Anyone who travels to areas of high altitude is at risk for high altitude pulmonary edema (HAPE). Classic HAPE symptoms include a worsening cough and shortness of breath with activity leading eventually to trouble breathing at rest. If left untreated, serious complications can occur. Many other conditions can mimic HAPE, and it is crucial for health care professionals to be able to distinguish between HAPE and other disorders. Illnesses that may present similarly to HAPE include pneumonia, a blood clot in the lung (pulmonary embolism), and chronic obstructive pulmonary disease (COPD) or asthma. Health care providers take a thorough history which along with the physical exam, blood tests and imaging help narrow the diagnostic possibilities.
- Pneumonia: In both HAPE and pneumonia, shortness
of breath, fast breathing, and a fever occur. Normal oxygen saturations are above 90%. In our experience, patients with pneumonia at altitude do not have low oxygen, unless complicated by HAPE, when it can be as low as 37%. Patients with pneumonia feel a lot worse than those with
HAPE. HAPE typically responds to high flow oxygen showing rapid improvement over a few hours. Pneumonia with low oxygen saturations will lead to immediate hospitalization. - COPD/Asthma: High altitudes may exacerbate COPD or asthma. How providers tell the differences is through something called
pulmonary function tests. This tests how well your lungs work and involves breathing into a device before and after being given albuterol.
If the peak flow test improves after the albuterol, then COPD or asthma are the more likely diagnosis. These patients usually improve on medication and do not have to leave the emergency department with oxygen.
The provider needs to be made aware of any history of COPD , asthma, vaping or smoking.
Miranda Bellantoni, FNP-Student
- Luks AM, Swenson ER, Bärtsch P. Acute
high-altitude sickness. Eur Respir Rev 2017; 26. - UpToDate. Distinguishing HAPE from Pneumonia
2018. - Brusasco V, Martinez F. Chronic obstructive
pulmonary disease. Compr Physiol 2014; 4:1.
