Anyone who travels to areas of high altitude is at risk for high altitude pulmonary edema (HAPE). Classic HAPE symptoms include a dry 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 that may cause similar symptoms. 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. Your health care provider will take a thorough history, but the following outlines the differences between HAPE and other similarly presenting conditions.

• Pneumonia: In both HAPE and pneumonia, shortness of breath, fast breathing, and a fever occur. Normal oxygen saturations are above 90%, and if you have HAPE or pneumonia, these could be as low as 60 %. However, if you have pneumonia, you will feel a lot worse than if you have HAPE. HAPE typically responds to high flow oxygen and you will get better over a few hours. Whereas if you have pneumonia with low oxygen saturations, you will need immediate hospitalization.
• COPD/Asthma: High altitudes may exacerbate your COPD or asthma. How providers tell the differences is through something called pulmonary function tests. This tests how well your lungs work. Your provider will have you breath into this device before and after being given albuterol. If your lung tests improve after the albuterol, then COPD or asthma are the more likely diagnosis. It is important to tell your provider if you have a history of COPD or asthma, and if you are a current or former smoker.
• Pulmonary Emboli (PE): Patients with a blood clot in their lung typically have the same symptoms as HAPE but will sometimes also have chest pain when taking deep breaths. You may also have blood in your sputum and/or calf pain or swelling. You are more at risk for a PE if you have had a recent orthopedic surgery (such as a hip or knee replacement), you have an irregular heart rate, have a clotting disorder, smoke, or are on birth control. If you have these risk factors and additional symptoms, your provider may order a lab test called a d-dimer  and a chest CT scan to help distinguish between a blood clot or HAPE.

If you are experiencing any of these symptoms, it is important to go see a health care provider immediately. A thorough history and exam will help aid in the correct diagnosis and prevent any potential complications. And most importantly, will help you get back on track to enjoy your high-altitude vacation and living!

Miranda Bellantoni, FNP-Student

1. Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev 2017; 26.
2. UpToDate. Distinguishing HAPE from Pneumonia 2018.
3. Brusasco V, Martinez F. Chronic obstructive pulmonary disease. Compr Physiol 2014; 4:1.