High Altitude

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Introduction

           High altitude is when the height of a structure or object is above the level of reference which is usually the sea level or earth’s surface; it is mostly referred to above 1500m. The high altitude areas are distinguished into three, high altitude, very high altitude and extremely high altitude (Gallagher & Hackett, 2004). Various changes are witnessed in high altitude areas with the most common one being that the temperature is usually colder and the air thinner; hence if one wants to survive they are required to adapt and acclimate to ensure they can survive with the less oxygen. The discussion below will focus on training in high altitude areas, illnesses that can result in working on such areas and their prevention and treatment.

           Firstly, to adapt to the altitude acclimation is necessary and involves one maximizing the oxygen amount entering the lungs from the heart achieved by breathing faster and deeper. Also, so that the muscles and the brain have a sufficient supply of oxygen requires the heart to pump more blood. According to Berglund, (1992) after training in high altitude areas the performance of athletes improves. Unfortunately, the data that supports that one’s performance improves in sea level after training in high altitude areas are inconclusive and ambiguous. The reason for this increased performance is attributed to be the Hypoxia-induced secondary polycythemia that increases the work capacity. After one is exposed to hypoxia, haemoglobin and haematocrit concentration is said to increase this stems from the plasma volume decrease which is then followed by erythropoiesis per se increase. Iron availability is one nutrition factor that regulates erythropoiesis among most people and its storage at adequate levels is required to ensure that there is an adaptation of haematological to hypoxia. While adequate iron is required in high altitude areas at moderate altitude there is a risk even if they are sufficient since rapid mobilization is usually needed to ensure the synthesis of haemoglobin at optimal. Unfortunately, while training in high altitude areas increases the athlete’s performance and is preferred because of the benefits of hypoxia training they are various illnesses that result in the event the athletes are not able to adapt or acclimate.

High Altitude Illness

           According to Gallagher & Hackett, (2004), the occurrence of the various illness among human differs not only because of the differences in individual physiology and anatomy but also from genetics disparities. The variables that determine whether an individual is prone to high altitude illness include sleeping altitude, ascent rate, barometric pressure, pre-existing illnesses, and temperature; those aspects that increase an individual prone to the illnesses are divide into intrinsic, environmental and behavioral factors. In regards to the ascension rate, the incidence of the illnesses increases as this rate increase and an individual with previous illnesses of high altitude conditions is more prevalent to get the illness. Concerning the prevalence of the conditions among individuals of different gender and age, these conditions are more prevalent in men since they are hardly on statistics on women. Also, AMS is prevalent between main sexes while HAPE and HACE are prevalent in males and all the conditions are in younger adults and children than adults above 50 years. The use of substance use also exposes an individual to the illnesses since the substances affect the sleeping patterns. However, physical fitness does not provide the prevalence of suffering from the conditions and pre-existing medical conditions too do not expose one to the illnesses.

           To ascertain the risk factors for the various high altitude conditions a study was conducted. The sample collected for the study was 3,994 sea-level incidents who went for a consultation on altitude medication for the first time before embarking on a journey of 3500m and above in a span of 17 years,1992-2008. For the baseline, the residents were questioned on their family and personal medical history, objectives of the journey, treatments, demographic characteristics and usual physical activity. The subjects were then classified as susceptible if they had previous experiences severity in AMS, HAPE, or HACE and the rest unsusceptible if they have never been in high altitude areas before the study. Also, the subjects underwent physiological measurements and later, during the study they were required to fill a questionnaire and indicate any symptoms of HAPE, HACE or AMS they might have and send it back after the end of the mountaineering activity. Moderate AMS was quantified as less than 6 while sever one was a minimum of 6, HAPE symptoms were recorded after any signs of respiratory issues and HACE was termed as neurological deficits. From the results of the questionnaires the subjects were classified into no or moderate AMS, severe AMS, HAPE or HACE; those with HAPE, HACE, and severe AMS were said to have serious high altitude sickness. After the study 1,326 subjects who accounted for 33.2% of the sample returned their questionnaires, despite the respondents being a bit older than the respondents there was no major difference between the two. Additionally, 318 of the 1,326 subjects experience serious high altitude sickness with 105 of the users of ACZ and 213 were nonusers. The study was among the recently published work offering insights in high altitude illness and the high population sample used was one strength of the sample. However, the study was prevalent for bias because of the low response rate hence to ascertain the findings of this study further studies are recommended.

