Mountain Medicine: HAPE
Differential Diagnosis
Differential Diagnosis of HAPE
• Asthma
• Bronchitis
• Heart Failure
• Hyperventilation Syndrome
• Mucus Plugging
• Myocardial Infarction
• Pneumonia
• Pulmonary Embolus
Discussions
High Altitude Cough and Bronchitis are both characterized by a persistent cough with or without sputum production. There is no shortness of breath at rest, no severe fatigue. Normal oxygen saturations (for the altitude) will be measured if a pulse oximeter is available.
Pneumonia can be difficult to distinguish from HAPE. Fever is common with HAPE and does not prove the patient has pneumonia. Coughing up green or yellow sputum may occur with HAPE, and both can cause low blood levels of oxygen. The diagnostic test (and treatment) is descent - HAPE will improve rapidly. If the patient does not improve with descent, then consider antibiotics. HAPE is much more common at altitude than pneumonia, and more dangerous; many climbers have died of HAPE when they were mistakenly treated for pneumonia.
Asthma might also be confused with HAPE. Fortunately, asthmatics seem to do better at altitude than at sea-level. If you think its asthma, try asthma medications, but if the person does not improve fairly quickly assume it is HAPE and treat it accordingly.