Journeys to High Altitude—Risks and Recommendations for Travelers with Preexisting Medical Conditions

Abstract

A literature review was completed using Ovid/ Medline (1950–Present) and Pubmed databases. The following search terms were employed: preexisting medical conditions and altitude, each individual condition and altitude, air travel and preexisting medical conditions, and high altitude medicine. Published articles were used as a source of further references not yielded by the primary search. Textbooks written by recognized experts in the field of high altitude medicine were consulted to source information not available elsewhere. The demographics of adventure travel are shifting. Expanding road, rail, and air networks as well as mechanized mountain lifts have rendered it increasingly possible for people of varying levels of health and fitness to reach remote high altitude destinations (Table 1). 1 High altitude cities and employment sites also attract holidaymakers, workers, and business travelers (Figure 1). 2 Passive ascent to altitude by airplane, automobile, train, hot air balloon, or cable car may result in sudden exposure to altitude without adequate time for acclimatization. View this table: Table 1 Altitude definitions 1 Figure 1 Relative elevations of selected high altitude destinations. The environmental conditions at altitude and the associated hypobaric hypoxia pose a significant physiologic challenge to the human body (Figure 2). Furthermore, many high altitude sojourns include strenuous physical activities such as skiing, hiking, and climbing. Emergencies in remote locations demand that the sick or injured rely on their companions or on their own compromised abilities to access the medical help they need. The conscientious traveler will take steps to gain the knowledge and skills necessary to minimize personal risk. However, many at‐risk travelers remain naive to the health risks of high altitude travel. 3,4 Similarly, physicians should prepare themselves with the knowledge required to advise their patients on safe travel to altitude (Table 2). The need for knowledge and preparedness is especially critical in the case of individuals with … Corresponding Author: Kelly Mieske, BSc, Department of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland. E‐mail: k.mieske1{at}nuigalway.ie