FYI - HAPE

[nobody]

Mountain Climbers Vulnerable to Subclinical Lung Disorder

February 06, 2002

Three out of four recreational climbers could be at risk of a mild form of the lung disorder called high altitude pulmonary edema, researchers conclude.

High altitude pulmonary edema (HAPE) is characterized by increased pulmonary artery pressure which leads to accumulation of fluid in the lungs. Severe HAPE is rare, occurring in 2-5% of cases, and is thought to only affect people with a specific genetic predisposition.

Writing in The Lancet, George Cremona from St. Raffaele University, Milan, and colleagues from Italy and San Diego, U.S.A., proposed that subclinical HAPE is far more frequent than suspected during even modest climbs of average effort.

They assessed 262 climbers of Monte Rosa (a 4559-meter mountain on the Swiss-Italian border) before ascent and about 24 hours later on the summit 1 hour after arrival.

Only one climber was evacuated for HAPE, but 40 (15%) climbers had evidence of lung-function deterioration (chest rales or interstitial edema [swelling] on radiograph after ascent). Of 37 of these climbers, 34 (92%) showed increased closing volume (the volume of air remaining in the lungs as the narrow airways begin to close after a full expiration; it is increased with edema and is therefore used as a measure of subclinical HAPE). Of the 197 climbers without clinical evidence of edema, 146 (74%) had an increase in closing volume - and therefore evidence of subclinical HAPE - at altitude.

Cremona comments, "If we assume that an increased closing volume at altitude indicates increased pulmonary extravascular fluid, our data suggest that three of every four healthy, recreational climbers have mild subclinical HAPE shortly after a modest climb."

In an accompanying commentary, Larry Sonna from the U.S. Army Research Institute of Environmental Medicine, concludes, "Methods suitable for use on site to better identify individuals at risk of altitude illness, and to identify early those who become ill, are under investigation. Unfortunately, other than a history of recurrent HAPE, there is yet no widely applicable clinical method to tell precisely who will develop clinically significant pulmonary edema at altitude. In view of the increasing popularity of recreational activities at altitudes capable of producing HAPE, better markers for susceptibility to this disorder are needed." This article was prepared by Health & Medicine Week editors from staff and other reports.

[Tad]

Well, T H A N K Y O U "Nobody". Your name clearly gives this post some importance. I'm sure it will impact us all.