Asthma and high altitude

Asthma and High Elevation Activity

My boys wanted to go snowboarding and in the back of my head, I kept thinking, “What about my asthma?” We loaded our car and went on a fun mountain vacation. Once we arrived at our mountain destination and started unloading the car, it seemed everyone was breathing harder. My boys asked me why they were breathing hard and I explained that at high elevations (5,000 feet to above sea level, 11,000 feet), we experience hyperventilation.

Understanding Asthma

Asthma is a long-term lung condition where the lungs become inflamed and air passages become narrowed. This is what causes asthma sufferers to wheeze, experience chest tightness and shortness of breath. My fellow RN Remedies blogger writes more in depth about asthma here. Asthma symptoms include:

  • Coughing—For some children, coughing is the only symptom of asthma. It may occur only at night or during exercise
  • Chest tightness or pain
  • Shortness of breath (faster, shallower breathing)
  • Wheezing (a high-pitched whistle when breathing)

Why High Elevation Triggers Asthma

If your child has asthma, they may experience struggling for air in high elevation territory because the amount of oxygen in the air decreases as altitude increases. Lungs will struggle for air and deep or quick breathing can occur. When the air is dry, especially during the winter months, it can also trigger asthma. When your child inhales cold, dry air, it can dry the mucus membranes lining their lungs. Mucus membranes are your child’s natural defense mechanism against viruses and bacteria. When your child’s mucus membranes are dry it can activate allergy symptoms. Considering 75 percent of asthmatics have allergies, this is important information to know. Continue reading! If your child’s asthma is stable, altitude will generally have little effect on their asthma. “If your child’s asthma is severe and you’re interested in traveling to high altitude, your child should see their doctor ahead of time to assure they are taking proper medications and that your child’s asthma has stabilized,” says Arnold Platzker, MD, from the Division of Pediatric Pulmonology at Children’s Hospital Los Angeles.

Altitude Sickness and Asthma

I reached out to Ronald Ferdman, MD, physician in the Division of Clinical Immunology and Allergy at Children’s Hospital Los Angeles and he brought up a great point about altitude sickness and asthma—anyone is at risk for altitude sickness (headache, loss of appetite, dizziness) and having asthma doesn’t increase your chances. Parents may confuse symptoms of severe altitude sickness with asthma. If your child is not responding well to their asthma medications, then it’s likely they are experiencing altitude sickness.

Manage Asthma during High Elevation Activity

During the winter months, families enjoy traveling to the mountains to enjoy winter sports and activities, like skiing, snowboarding, sledding and ice skating. But, if your child has asthma it can be an undesirable experience for them. Here are some ways to manage your child’s asthma during high altitude fun:

  • Always bring your child’s prescribed asthma rescue medication, such as their inhaler.
  • Store your child’s inhaler in a warm spot, like your pocket. Inhalers do not work well in very old temperatures.
  • Encourage your child to wear a scarf over their mouth and nose to help warm up cold air and decrease irritation.
  • If your child has an asthma attack on the mountain, help your child stay calm and relaxed. Coach them to take slow, deep breaths while giving their prescribed rescue medication.

If your child has difficulty breathing or if they are bending over to breathe, flaring their nostrils or raising their shoulders to breathe is most likely in distress. If they are in distress or if a child’s lips or fingernails turn blue, go to an emergency room immediately.

Discussion

In this study we evaluated a small group of patients with asthma during an expedition to extreme altitude as well as during the preparation phase. The main findings of our study were: (1) patients with asthma with adequate asthma control are able to climb to high altitude (>4000 m); (2) exposure to environmental conditions at high altitude (hypoxia, exercise, cold) was associated with a moderate loss of asthma control and neutrophilic airway inflammation; (3) the cold temperature probably features as the most important contributing factor, as 24-hour exposure to cold by itself induced increased airway obstruction and increased airway neutrophilia; (4) climbing to altitudes >4000 m was associated with a small restrictive impairment of dynamic lung volumes and 17% of the patients with asthma experienced severe AMS; (5) asthma patients with the lowest oxygen saturation at the end of a maximal exercise test during hypoxia were more prone to develop AMS during the expedition.

