|This information is intended to be educational in nature and should not be construed as medical advice. You should consult your physician regarding any specific medical conditions or questions and before taking any medications.|
High Altitude Bronchitis
Development of a persistant cough at high altitudes is a problem well-known to climbers, but surprisingly little research has been done on this problem. Sojourners to high altitude find themselves hyperventilating to acquire scarce oxygen, and the air that they are breathing is both cold and extremely dry. At elevations of 4000 m (14000 ft) and higher the presence of a cough becomes increasingly common.
I feel, based on my own clinical observations as well as discussions with other physicians experienced with high altitude medicine, that this condition probably represents a cold-dehydration irritant bronchitis. It is characterized by a persistant, sometimes paroxysmal cough. In climbers it may become so forceful that rib fractures occur. It may be productive of purulent green sputum. It is not associated with a fever, with shortness of breath, or with desaturation. If any of these are present with a cough, the diagnosis of HAPE (High Altitude Pulmonary Edema) MUST be considered first.
I have not found antibiotics to be helpful. Evaluation and treatment is centered around exclusion of HAPE, and symptomatic treatment of the cough. Use of a scarf or mask to warm and humidify air can be helpful both in preventing and treating this cough. Hard candies or cough drops, when used nearly continuously, can also provide significant relief. Our favorites are peppermint candies, hard lemon candies, and Fisherman's Friend® throat lozenges.
I feel that modest doses of narcotics are safe, and typically use codeine 30 mg
every 3-4 hours, for cough suppression. Results are mixed with regard to cough control,
but higher doses may cause loss of judgement, and could be risky with regards to
respiratory depression at altitude. Alternatives include
hydrocodone 5-10 mg every 3-4 hours, or benzonatate (Tessalon Perles®) 100 mg
every 6-8 hours.