           Acute Mountain Sickness(AMS) is the first illness and according to Lake Louise Consensus Committee is a headache and another symptom among the following vomiting, fatigue, nausea, weakness, loss of appetite, dizziness or sleep disturbance. The headaches are severe in the night and early mornings and are caused by altitude above 2500m, the symptoms depiction are prevalent 6-12 hours after climbing. While the illness is not serious and may cause a delay in the climbing if not identifies can lead to more severe illness either high altitude pulmonary oedema (HAPE) or high altitude cerebral oedema (HACE). However, to confirm the diagnosis a clinical diagnosis should be ascertained and not reliance on physical findings. Luckily, the illness requires just one to stop the climbing and take a rest but in the event, one cannot descent because of the weather drugs and oxygen may be administered. 

           Additionally, we have HACE illness which is life-threatening but rare and occurs mostly to those who ascend to 4500m and its preceded by AMS. There are various symptoms associated with the illness, among them altered consciousness; the progression from AMS will have the person showing symptoms like hallucinations, ataxic disorientation, confusion and irrational. The treatment of the condition requires immediate descending and heel-toe walking is recommended to gauze the ataxia the symptoms which can persist even when treatment of the condition has been given. The hyperbaric chamber can be used for descent. The chamber has been in use since 1980 and the patient is laid in the bag flat and strokes are pumped to maintain the pressure inside, the recommended time is about 2 hours. Unfortunately, any patient whose condition has necessitated using the chamber should descent immediately she starts feeling better.

           Moreover, HAPE is another condition and is common among people who have rapidly ascended to 4500m and can occur concurrently with HACE. The condition too can be preceded by AMS and its signs include a dry cough which can then progress to become wet and bubbly with sputum; in rare cases, it can be bloodstained. To treat the sickness oxygen must be provided immediately and descent too and the patient if cannot walk should be carried while sitting and kept warm (Hackett & Roach, 2001). 

Prevention of Altitude Illness

           As more athletes continue to prefer the high altitude training to ensure they have a competitive advantage over their competitors, the illness associated with the high altitudes is inevitable. However, prevention is better than cure and in this case, the athletes should first ensure that they acclimate; this takes different time between people. Also, rapid ascension should be prohibited and rest is recommended after every 3000m ascension and when a patient shows signs of the conditions descent should be done. Additionally, for athletes who are more prone to the conditions medications should be administered. Unfortunately, HAPE illnesses have been said to cause death in few cases and after some trials, it has been acknowledged that taking medications a day prior to ascent has reduced the risks of this illness (Hackett & Roach, 2001). While most studies and study have depicted that athletes prefer to train in high altitude to enhance their performance a study by US Army Public Health Command this is contrary to their findings(MA Qadar, 2013). The study claimed that at high altitude the less oxygen leads to breath shortness and increases the heart rate which in the long run can result in reduced memory, judgment, attention and can decrease the night vision.

Conclusion

           High altitude while is associated with various illnesses that even in the rare case can result in death remains a preference area for raining for the athletes. The notion can be attributed to the fact that by performing great at this area reflects their exemplary performance at moderate altitudes. The conditions that are bound to happen if the athletes are not able to adjust to the conditions in these areas symptoms can only be clinically diagnosed and not relied on any physical observations. The high altitude illnesses are treatable and can be prevented but all they depict is that any prevalence of them requires abandoning the ascension and can be achieved by using the hyperbolic chamber too. Moreover, from all the studies that have been conducted recently, they have been depicted that while training in these areas predicts better performance in moderate altitudes the ramifications, in the long run, are disastrous and hence it should not be advocated. While mountaineering is fun it stands a better chance if it is only used for recreational activities and not sporting activities since one someone suffers from the high altitude areas future effects are more.

References

Berglund, B. (1992). High-Altitude Training. Sports Medicine, 14(5), 289-303. https://doi.org/10.2165/00007256-199214050-00002

Gallagher, S., & Hackett, P. (2004). High-altitude illness. Emergency Medicine Clinics Of North America, 22(2), 329-355. https://doi.org/10.1016/j.emc.2004.02.001

Hackett, P., & Roach, R. (2001). High-Altitude Illness. New England Journal Of Medicine, 345(2), 107-114. https://doi.org/10.1056/nejm200107123450206

MA Qadar, K. (2013). High Altitude Illness and Adaptation: Hints from Proteomics. Journal Of Proteomics & Bioinformatics, s3. https://doi.org/10.4172/jpb.s3-004