In our study we found a loss of asthma control after the expedition at high altitude that was associated with increased asthma symptoms and rescue medication use as well as a reduction in pre-BD FEV1. Nevertheless, most of the patients with asthma were able to climb to high altitude (>5000 m) and only one patient experienced a severe asthma exacerbation. As a result, we feel that climbing to high altitude should not be considered as a contraindication for patients with asthma who are well-controlled and who take appropriate preparatory measures. This agrees with previous data in the literature, although limited information was available about the exposure of subjects with asthma to high altitude and the suitability of mountaineering as an appropriate form of sport for them. In a study by Golan et al,13 147 patients with asthma were identified who had engaged in high altitude trekking. Two independent risk factors for attacks during travel were identified: frequent use (>3 times weekly) of inhaled bronchodilators before travel and participation in intensive physical exertion during treks. Cogo et al14 studied the effect of high altitude on bronchial hyperresponsiveness both at Capanna Regina Margherita (4559 m) and Pyramid Laboratory in the Himalayas (5050 m) in a group of 11 patients with mild asthma in a stable condition and with normal respiratory function at sea level. None of the patients participating in these studies experienced a severe asthma exacerbation. A significant reduction of bronchial responsiveness to both challenges was demonstrated at the highest altitude.14 ,15 Huismans et al evaluated 24 patients with asthma during trekking at high altitude in the Tibetan Everest region.5 Asthma symptoms did not significantly increase during the expedition. Similar to our data, two of the 24 subjects in this study experienced a severe asthma exacerbation and 40% had increased medication use. There may be a number of reasons for the relatively low incidence of acute asthma exacerbations in our study and previous studies. The patients with asthma who participated were selected on the basis of adequate asthma control and asthma medication was optimised several months prior to the expedition. Allergen avoidance at higher altitude with subsequent improvement of bronchial responsiveness and airway inflammation may also result in a favourable effect on asthma symptoms.6 ,16 ,17 A few studies documented higher levels of catecholamines and corticosteroids during the first 2 weeks of altitude exposure.18 ,19 Increased plasma epinephrine and steroid concentrations, in addition to the anti-inflammatory treatment, can also reduce hyperresponsiveness and subsequent symptoms in subjects with asthma.20–22

Despite the fairly moderate increase in asthma symptoms and medication use as well as a limited reduction in pre-BD FEV1, we have shown that the expedition resulted in increased airway inflammation with a predominant neutrophilic infiltration into the airways. PeNO values were measured during the expedition and tended to decrease slightly. Similarly, sputum eosinophils evaluated after the expedition did not increase significantly. However, the absolute and relative number of neutrophils in sputum significantly increased, which is an important observation in our study. There are no previous studies evaluating airway inflammation in subjects with asthma or normal subjects when exposed to high altitude. We hypothesise that the combination of cold air (lowest temperature measured inside tent during the expedition was −16°C) and high ventilation rate may feature as the most important contributing factor in provoking airway obstruction and inflammation, as we showed in these patients with asthma that short-term exposure to cold air (24 h at ≤−5°C in normoxia) prior to the expedition by itself also induced airway obstruction with a significant increase in sputum neutrophils without affecting FeNO levels. These findings are in agreement with studies evaluating airway inflammation in athletes with asthma performing sports that require high ventilation targets in cold circumstances.23 Athletes exposed to cold air have a higher prevalence of asthma and airway hyperreactivity24 and also have a higher density of neutrophils in bronchial biopsy specimens.25 Athletes exposed to cold air also have slightly more bronchial epithelial cells in the airways compared with healthy subjects and their sputum neutrophil count correlated positively with the duration of training.26 This suggests that cold air—whether or not combined with exercise—may negatively affect lung function and induce a neutrophilic type of inflammation different from the eosinophilic/Th2-driven inflammation that is classically seen in patients with asthma. IL-17A is thought to be responsible for attracting neutrophils to the site of inflammation via induction of IL-8 in airway structural cells.27 The source of IL-17A in the airways of patients with asthma is a matter of debate. In patients with newly diagnosed cystic fibrosis, CD4 T lymphocytes express IL-17A in the airway wall.28 Neutrophils themselves may produce IL-17A in patients with cystic fibrosis and thereby contribute to a positive feedback loop.28 ,29 A high ventilation rate or long-term exposure to cold air may directly damage the airway epithelium and activate the immune system. Serum CC16 levels were measured to evaluate airway epithelium damage, but no difference was detected when evaluated after the expedition. Increased serum CC16 levels might, however, be a measure of acute damage and therefore no longer elevated 72 h after the expedition. On the other hand, a positive correlation was found between sputum IL-17 mRNA levels and serum CC16 levels, indicating a possible relation between airway epithelium damage and activation of the IL-17A/neutrophil axis. Our small study population did not allow us to analyse the impact of cold exposure on different asthma endotypes or phenotypes, but it could be speculated that patients with asthma with a neutrophilic endotype might be more prone to develop increased neutrophilic airway inflammation when climbing to high altitude or exposure to cold.

