Asthma & Altitude

[ZimZam]

does anyone have any experience climbing with asthma. my doctor told me that asthmatics are more susceptable to HAPE. I was planning on some volcanoes this summer.

[BirdDog]

I have mild asthma, but it have never bothered me at altitiude; in fact I feel way better the higher I go. If you're talking Cascade volcanos, none of them are high enough to really be concerned about HAPE. It can happen on Rainier, but seldom. You will be more prone to AMS (acute mountain sickness). Take time to aclimatize and AMS won't be a problem.

 

[dvs]

ZimZam-

 

I have moderate to severe asthma and also seem to breathe easier up high. I think that lots of the stuff that causes most of us trouble (pollen, cats, etc.) is missing at altitude. However-it certainly is possible to get HAPE at volcano altitudes. A friend of mine had to be carried off of Mt. Whitney and straight into the hospital-they said this happens a lot there. Just don't go up too fast and you'll be fine (sea level to 12000 feet in a day gets a lot of people).

[DPS]

There is actually some anecdotal evidence that suggests asthmatics do better at altitude than non-asthmatics. Some notable high altitude climbers with asthma and other lung problems: Lou and Jim Whittaker, Galen Rowell, Anatoli Boukerev

[Alpine_Tom]

Like BirdDog, and dvs, I've got mild asthma of various types, including allergies and exercise-induced asthma. And, like them, it seems the higher I go the better I feel. I've never been higher than Rainier, but I've never had any AMS symptoms up there, either.

[ryland_moore]

The Everest series running on Discovery channel Tuesday nights at 10pm has an exercise induced asthmatic on the team and he was attmepting to climb without oxygen and was doing really well until the summit bid....

[mneagle]

Clinics in Chest Medicine

Volume 26 • Number 3 • September 2005

Copyright © 2005 W. B. Saunders Company

 

Pulmonary Function Testing and Extreme Environments

 

 

ASTHMA

Convincing evidence is lacking that lower air density at altitude conveys much advantage in patients who have COPD and asthma. Stable asthmatics who do not have hypoxemia at sea level have little added risk at altitude other than remote location in the event of bronchospasm. Reduced exposure to allergens and pollutants in mountain areas may reduce the likelihood of exacerbation, although complete absence of these triggers cannot be assumed. Exercise in cold, dry air theoretically could provoke some asthmatics, although Matsuda and coworkers [125] report no changes from sea level in FEV1, exercise time, oxygen consumption, or heart rate in children who have exercise-induced asthma exposed in a hypobaric chamber. Nonspecific airway challenge testing on current asthma therapy before travel may provide some reassurance.

 

Asthmatics may opt to monitor spirometry in field settings. Jensen and colleagues tested several devices by mechanical means in an altitude chamber and found that portable flow meters underestimate PEF as a function of increasing altitude and increasing target peak flow [126]. Pedersen and colleagues address similar issues and advocate carefully developed correction factors for meaningful use of selected instruments in settings of variable barometric pressure [127].

[jordansahls]

Like most of the guys who have responded I also have mild Asthma. I can say that it has never really affected my performance at altitude. I actually feel way better when I get up higher. I climbed Rainier a while ago and didn't even need my inhaler, it was great!

[Fairweather]

Unless you are 100% certain what your triggers are, I would keep an Albuterol inhaler warm and available at all times while climbing. My lungs get tight in March and April with tree pollen and I use an inhaler sparingly when I run outdoors during these two months. I did notice tightness once on Mount Hood during a very, very cold January climb, so I can't be certain that pollen is the only culprit. Go out and buy a 'peak flow' meter. They're only about 30 bucks. It might help you guage your own lung performance, and keeping a log of the readings might help your doctor better advise treatment.

[carolyn]

This is good to hear.

I just developed asthma this year. it's been pretty persistent and severe.

I am heading to colorado next weekend for a few weeks both to climb and visit family.

I was extra worried after getting a cold last week.

 

 

Its good to hear an overwhelming response that altitude seems to be better for the lungs. Fingers crossed I my cold doesnt turn into something worse, and that my lungs take on the altitude as well as all of yours.

 

 

[mneagle]

This is good to hear.

I just developed asthma this year. it's been pretty persistent and severe.

I am heading to colorado next weekend for a few weeks both to climb and visit family.

I was extra worried after getting a cold last week.

 

 

Its good to hear an overwhelming response that altitude seems to be better for the lungs. Fingers crossed I my cold doesnt turn into something worse, and that my lungs take on the altitude as well as all of yours.

 

 

 

The mountains are no place for people with severe persistent asthma. Stick to cragging until you get it under better control. Even with good control you should consider bringing an Epi-pen if your asthma is really that bad.

 

I'm glad others have had luck with their asthma and climbing but you have to understand that there is a selection bias on a climbing website. Those with a bad response probably either died or took up another hobby and wouldn't be prowling cc.com.

