it take for me to recover?
- How can I safely reach high places in the future?
- Can I continue my journey?
- When should I see you again?
Can HAPE be prevented? Yes, here's how!
Gradual ascent is the best way to prevent altitude sickness, including HAPE. If you start to experience symptoms of altitude sickness, stop ascending further and acclimate to the altitude, or descend until you feel better. Don't wait until your symptoms get worse.
Here are some more tips to reduce the risk of HAPE when traveling to high altitudes:
- Plan your trip carefully and follow the guidelines for how much height you want to gain per day.
- If you have to go to high altitudes suddenly on a flight, think about that too. Even if you don't go up on foot, you need to acclimate your body to the altitude.
- Plan rest days to help your body adjust. It is recommended to take a day or two off every three days.
- If you have any health conditions that may be affected by altitude, talk to your doctor about it.
- If you are at risk for HAPE, ask your doctor about taking preventive medications or prophylaxis. Sometimes, doctors prescribe the same medications to treat HAPE as to prevent it.
When we set out to accomplish something big, it's natural to be in a hurry to get to the goal quickly. But when you're at high altitude, rushing can be dangerous. Whether you're attempting to scale the world's highest peak or just going for a weekend hike, give yourself plenty of time to acclimate to high altitudes and follow the guidelines for safe ascents.
Never travel alone. Always talk to the people you are traveling with and see how they are feeling. Be aware of how to seek medical advice if you feel unwell. No matter how physically fit you are, you never know when you may need extra help.
Take-Home Message
Okay, so let's remind you again of the most important points from what we've talked about:
- HAPE is a dangerous condition in which the lungs fill with water at high altitudes.
- Going up too quickly is the main risk factor.
- Be suspicious if you experience symptoms such as coughing, difficulty breathing, increased heart rate, and blue skin.
- The main treatment is to descend and take oxygen as soon as symptoms appear.
- The best thing to avoid is to go up slowly, giving your body time to adjust.
- It is a good idea to talk to a doctor before traveling, especially if you have other health problems or have previously had HAPE.
Remember, going to high places can be a wonderful experience. But to do it safely, it's essential to be aware of these things. Your safety is in your hands!
` HAPE, mountain sickness, lung disease, altitude sickness, breathing difficulties, oxygen, mountain climbing
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