In addition to cold air, the subjects with asthma were exposed to hypoxia during the expedition. As a result, oxygen saturation progressively decreased and heart rate at rest increased. It is known that VEGF-A is induced by hypoxia.30 We found that both sputum VEGF-A mRNA and serum VEGF-A protein levels were significantly increased after the expedition. VEGF-A may increase vascular permeability and, by doing so, could facilitate transient migration of inflammatory cells to the interstitium and airway lumen. VEGF-A recruits a proangiogenic subset of neutrophils in transplanted hypoxic tissue.31 Placental growth factor, another member of the VEGF family, was shown to induce IL-17A and recruiting neutrophils to the airways in an asthma mouse model.32 Our results corroborate the previous data that VEGF-A may contribute to increased airway neutrophils after exposure to prolonged hypoxia.

A reduction in both FEV1 and FVC was shown in our study during the expedition, which was partially reversible after acclimatisation. This restrictive impairment corroborates previous data showing a reduction in dynamic lung volumes in both normal subjects studied in real and simulated altitude and in subjects with asthma.5 ,15 ,16 Huismans et al observed similar changes in lung function in both patients with asthma and normal subjects with increasing altitude. Several factors may explain the observed decline in lung function such as occurrence of (subclinical) pulmonary oedema, increased central blood volume, reduced respiratory muscle force or a combination of these factors.3 Several of our subjects with asthma experienced minor and transient symptoms of AMS (LLS<5), but only a few developed severe AMS (LLS > 5) which prevented them from climbing to higher altitude. The patients with asthma who experienced severe AMS during our expedition also seemed to have the lowest peripheral oxygen saturation during the preliminary hypoxic exercise test. These findings are in agreement with previous studies that found a correlation between low arterial oxygen saturation and the incidence of AMS.33 ,34 Karinen et al34 also showed that climbers who had high arterial oxygen saturation at rest and after exercise at high altitude were less prone to develop AMS. The pathophysiology of AMS is not exactly known, although hypoventilation, impaired gas exchange, increased sympathetic activity, fluid retention and redistribution and raised intracranial pressure are likely to be involved.35 Hypoxaemia increases the blood flow by vasodilation and, together with an altered permeability of the blood-brain barrier, predisposes to cerebral oedema. Performing a hypoxic exercise test may be helpful in trying to identify those individuals with asthma who are most likely to develop AMS.

Conclusions

Patients with asthma can travel to high altitude when their asthma is well-controlled. Close follow-up is advised because loss of asthma control may occur, the exposure to cold temperatures could promote a neutrophilic airway inflammation and some patients may experience an acute exacerbation. A hypoxic exercise test may identify those patients with asthma who are likely to suffer from AMS when climbing to high altitude.

Although he really can’t predict what will happen, Dr. Mark said that moving from Mesa to Prescott is certainly not contraindicated. He suggests, if possible, first going to Prescott for a couple of weeks in summer and winter to see how you do. He notes that the American Lung Association has its pediatric asthma camp (Camp Not-A-Wheeze) just outside of Prescott. Pulmonary and allergy physicians from Tucson and Phoenix have attended this camp for years and rarely see children with asthma, even severe asthma, do worse in this environment.