 

Also, upper respiratory tract infections probably increase the likelihood of developing HAPE (at least in children) that travel to high altitude, so I would be extra careful. (Ref: Durmowicz AG, Noordeweir E, Nicholas R, Reeves JT: Inflammatory processes may predispose children to high-altitude pulmonary edema. J Pediatr 1997; 130:838-840.)

[montypiton]

In 1976 I climbed Pico d'Orizaba with a group of friends, of whom one had had a childhood history of asthma. Walt had not had an attack in so many years, he had quite literally forgotten he had been asthmatic. When he began to have breathing difficulties, after a night at 16000' we all suspected HAPE, & reacted accordingly, initiating evacuation (he was past the point of moving under his own power) It was not until we got him to a physician in Mexico City that he was properly diagnosed and treated with an ordinary inhaler from a nearby pharmacy. But, here's the kicker- he nearly died before we got him evacuated. If you're asthmatic, and going to altitude, pack your meds!!!

[carolyn]

Thanks for the reminder to be cautious.

I did speak with the dr today and have a plan.

Im likely hanging out in Ouray most of the time, so I dont have to worry about long approaches or being in a remote area.

 

Have all of you had asthma your entire life or did you get it as an adult?

[Alpine_Tom]

This is good to hear.

I just developed asthma this year. it's been pretty persistent and severe.

I am heading to colorado next weekend for a few weeks both to climb and visit family.

I was extra worried after getting a cold last week.

 

 

Its good to hear an overwhelming response that altitude seems to be better for the lungs. Fingers crossed I my cold doesnt turn into something worse, and that my lungs take on the altitude as well as all of yours.

 

Before I got my asthma properly under control, it was awfully debilitating. Particularly, running in cold weather became almost impossible. My wife suggested running with a scarf around my face. I had all sorts of really sensible reasons why she was wrong, but went ahead and tried it so I could say "I told you so" and was astonished to see how much good it did. My current theory is that it keeps the air coming into your lungs a bit moister. In any case, it's well worth trying.

(Actually, I didn't use a scarf, but one of those fleece ear band things.)

 

 

[chris]

I can tell all of you from personal experience that nothing is scarier than helplessly watching your partner suffering from a full asthma attack at 14000', 240m up an ice climb, in northwestern Sichuan Province, China. If the meds hadn't worked she would have been in a world of trouble. It was also a scary moment to realize that the air pressure and temps effected the pressure within her inhaler.

In her case, this expedition taught us that cold air actually irritates her lungs and makes her more susceptible to asthma events. We're experimenting with neck/face warmers this winter.

[mbcracken]

... It was also a scary moment to realize that the air pressure and temps effected the pressure within her inhaler...

 

Isn't there now a way to disperse the drug in a powdered form? I know that for a while I was using a powdered asthma drug that was not for immediate intervention but a drug used more as a way to helpthe lungs build up strength. Singular or something like that?

 

-Mike

[chelle]

Singular is a tablet. Albuterol is in an inhaler or a nebulizer and is for "rescue". Other powdered forms of inhalers are available for management of inflammation and tend to be long acting broncho dilators and steroids. As you said these are not for relief from an accute attack.

 

mtnfreak - Cold air is my primary trigger and using a neck gaitor or scarf helps alot. Also warming up much more slowly also helps.

[iluka]

Great discussion.

 

People have related a lot of great information about their personal experiences with asthma. All very useful to hear but at the same time, it's anecdotal and what applies to or works for one person will not necessarily apply to or work for someone else. For example, some people see their asthma get worse with cold air while others actually do better in the cleaner air in the mountains. While some do well with cleaner air in the mountains, others may do worse trekking in remote areas where the local air quality in villages with alot of wood or yak dung stoves can be pretty bad. The bottom line is you have to be cautious taking in all this advice.

 

A work colleague and I have actually examined this issue in great depth recently, reviewing all the information in the medical literature pertaining to asthma and high altitude. Not a lot of great research data out there. In fact, only 3 formal studies have taken a small number of asthma patients to high altitude and measured various markers of their lung function. The patients that were studied only had mild asthma. The remainder of the studies are all very indirect attempts to get at the questions. It's hard to draw very firm conclusions from all of this because even the formal studies had some problems with them. We've written this up and are getting set to publish it in a larger article on lung disease at high altitude. The conclusion we reached regarding going to altitude with asthma is as follows:

 

"Patients with mildintermittent or mild persistent asthma can ascend to altitudes as high as 5000 m. They should maintain

their preexisting medication regimen and should travel with an ample supply of rescue inhalers and oral prednisone to treat any asthma exacerbations that occur in remote areas away from medical attention. Patients should consider traveling with their fixed orifice peak flow meters, since variable orifice

meters underestimate flow at higher altitude and with cold. Even if the absolute peak flows are not accurate, however, the trends may provide useful information to guide management. In cold or

windy environments, patients should consider protecting the nose and mouth with bandanas or balaclavas to warm and humidify the inhaled air. Because of the lack of data and the lack of medical

facilities in many high altitude regions, patients with more severe disease at baseline should be cautioned against traveling to remote high altitude regions. If such travel cannot be avoided, aggressive attempts to control the patient’s symptoms with high dose inhaled steroids or even oral steroids should be

made prior to such travel."

