HAPE

High altitude pulmonary edema results from fluid buildup in the lungs. This fluid prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and death.

 

Symptoms of HAPE include:

  • Shortness of breath at rest
  • Tightness in the chest
  • Persistent cough bringing up white, watery, or frothy fluid
  • Marked fatigue and weakness
  • A feeling of impending suffocation at night
  • Confusion, and irrational behavior

 

Confusion, and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent of around 2,000 feet (600 m) is a necessary life-saving measure. Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.

  • What are the symptoms?

HAPE usually develops after 2 or 3 days at altitudes above 2500 m. Typically the sufferer will be more breathless compared to those around them, especially on exertion. Most will have symptoms of acute mountain sickness. Often, they will have a cough and this may produce white or pink frothy sputum. The breathlessness will progress and soon they will be breathless even at rest. Heart rate may be fast, the lips may turn blue and body temperature may be elevated. It is easy to confuse symptoms of HAPE with a chest infection, but at altitude HAPE must be suspected and the affected individual must be evacuated to a lower altitude. If you think you have had HAPE, register on the HAPE database.

  • Who gets HAPE?

Unfortunately, it is currently impossible to predict who will get HAPE. This is one of the reasons why we have established the HAPE database. People who have had HAPE before are much more likely to get it again. Therefore, there must be some factor that puts certain individuals at high risk of the condition. However, just like acute mountain sickness, there are some known risk factors. A fast rate of ascent and the altitude attained will make HAPE more likely. Vigorous exercise is also thought to make HAPE more likely and anecdotal evidence suggests that people with chest infections or symptoms of the common cold before ascent may be at higher risk.

  • What causes HAPE?

Despite years of careful research the exact causes of HAPE remain poorly understood. Fluid has been shown to fill up the air pockets in the lungs preventing oxygen getting into the blood and causing the vicious circle of events that can kill people with HAPE. As with many biological processes many factors play a role in the disease and there is good evidence to support a number of theories about how this fluid gets there.

Normally, oxygen gets into your blood and is supplied to the body from your lungs. Each time you take a breath in, air rushes into the tiny air pockets at the end of all the airway branches in your lungs. At the same time, blood from your heart is brought close to these thin-walled air pockets, so that oxygen can move into your blood while waste products move out. Oxygen-rich blood then returns to the heart and is supplied to the body. If, by accident, you inhaled a small object into your lungs, it would become stuck in one of the airways branches. Little oxygen would get to the downstream air pockets. To prevent this area of lung supplying blood starved of oxygen back to the heart (and therefore the rest of body), blood vessels in the area closed down or constrict. This is normally a very good thing and is an example of the body protecting itself.

At altitude however, this same process is a cause of the disease HAPE. Because the whole lung is starved of oxygen, the whole lung reacts in the same way – blood vessels constricting all over the place and not just in small areas. The blood in these vessels is squeezed and the pressure goes up forcing fluid out of blood and into air pockets. Click for a more detailed explanation of what happens to the lungs at high altitude.

Very dangerous and reactive substances are formed in your blood when you are starved of oxygen and these can directly damage the special membrane between air and blood in your lungs causing further fluid leak and worsening HAPE.

  • How is HAPE treated?

The most important treatment for HAPE is descent. Providing extra oxygen and/or raising the air pressure around a victim with a Gamow bag (see right) can reverse the underlying process, lack of oxygen, but these measures are really no substitute however for rapid descent down the mountain. Some drugs can be helpful, but should only be used by trained doctors. Nifedipine is a drug that helps to open up the blood vessels in the lungs. By doing so, it reduces the high pressure in those vessels that is forcing fluid out into the lungs. Sildenafil (Viagra®), by a different mechanism, also opens up the blood vessels in the lung and may be a useful treatment for HAPE. Following recent research, medics may also give the steroid, dexamethasone. Drug treatment should only ever be used as a temporary measure; the best treatment is descent.

  • Immediate descent is absolutely essential
  • Dexamethasone and acetazolamide should both be given, if available
  • Pressure bags and oxygen gas can buy time