A 2007 study from Europe published in the April, 2007, Archives of Diseases in Children that investigated atopic (allergic) children with asthma found that their rate of hospitalization did increase the higher up the kids lived. On the other hand, a 2009 report on U.S. “asthma capitals” found that asthma prevalence in cities at higher elevation (Denver, Colorado Springs and Albuquerque, for example) is quite low compared to other cities.

So while conclusions from research on asthma and elevation appear to be mixed, Dr. Mark says that most patients do as well or perhaps a bit better at elevations like that of Prescott. He cautions, however, that if you go too high (over 9,000-10,000 feet), you may find, as other asthma patients have, that you have more trouble breathing simply due to the dryness of the air.

Andrew Weil, M.D.

Ask the experts

Does climate and/or altitude affect asthma?

Doctor’s response

In general climate and altitude do not affect asthmatics who are in stable condition and whose symptoms are well controlled. Relocating seldom improves asthma. Some people find temporary relief from local pollen allergies but allergy symptoms soon crop up with the new environmental allergens. A person might find relief from asthma symptoms triggered by cold air or big city pollution but the new environment will likely bring different triggers. New forms of treatment focusing on good asthma control, however, can reduce symptoms without uprooting a family.

Altitude likewise has little effect on stable asthmatics. If the asthma is so severe that the person’s blood oxygen is low (very unusual except during an acute attack), being at altitude or on an air flight would further reduce the blood oxygen level. The dry and often cool conditions experienced at significant altitude might trigger asthma symptoms. Humid air is more ideal for keeping the airways moist. Even the effects of dry, cool air, however, can be prevented by keeping the asthmatic condition under good control.

Thank you for your question.

Medical Author: Alan Szeftel, M.D.
Medical Editor: William Shiel, MD, FACP, FACR

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Asthmatics with Altitude: Traveling with Asthma to Higher Elevations8 min read

Annie Sullivan views the world as her oyster. At just 27 years old, she has been to nearly every continent, having traveled to

Annie Sullivan in Antarctica

Antarctica, through the high altitudes of the Andes Mountains of Cusco, Peru, down the Mekong River in Vietnam and Cambodia and through Egypt, Russia and the Galapagos Islands in Ecuador.

So far, she’s been to about 40 countries.

Sullivan caught the travel bug early in life, thanks to her family.

“I think I was about 7 when I went on a cruise to Alaska with my parents and three siblings. We’d taken other smaller trips before that, but that was the first time I really realized how different the world could be,” she says now.

“After that, I knew I wanted to see as much as I could in the time I had on this Earth.”

Not only did her family ignite her desire to see the world, they continued to fuel it.

“It helped that my parents love traveling and took us on amazing adventures. I guess you could say that once I started learning about different cultures, I just kept wanting to know more,” she says.

There was just one hitch to her aspiration to see the world – she was diagnosed with child-onset asthma at a young age.

The hassle of traveling with asthma

“When I was about 18 months old, I began wheezing after developing a cold. Shortly after, I was diagnosed with asthma,” Sullivan says. When she was younger, her asthma was much more severe than it is now as an adult. Periodically, her attacks would land her in the hospital and she had to have nebulizer treatments every four hours in addition to her daily medications.

This course of treatment proved challenging when she and her family traveled.

“The nebulizer treatments presented a difficult problem when traveling because we didn’t have a portable nebulizer. I remember having to stop in McDonald’s and other roadside restaurants on long road trips and to find an outlet to plug my machine into.”

Now, the publicity coordinator at a publishing company and budding author in Indianapolis, Indiana, says she is able to generally control her asthma with medication. But it’s still not all that simple when it comes to traveling.

“I have a portable nebulizer that I take with me on every trip in case of emergencies along with a supply of Albuterol to last at least five or so days, depending on how remote the destination is,” Sullivan says.

