HAPE risks underestimated, study warns

High-altitude pulmonary edema (HAPE), a potentially fatal lung condition, occurs more frequently at moderate altitude (below 8,000 feet) than past research indicates. A study published in the January issue of Chest, the peer-reviewed journal of the American College of Chest Physicians, suggests that HAPE may regularly occur at moderate altitude, affecting young, healthy skiers.

The study, conducted by researchers at Moutiers Hospital and Nord Hospital, Marseilles University School of Medicine, both in France, reviewed patient charts from the emergency department at Moutiers Hospital. During a 9-year period (1992 to 2000), 11,420 patients were admitted to the emergency department. Of the admitted, 52 patients — 44 males and eight females, with a mean age of 37 years — had HAPE symptoms. All patients were vacationers at ski resorts set at moderate altitudes around Moutiers, France. Patients skied at altitudes between 4,590 feet and 7,870 feet (1,400 meters and 2,400 meters). Mean sleeping altitude was 4,270 feet (1,300 meters).

Researchers surmised that the reason most of the patients in the study were relatively young skiers is because young skiers seem more likely to start intense physical activity without prior training than older skiers.

HAPE is a condition marked by an increase in lung blood pressure followed by fluid buildup in the lungs. Patients in the study experienced symptoms on the second day of their stay. Nearly all patients experienced cardiorespiratory symptoms, such as dyspnea (labored breathing) and moist rales (abnormal breathing sounds), during examination; all patients had fluid buildup in the lungs, with 43 patients having at least half of each lung filled. Upon examination, patients had no signs of infection, intoxication, preexisting health conditions or other types of edema. Although severe forms of HAPE can be fatal, all patients in the study were treated and fully recovered within two to six days.

“Patients with preexisting lung conditions, such as chronic bronchitis, may be more susceptible to developing pulmonary edema at moderate altitudes,” said Lawrence Raymond, MD, ScM, FCCP, director of occupational and environmental medicine, Carolinas HealthCare System, who wrote an editorial accompanying the study. “Paradoxically, many asthmatics do better at altitude. But the study results suggest that anyone, regardless of health or fitness level, who ascends to these altitudes and performs vigorous physical activity without proper acclimatization may be at risk for developing this condition.”

CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at http://www.chestjournal.org/. ACCP represents more than 15,000 members who provide clinical, respiratory and cardiothoracic patient care in the United States and throughout the world. ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research and communication.