Correspondence

Critical Remarks

Dtsch Arztebl Int 2012; 109(25): 445-6. DOI: 10.3238/arztebl.2012.0445b

Küpper, T; Gieseler, U; Löllgen, H

LNSLNS

The authors did not give any search criteria for the selective literature search (key words, databases). The listing is not based on recommendations from international medical specialty societies (1). Altitude headache is not “migraine-like” but diffuse and thudding. Categorically advising against travel to altitudes higher than 2000 meters in various conditions is not differentiated enough. The deciding factor is the current function, for example after myocardial infarction (size, localization, effects [ejection fraction], complications, single-/multivessel disease, stent/aorto-coronary venous bypass [ACVB] graft, early acute recanalization, residual stenosis). Without these data, assessment is not possible in the individual case scenario. Alpine medical questions also remain unanswered (experience of mountaineering, economy of movement).

An ICD patient in stable condition is principally fit to travel to high altitude. What is more important is the underlying disease. The same holds true for venous thrombosis or pulmonary embolism: a patient who is stable and whose fluid balance is also stable is fit to travel to high altitudes.

In relation to patients with cardiopulmonary disorders, the oxygen diffusion impairment in interstitial lung disease was not mentioned.

Older patients and obese patients should be asked about snoring (screening for sleep apnea).

One of the cited studies has methodological weaknesses (2). A coauthor reported that the planned pre-acclimatization could not be realized because of significantly scattered data resulting from a deviation from the study protocol, owing to external circumstances (weather). No consensus exists regarding the protocol for pre-acclimatization in isobaric hypoxia, although there is no doubt that this is possible.

Administering 2×125 mg/d acetazolamide results in fewer adverse effects while the effectiveness remains the same (3). Tadalafil has been recommended, although the data are scarce and substantial side effects at high altitudes have been reported.

We cannot but agree wholeheartedly with the authors in that nifedipine and dexamethasone are essentials in a mountain guide’s emergency kit. We would make this a requirement for every mountaineer at high altitude.

Summarized, these critical remarks intended to point out some limitations of the article, and it should be used with care for the purposes of CME.

DOI: 10.3238/arztebl.2012.0445b

PD Dr. med. Thomas Küpper

Institut für Arbeits- und Sozialmedizin der RWTH Aachen

tkuepper@ukaachen.de

Medizinische Kommission der Union Internationale des Associations
d’Alpinisme (UIAA MedCom), Bern/Schweiz

Dr. med. U. Gieseler

Medizinische Kommission der Union Internationale des Associations
d’Alpinisme (UIAA MedCom), Bern/Schweiz

Abteilung für Innere Medizin, Diakonissenkrankenhaus Speyer

Prof. Dr. med. Herbert Löllgen

Praxis für Innere Medizin, Kardiologie, Remscheid

Conflict of interest statement

Professor Löllgen has received honoraria for acting as an adviser from Actavis and ESA. Drs Küpper and Gieseler declare that no conflict of interest exists.

1.
Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al.: Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med 2010; 21: 146–55. CrossRef MEDLINE
2.
Schommer K, Wiesegart N, Menold E, Haas U, Lahr K, Buhl H, et al.: Training in normobaric hypoxia and its effects on acute mountain sickness after rapid ascent to 4559m. High Alt Med Biol 2010; 11: 19–25. CrossRef MEDLINE
3.
Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP, et al.: Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol 2006; 7: 17–27. CrossRef MEDLINE
4.
Schommer K, Bärtsch P: Basic medical advice for travelers to high altitudes. Dtsch Arztebl Int 2011; 108(49): 839–48. VOLLTEXT
1. Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al.: Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med 2010; 21: 146–55. CrossRef MEDLINE
2. Schommer K, Wiesegart N, Menold E, Haas U, Lahr K, Buhl H, et al.: Training in normobaric hypoxia and its effects on acute mountain sickness after rapid ascent to 4559m. High Alt Med Biol 2010; 11: 19–25. CrossRef MEDLINE
3. Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP, et al.: Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol 2006; 7: 17–27. CrossRef MEDLINE
4. Schommer K, Bärtsch P: Basic medical advice for travelers to high altitudes. Dtsch Arztebl Int 2011; 108(49): 839–48. VOLLTEXT