If you or a loved one has asthma, you know that albuterol is a medication that comes in an inhaler that relaxes muscles in the airways and increases airflow to the lungs – it’s used to prevent and treat wheezing, shortness of breath, coughing and chest tightness. When traveling, Sullivan also takes the oral steroid medication Prednisone with her as another emergency back-up.

Annie Sullivan at Machu Picchu

Because of her asthma and the potential for environmental elements that can trigger an attack, Sullivan’s condition is at the forefront of her mind when she’s planning her trips.

“I know I may never make it back to Beijing because of the pollution levels there now. I also know to be cautious in Europe because, in my experience, many more people smoke openly there, which irritates my lungs. I was careful in Antarctica to keep my mouth and nose covered whenever the cold air started to hurt my lungs. And I knew that when I went to Cusco in Peru, I’d have to be ready for the altitude change.”

According to Dr. Julie Kuriakose, one of the founders and operating partners of Hudson Allergy in New York City, it’s important to know what your asthma triggers are, especially when traveling.

“The environment can play a tremendous role in triggering asthma attacks. As for why environmental elements can trigger asthma—it’s complicated. Some environmental exposures are simply irritating our airways, other environmental exposures are triggering immunologically mediated allergic reactions and other exposures may be epigenetically modifying our genes,” she explains, noting that asthma triggers can vary from person to person.

Heightened issues – trying to breathe at higher elevations

One such environmental trigger that can impact some people with asthmatics is higher altitudes.

“If your asthma is stable, altitude may have minimal clinical effects. But, at high altitudes, the air might be colder and more dry, both of which are potential asthma triggers,” Dr. Kuriakose says.

When it comes to higher altitudes, it’s not just the cold air that could impact someone’s asthma. The air is also thinner. Since there’s less air pressure, the result is less oxygen. Some people – even those without asthma or other breathing conditions – find that the thinner air can cause them to feel light-headed and fatigued. They may also have more difficulty breathing as a result of the lower oxygen level.

This is exactly the issue Sullivan ran into when she traveled to the Andes Mountains in Peru, which have an average elevation of about 13,000 feet above sea level.

“Every time I climbed a staircase, I felt winded. But in order to see some of the amazing sites that Peru offered, I often found

Annie Sullivan in South Georgia Island.

myself climbing uneven rock staircases with dozens of steps,” she says. “When I felt out of breath, I would sit down and rest. It helped that we had a private tour guide, so I was never holding up the rest of a tour group.”

The possibility that this could happen was something Sullivan was prepared for.

“Before I left home, I knew sometimes I would get winded. I prepared by exercising more so that I was in the best shape I could be.”

Although the cold and lower oxygen content may prompt some people’s asthma symptoms, higher altitudes can actually be beneficial to others, depending on their triggers.

“There may be less allergens in the air at higher altitudes, such as dust mites, which could be beneficial for dust mite allergic asthmatics,” Dr. Kuriakose says.

Don’t stop traveling… but plan ahead

Just because you have asthma doesn’t mean you shouldn’t travel – it just means you have a little more work and planning to do before you take flight.

“I would advise all asthmatic patients to make an appointment with the physician managing their asthma to discuss how to specifically prevent and manage their asthma symptoms prior to traveling. Each patient should have a written asthma action plan,” Dr. Kuriakose recommends.

However, in the case of someone with unstable or poorly controlled asthma, Dr. Kuriakose advises against traveling. Severe asthma is characterized by daytime symptoms throughout the day, nighttime symptoms as often as seven times per week, using a rescue inhaler several times a day, and extremely limited daily activities.

“Asthma severity can change, improve or worsen, therefore your asthma medications may need to be adjusted accordingly. So schedule regular follow up visits with your allergist,” says Dr. Kuriakose.

By meeting with your physician, working with her to get your asthma better managed and under control can put you on the path to traveling the world.

If someone with asthma is on the fence about traveling, Sullivan’s advice is “go for it!”

“Asthma doesn’t define who I am and I don’t let it dictate where I can go. With technology advancing, it’s so much easier to travel today than it ever was before with asthma,” she says.

Annie Sullivan at Bayon Temple in Cambodia

Today’s nebulizer machines are smaller and more portable and it’s easier to keep in touch with your doctors during your travels in case of an emergency.

