Jan. 22, 2003 -- A potentially fatal lung condition may strike eager ski vacationers much more often and at lower altitudes than previously thought. A new study shows high-altitude pulmonary edema (HAPE) occurs more commonly at moderate altitudes below 8,000 feet, and healthy, young, vacationing men may be most at risk.
HAPE is a condition brought on by a combination of intense physical exertion at a high altitude without getting used to the altitude. It results in an increase in blood pressure and fluid buildup in the lungs. Previous research has suggested that the condition occurs only at the highest altitudes, but a study in the January issue of Chest shows that it frequently occurs at more modest altitudes commonly found at major ski resorts.
"The occurrence of HAPE at altitudes of <2,500 m [8,200 feet] is said to be rare, but its incidence is probably underestimated," writes researcher André Louis Cabry, MD, of the emergency department at Hospital de Monteirs in Monteirs, France, and colleagues. "The patients are often skiers or hikers who have easy access to moderate altitude and start physical activity without prior training."
Researchers recorded 52 cases of the condition reported to a community hospital in the French Alps between 1992 and 2000. All of the patients were vacationers at ski resorts set at moderate altitudes in the area who skied at altitudes between 4,590 feet and 7,870 feet and slept at an average altitude of 4,270 feet.
Of the 52 patients admitted for HAPE, 44 were men and eight were women, with an average age of 37. Most of the patients in the study began experiencing symptoms around the second day of their stay. By the time they sought medical attention, 96% had difficulty breathing, 77% had wet lungs or abnormal breathing sounds, and all of the patients showed X-ray evidence of some fluid buildup in the lungs. Forty-three of the patients had at least half of each lung filled. All patients had low oxygen levels and improved with treatment.
No signs of infection or other possible cause of illness were found. All of the patients were treated with supplemental oxygen, bed rest, moderate fluid restriction, and continuous air pressure delivered to the lungs and made a full recovery after a short hospital stay.
In an editorial that accompanies the study, Lawrence Raymond, MD, director of occupational and environmental medicine for Carolinas HealthCare System in Charlotte, N.C., says the findings are surprising.
"This remarkable account of previously healthy persons is all the more noteworthy because the skiers slept at a mean altitude of 1,300 m [4,270 feet]," writes Raymond. HAPE is frequently attributed to the altitude of rest rather than that of daily activity.
"Whereas the altitude exposure of these skiers was much more mild than that of previous reports, their illnesses were not," notes Raymond.