She died on the Breckenridge bike path clutching her inhaler, I heard. For years I was reminded by a memorial along the path. Then another man called last week say he is selling his house located at 10,500 feet because his trouble breathing interferes with skiing and rock climbing. “I use my inhaler 50 times a day,” he told me. “The doctor said I have asthma.”  Recently two doctors in Summit County have started to question whether some people living at high altitude may have another cause of their breathing problems such at high altitude pulmonary edema or pulmonary hypertension.

I frequently see children in my office with a respiratory illness and low oxygen, with readings in the 80’s or below. They are not leaning forward, gasping for air, using their rib muscles to breathe, like a person with an asthma attack severe enough to cause low oxygen. They do not have wheezes heard with the stethoscope. We usually give a trial of albuterol, since the medicine has minimal side effects and asthma is a common condition, but it rarely makes a big difference. We also test peak flows on patients over 5 to try and measure airway resistance seen in asthmatics. Then we send them home on oxygen, the treatment for high altitude pulmonary edema, and they get better.

Many of the families whose children need oxygen during illnesses are evaluated by lung specialists at Colorado Children’s Hospital or National Jewish Hospital. They are all told they have asthma and treated with inhaled steroids and albuterol. Pulmonary testing in the older children suggests reversible airway disease in about half. Recently the pulmonologist told us he does not believe the child had HAPE and requested a chest x-ray at the time of any future episode.

“Fulminant cases of HAPE do show dramatic changes in the x-rays, such as a recent case of a six year old who returned from sea level and overnight his oxygen dropped into the 40’s. But when we see patients with milder illness they often have clear lungs and the chest x-ray will not be abnormal until a day or two later. I rarely orders x-rays to make the diagnoses.

Since the pulmonologists are skeptical about the occurrence of HAPE in residents at high altitude, Dr. Ebert-Santos is proposing the syndrome be called “Acute Hypoxia of High Altitude Residents” or AHHAR. We need to figure out what is going on with our lungs at altitude. I’m trying to organize research concerning these issues.

Mary told me about two of her daughter’s friends whose families had to move after the girls had recurrent high altitude pulmonary edema (HAPE). This is easy to recognize in it’s classic form: a tourist has trouble breathing during the first 48 hours at altitude. But these girls lived here, and got sick returning from visits to lower latitude, which we call “reentry” HAPE. Both forms are not common, probably less than one out of one thousand people are affected. Certain people are more susceptible. Luckily it is prevented by taking diamox (acetazolamide) before traveling.

For families who live here I recommend buying a home pulse oximeter for less than $50 at Walmart or Walgreens. The affect person can have oxygen ordered by their doctor and delivered to the home if readings are below 90% saturation. The good news is that it doesn’t happen every time they travel and they tend to outgrow reentry HAPE in the teen years.