“Some destinations may not be appropriate for those with severe asthma, but for those with their asthma under control, it’s all in the preparation. As long as you have a plan, like having extra medications, knowing the location of the nearest hospital, and/or looking up local doctors before you leave, then asthma shouldn’t hold you back,” Sullivan says.

If you are asthmatic and planning to travel, here are some things you should be aware of and plan for.

First, you may need to spend a little extra time in airport security.

“More than once I’ve been pulled aside, especially when I traveled with my old, clunky nebulizer, to have the machine tested for bomb residue. Many TSA agents aren’t familiar with what it is,” Sullivan says.

If you are bringing a nebulizer and are traveling overseas, think about if you will need convertors or adapters to plug in and charge devices. You should also make sure to have copies of all of your prescriptions with you. In fact, bring multiple copies and store them in different bags, just in case something happens to your luggage.

If you are bringing the liquid form of one of your asthma or allergy medications, make sure you check what TSA policies are before heading to the airport. You’ll likely need to have some of the medication in your carry-on luggage just in case, so make sure you’re educated about the policies associated with liquid medications.

Speaking of medications, you should take more than you think you’ll need. It’s better to have too much rather than not enough; you could find yourself stranded somewhere or dealing with flight delays.

You should also take the time to research your destination.

“Look into doctors and hospitals close to where you’ll be staying ahead of time so you’re not panicking searching for one if something goes wrong,” Sullivan suggests.

That research can extend into looking for translations if you’re going somewhere where you don’t speak the language.

“Find the translation for asthma and how to ask for a doctor or hospital, so that you can take it with you for emergency purposes.”

And, of course, you should look into what potential asthma triggers you could run into in your destination.

“When planning a trip, I always do a lot of research into what vaccines I might need. In doing so, I usually come across any other medical issues that are commonly triggered in the area. I look for anything that might trigger my asthma so that I can be better prepared for it,” she says.

This prep work also includes meeting with her doctor before going to any destinations where medical assistance might not be readily available or where there is a language barrier. This pre-travel doctor’s visit also provides the opportunity to make sure you have enough emergency supplies of your medication.

“I think things like elevation, climate and pollution should always be considered when someone with asthma is planning a trip. But they should never hold someone back. There are often solutions, like smoke-free restaurants and hotels, wearing masks to help combat pollution and keeping yourself covered up in harsh climates,” Sullivan says.

So be smart about your asthma when traveling.

But don’t let it stop you.

  • Categories: Allergies, Asthma, Featured, Health, Medical Conditions, Travel Tips, Uncategorized
  • Tags: healthy travel

Nicole Jenet 1:10 pm

High Altitude and Asthma

Recently, we took a trip to Moab, Utah to hike in Arches National Park and see the world famous Delicate Arch. The elevation is a little over 4,000 feet which is about the same altitude of where I live, but that altitude can still cause problems for some people.

In fact, we had a friend traveling with us from Australia and we kept checking on her to make sure she was okay with the change in altitude. Some people (even if they don’t have asthma) have a hard time at higher elevations and can experience altitude sickness. When you have asthma, it can be harder to breathe at higher altitudes.

When your asthma gets triggered

I had a tough time that day. With asthma, there can be lot of things added together that make it hard to breathe. The first thing that happened was our hotel room. I’m not sure what set off my asthma, but I woke up during the night sneezing and coughing and my chest was tight. So, I started off the day with a couple of puffs of Albuterol.

Then we headed to Arches National Park to hike to Delicate Arch. The trail is 3 miles round trip, and it is pretty steep. It was very hot too – almost 90 degrees that day (and heat is another asthma trigger.) We had lots of water, and were dressed appropriately, but I was not sure if I could make it up the trail.

Off we went – but I only made it about 1/4 of the way. I stopped to try and catch my breathe and have some water, but quickly realized that I shouldn’t continue on. Since Exercise is another asthma trigger.

At first I was a frustrated, I had prepared well and even brought hiking sticks to help me up the steep parts of the trail. But I knew that starting out the day with tight lungs from a dusty hotel room, being in the heat, and hiking a steep trail was probably not a good mix.

