High Altitude and Common Medical Conditions

Abstract

Increasing numbers of people are traveling to high altitude for work or pleasure. Given the prevalence of medical conditions in the general population, it is likely that many of these travelers will have one or more underlying medical problems. Unsure of how they will tolerate high altitude, these patients often seek input from their primary care physicians or travel clinical providers to determine if it is safe for them to make such a sojourn and, if so, what precautions should be taken during their trip to avoid problems that might lead to unplanned interruption of their trip. Clinicians faced with these concerns must address whether the underlying medical condition could be adversely affected by the hypoxic environment or alters the traveler’s risk for developing high-altitude illness. This chapter provides information to guide clinicians in answering these questions as they pertain to patients with a wide variety of medical problems including pulmonary diseases such as chronic obstructive pulmonary disease, asthma, and obstructive sleep apnea; cardiac problems including coronary artery diseases, cardiomyopathy, and adult congenital heart diseases; as well as gastrointestinal, endocrine, hematologic, neurologic, and renal disorders. For each disorder we consider the primary challenges faced by those patients at altitude and provide recommendations for pretravel assessment as well as risk mitigation during the trip. The chapter concludes by considering medication use at high altitude and, in particular, whether medications used for treatment of underlying disorders have the potential for adverse interactions with medications used in the prophylaxis and treatment of acute altitude illness and whether the dose and choice of altitude illness medication needs to be altered depending on the patients underlying health issues.