 

As far as asthma and HAPE: it's not an issue as asthma is NOT a risk factor for HAPE. The main risk factors for HAPE are:

- Going to high too fast (by far the most important)

- Overexertion

- Preceding viral or upper respiratory tract infection

- Individual susceptibility (most HAPE patients have a characteristic pattern in which the blood pressures in their lungs -- pulmonary artery pressures -- skyrocket when they go to high altitude, much greater increases than in people who don't get HAPE.

 

 

Edited December 12, 2006 by iluka

[mbcracken]

Singular is a tablet. Albuterol is in an inhaler or a nebulizer and is for "rescue". Other powdered forms of inhalers are available for management of inflammation and tend to be long acting broncho dilators and steroids. As you said these are not for relief from an accute attack.

Very well said. I had thought there was some development on powdered delivery of albuterol. googling turned up...

http://cat.inist.fr/?aModele=afficheN&cpsidt=1983040 I know it was was done by those whacky frenchies, but stil looks promising for a way to deliver Dry Powder Inhalers (PDI) that are not affected by pressure. Interesting study to see the difference between the MDI (Meter Delivery Inhalers (pressurized) vs. PDI ( Not sure how the powder would work with moisture and cold though...

 

mtnfreak - Cold air is my primary trigger and using a neck gaitor or scarf helps alot. Also warming up much more slowly also helps.

Do you know if your primary trigger worstened by altitude? Or is it just whenever it is cold?

 

My asthma is very mild these days as long as I prevent exposure to allergents (horses, cats, dogs, etc...). I hjave noticed over the last 3-4 years that after a hard 2 hour XC skate session I seem to develop some mild asthma over the next couple hours of recovery. Does not happen during summer (warm weather) workouts.

 

Cheers,

Mike

[chris]

Mike,

In our case we know for certain that montanapup's asthma is exercise-induced, not necessarily allergens. She's been as high as 18000' feet in spring and summer without incidences, and has had incidences trail running this winter at sea level here in Bellingham.

[jonmf76]

Hello all:

 

This topic is near and dear to me. I developed asthma on my first climb on Denali, with coughing beginning at 8000'. I assumed it was just dry air cough, but after the climb it never went away until I was diagnosed with exercise induced asthma.

 

Since then, I have done 2 more Denali climbs. On the second climb, I began to develop HAPE symptoms (rales) because I was feeling strong and climbed too fast. I went to 11,000' in 3 or 4 days. That night I could hear crackling in my lungs and descended the next day to recuperate, before moving back up. I believe I was on Singulair for that climb and may have taken Decadron as well..

 

On the third climb, I was on proper meds (singulair) and carried Albuterol inhaler, which was at constant risk of freezing. Climbed to 17,000' with asthma indistinguishable from general high altitude breathing difficulties.

 

Prior to all of this, I had summited Orizaba in Mexico (just under 19,000'(5700M)), but that was before I had either known I had asthma, or had it at all.

 

On Denali I spoke with Peter Hackett, the guy who kinda wrote the book on all this and we discussed asthma and high altitude climbing. The concensus was that asthma had no direct effect on HAPE. He suggested with proper meds, there should be essentially no problem...(obviously, he doesn't have asthma! lol.) My pulmonary specialist in Anchorage mirrored his comments. They all seem to agree that other than the cold as a trigger, altitude shouldn't effect asthmatics differentially.

 

Since all of that, the use of Advair diskus has been the most effective treatment. It is a combo of broncodialators and steroids in powder inhalant form. The stuff really works. I have not yet tried that combo with high altitude.

Edited December 13, 2006 by jonmf76

[iluka]

Its good to hear an overwhelming response that altitude seems to be better for the lungs.

 

For some it's better for others it's not. There has been thought for a long time that people with severe asthma often do better with moving to higher elevations. That's one of the reasons Davos in Switzerland has been popular over the years with people with bad asthma. One reason for the improvement up there... much fewer allergens. In particular, dust mite burden goes down at altitude.

 

Short term exposure to altitude will have varying effects on people.

 

Things at altitude that will improve control:

- Lower allergen burden

- Better air quality

 

Things at altitude that will worsen control:

- Cold air

- Dry air

- Travel through villages in the developing world with poor air quality.

- Hyperventilation: this leads to lower blood CO2 levels which can cause the airways to spasm in some cases (bronchoconstriction).

 

How this all plays out will vary from person to person depending on what the main trigger of their asthma is. In addition, exercise may trigger asthma in some, whether they are up high or down at sea-level.