So, our friend and family continued on up the trail. I started back down the trail to wait in the car. I had a long trail back to the car to think. As I hiked alone back to the car, I saw a vulture circling overhead! If I wasn’t so tired, it would have been funny! Did I look that bad trying to hike back down the trail? The vulture was out of luck because I was going to make it back to the car!

When you realize, you need to stop

I had lots of time to reflect on my decision (that’s the problem with hiking – you usually go further than you realize and then have to hike all the way back.) When I crested the last hill, I could see the parking lot and was SO glad I had decided not to finish the hike.

I realized that instead of being disappointed, I should be glad my body let me go that far up the trail. And I listened to my body! Normally I would have pushed through the hike (because who wants to be the weak person that has to drop out of an activity?)

But this time, I listened to my body. And I respected it for how well it had held up. My lungs can only take so much, and a dusty hotel room, hot temperatures and high elevation had overwhelmed them.

Be careful in high elevations and don’t be afraid to slow down if your asthma is flaring up. After all, we only have one set of lungs so we need to take care of them and they will take care of us.

High-Altitude Asthma Treatment

Could Rocky Mountain high be the answer for severe asthma treatment? Over the years, a number of studies have shown that people with severe asthma can benefit from high-altitude treatment or living at a high altitude for an extended amount of time. High-altitude means 1,500 to 2,500 meters above sea level, or about 5,000 to 8,200 feet. Think Denver, Colo., and Albuquerque, N.M.

Treating asthma in high altitudes is not a new idea, says Clifford Bassett, MD, a spokesman for the American Academy of Asthma, Allergy and Immunology and director of Allergy & Asthma Care of New York. For more than a century, people with lung diseases including asthma have been sent to the mountains as treatment. In fact, the country’s leading hospital for respiratory diseases, Denver’s National Jewish Health, was established in 1899 to care for people with TB who migrated to the area because the climate seemed to offer relief.

What is it about high-altitude treatment that’s beneficial? “We know that when you have higher altitudes, there tend to be less living indoor allergens like dust mites,” says Dr. Bassett. “Dust mites don’t thrive well at elevations over 2,500 feet.”

Dust mites are miniscule bugs — too small to see — that live in bedding, carpet, and some fabrics. Some people are allergic to their body parts and droppings. If you have asthma and are allergic, come in contact with dust mites, and it can trigger an asthma attack.

Less Pollution at Higher Altitudes

The air is also clearer at higher altitudes. Air pollution causes the inside of the lungs to become inflamed, making it hard for those with asthma to breathe. The less air pollution, the better their asthma control.

A study published in the European Respiratory Journal found that adults with severe asthma who underwent treatment in Davos, Switzerland, which is at an altitude of about 5,250 feet, improved regardless of whether they had allergies. At the end of 12 weeks of treatment, the participants not only had better lung function, but also were able to use less medication to treat their severe asthma while living in the mountain climate. The researchers see high-altitude treatment as a promising therapeutic option for people who have severe asthma.

Still, Bassett isn’t convinced that taking someone with moderate to severe asthma and sending him to a high-altitude resort will make his asthma better. “I don’t think it is that simple,” he says. “I think it’s interesting and unique, but I’m not sure you can apply high-altitude asthma treatments to the real world. I don’t think it’s ready for prime time.”

Bassett suspects that perhaps the patients in the high-altitude treatment study had better compliance with their asthma treatments — research participants are handed their medications and know they are being watched, he says.

The Downside of Higher Altitudes

Higher altitudes could actually pose problems for some people with asthma. Higher altitudes tend to be colder, and some people’s asthma is triggered by colder temperatures.

The air is also thinner at higher altitudes. There’s less air pressure and, as a result, less oxygen. Some people find the thinner air causes them to feel light-headed and fatigued, and they can experience insomnia, palpitations, loss of appetite, diarrhea, and stomach pain. You may also have more difficulty breathing because of the lower oxygen content, Bassett notes.

