High Altitude Pulmonary Edema

Overview

High altitude pulmonary edema (HAPE) is a serious condition where fluid builds up in the lungs after going to a high altitude. Altitude means height above sea level. HAPE makes it hard for oxygen to get into your blood, so you can feel very breathless and very unwell. It is a medical emergency and needs urgent help.

HAPE is uncommon among all travelers, but it is one of the most serious altitude illnesses. The risk is higher when people go up too fast or sleep at high altitude without getting used to it.

Anyone can get HAPE, including fit young people. People who have had HAPE before, who climb too fast, or who have certain heart or lung conditions may be at higher risk. Children can also get it, though it is less common.

Symptoms

Common symptoms

• Breathlessness that is worse than expected for the altitude, especially with activity
• A cough, which may be dry at first
• Chest tightness or a feeling of not getting enough air
• Tiredness, weakness, or feeling very unwell
• Fast heartbeat
• Headache, often along with other altitude sickness symptoms
• Poor sleep or feeling restless at night

Symptoms in children

• Fast breathing
• Cough
• Fussiness, crying more than usual, or being hard to comfort
• Poor feeding or drinking
• Unusual sleepiness or low energy
• Pale or blue lips or fingertips
• Vomiting

Symptoms in older adults

• The same emergency signs as in younger people, such as breathlessness at rest and blue lips
• Confusion or unusual sleepiness may be an early sign
• Breathlessness may be mistaken for getting older or being less fit
• Existing heart or lung disease can make altitude illness more serious
• Call your local emergency number right away if HAPE is suspected

Causes

Main causes

• Low oxygen at high altitude causes blood vessels in the lungs to tighten unevenly.
• This raises pressure in the lung blood vessels and fluid leaks into the air sacs.
• The fluid makes it harder for oxygen to pass into the blood, which causes severe breathlessness.

Risk factors

• Going up to high altitude too quickly
• Sleeping at a high altitude soon after arriving
• Having had HAPE before
• A personal history of altitude sickness
• Cold weather or a respiratory infection
• Strenuous activity soon after arriving at altitude
• Certain heart or lung conditions
• Drinking alcohol or taking medicines that make you drowsy while at altitude

When to see a doctor

See a doctor urgently if:

• At altitude, breathlessness at rest, a worsening cough, chest tightness, confusion, or blue lips need emergency help, not a routine appointment.
• If you are with someone who has these signs, call your local emergency number and help them get to lower altitude if it is safe to do so.
• Do not wait to see if symptoms improve on their own.

Book a routine appointment if:

• Before traveling to high altitude, talk with a travel health professional if you have had HAPE before or have heart or lung disease.
• Ask for advice before high-altitude travel if you are pregnant or have other long-term health conditions.
• See a doctor after returning if you still have breathlessness, cough, or unusual tiredness.

Diagnosis

A doctor usually recognizes HAPE from the symptoms and the setting: you are at high altitude and have breathlessness, cough, or other warning signs. They will check your breathing and oxygen level and may do further tests. If HAPE is suspected, treatment starts quickly; you should not wait for tests.

Tests that may be done

• Physical examination, including listening to your chest
• Pulse oximeter, a small clip on the finger that estimates oxygen in your blood
• Chest X-ray if available
• Blood tests if you are in hospital
• Heart tracing (ECG) if needed

What to expect at your appointment

You may need oxygen and help getting to a lower altitude right away. In hospital, staff may monitor your breathing, oxygen level, and heart. Most people improve quickly once they receive oxygen and descend.

Treatment

HAPE is an emergency. The main treatment is to get to a lower altitude and receive oxygen as soon as possible. Call your local emergency number and start descent only if it is safe and you have help.

Self-care at home

• Call for emergency help immediately.
• Descend to a lower altitude if it is safe and you can do so with help.
• Rest and avoid exertion while waiting for help.
• Keep warm and stay calm.
• Do not drink alcohol or take medicines that make you drowsy.
• Do not wait to see if you get better on your own.

Medical treatments

Doctors treat HAPE with oxygen, descent to lower altitude, and close monitoring. In some settings, a portable hyperbaric chamber may be used; this is a bag that simulates going down to a lower altitude. Clinicians may also prescribe medicines, but only they can decide what is safe and appropriate. Hospital care may include breathing support and treatment for complications.

When is surgery considered?

Surgery is not used to treat HAPE.

Living with this condition

After HAPE, follow your doctor's advice about recovery. Avoid going back to high altitude until you are fully well and have talked with a healthcare professional. If you travel to altitude again, go up slowly and watch closely for early symptoms.

Lifestyle tips

• Plan your ascent slowly, with rest days to get used to the altitude.
• Avoid alcohol and medicines that make you drowsy at altitude.
• Stay warm and avoid getting overly tired.
• Learn the warning signs of HAPE and share them with your travel group.
• Make a clear plan for how to get help and descend if someone becomes unwell.

Diet and exercise

Eat regular meals and drink normally. Avoid heavy exercise in the first days at high altitude. Being very fit does not prevent HAPE, so do not ignore symptoms just because you feel strong.

Mental health and emotional wellbeing

A breathing emergency can be frightening, and it is normal to feel anxious afterward or worry about future travel. Talk with your doctor, a counselor, or a mental health professional if these feelings affect your daily life. If you ever feel unsafe or have thoughts of harming yourself, seek emergency help or local crisis support right away.

Prevention

HAPE can often be prevented by going up to high altitude slowly, getting used to the height, and acting quickly if symptoms start. People with a history of HAPE should get advice before traveling again.

Vaccines

There is no vaccine for HAPE. Keep routine vaccinations up to date and ask a travel health service about any travel vaccines you may need.

Screening programmes

There is no routine screening test that can predict who will get HAPE. A travel health consultation can review your risk, especially if you have had HAPE before or have heart or lung disease.

Complications

If left untreated

• Worsening low oxygen levels in the blood
• Severe breathlessness and exhaustion
• Brain swelling from altitude, which can cause confusion or coma
• Heart strain
• Death if not treated quickly

Long-term outlook

Most people recover well when HAPE is recognized early and treated with descent and oxygen. HAPE can happen again, so future high-altitude trips need careful planning and a low threshold to get help.

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