Bassett is all for controlling asthma with environment. He goes so far as to give his patients a list of house plants that can help purify the air and help them breathe easier. But should high-altitude be added to the list of asthma treatments? Maybe for some, Bassett says, but it’s too soon to say for sure.

SATURDAY, Oct. 4, 2003 (HealthDayNews) — Depending on what kind of asthma you have, your condition can worsen or improve at higher altitudes.

According to Britain’s National Asthma Campaign, there is about half the oxygen at heights of 18,000 feet than there is at sea level. Problems don’t usually occur until about 8,000 feet, though, and only occasionally as low as 5,000 feet.

Less oxygen means your body has to find ways to adapt. In the first several days at high altitude, you’ll increase your breathing rate and volume to take in more oxygen. Over the course of several weeks, your body starts producing more red blood cells, which transport oxygen to the cells, so the cells stay properly oxygenated.

Once you’re acclimatized to the new altitude, the asthma shouldn’t pose a problem, the National Asthma Campaign says.

On the other hand, people whose asthma is triggered by dust mites could experience dramatic improvement at higher altitudes. That’s because the house dust mite can’t survive above the snow line.

Heed this advice for problem-free traveling, even at high altitudes:

  • If you’re planning a trip that will involve visiting high altitudes, talk to your doctor several weeks before leaving so you can agree on a management plan, the National Asthma Campaign advises.
  • Be aware that higher altitudes tend to have colder temperatures, which can exacerbate asthma in some people. Climbing may also trigger exercise-induced asthma.
  • If possible, ascend slowly over the course of several days so your body has time to adapt.
  • Make sure to carry your medication and inhaler with you at all times.
  • Warm pressurized inhalers with your hands before using. They may not work properly in freezing conditions.

More information

The American Academy of Allergy, Asthma and Immunology has more on asthma.

Does high altitude affect COPD?

Share on PinterestPeople with COPD should change altitudes slowly.

Tips include:

1. Plan

Taking the time to plan can help people with COPD limit the effects of traveling to high altitudes.

Aim to change altitude as slowly as possible. A gradual adjustment is especially important for people with COPD.

One study of acute mountain sickness (AMS) suggests that the optimal rate of ascent should be no more than 500 m per day (about 1,640 ft) when starting at elevations higher than 2,500 m (around 8,200 ft) above sea level.

2. Talk to a doctor or pulmonologist

High altitudes can cause a range of health issues, including high-altitude pulmonary edema (HAPE). This potentially life-threatening condition involves fluid in the lungs, and it can occur in otherwise healthy individuals.

People with COPD are more vulnerable to altitude-related illnesses, including HAPE.

Other factors that increase susceptibility include:

  • a history of altitude sickness
  • quick increases in altitude
  • final altitude
  • how cold the area is
  • how much exercise a person does at a high altitude
  • the use of alcohol or sleeping pills

A doctor can advise about the best ways to reduce risk. They can also perform tests to assess fitness for flying or traveling to high altitudes.

3. Test COPD symptoms

To determine whether it is advisable for a person with COPD to fly or travel, a doctor may perform the following tests:

  • Spirometry. This involves breathing into an instrument called a spirometer, which measures lung function.
  • Diffusing capacity test. A person exhales, and the doctor sends the collected air for analysis.
  • Arterial blood gas test. This measures oxygen and carbon dioxide levels in the blood.
  • Oxygen saturation test. Results indicate how many red blood cells are carrying oxygen.
  • The 6-minute walking distance test. Doctors use this to determine a person’s capacity for functional exercise.
  • Hypoxemia prediction equations. These check for a low concentration of oxygen in the blood.
  • Hypoxia inhalation test. This helps determine whether enough oxygen is reaching the tissues.

After performing these tests, a doctor may recommend traveling with supplemental oxygen.

4. Take it easy at high altitudes

Limiting exercise, alcohol consumption, and the use of sleeping pills during the first 2 days at a high altitude may minimize the occurrence and severity of symptoms.

Results of a study published in Sports Health indicate that athletes may be especially vulnerable to acute high-altitude illness. The authors emphasize that changing altitude slowly helps to reduce strain on the body.

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