Altitude illnesses

Hackett, P. H. & Roach, R. C. High-altitude illness. N. Engl. J. Med. 345, 107–114 (2001).

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Burtscher, J., Swenson, E. R., Hackett, P., Millet, G. P. & Burtscher, M. Flying to high-altitude destinations: is the risk of acute mountain sickness greater? J. Travel. Med. 30, taad011 (2023). This study revealed a 4.5-fold steeper increase in the acute mountain sickness incidence for air travel to altitudes between 2,000 m and 4,559 m compared with slower modes of ascent (that is, hiking or combined car and/or air travel and hiking).

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Villafuerte, F. C. & Corante, N. Chronic mountain sickness: clinical aspects, etiology, management, and treatment. High. Alt. Med. Biol. 17, 61–69 (2016). This publication recommends periodic travel to lower altitudes for those at risk of or diagnosed with EE, whereas permanent relocation to lower altitudes or sea level is recommended for those with severe chronic mountain sickness.

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Gonggalanzi et al. Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658 m above sea level: a cross-sectional study. Arch. Public. Health 74, 23 (2016).

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Bhandari, S. S. & Koirala, P. Health of high altitude pilgrims: a neglected topic. Wilderness Env. Med. 28, 275–277 (2017).

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Tremblay, J. C. & Ainslie, P. N. Global and country-level estimates of human population at high altitude. Proc. Natl Acad. Sci. USA 118, e2102463118 (2021).

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Burtscher, M., Hefti, U. & Hefti, J. P. High-altitude illnesses: old stories and new insights into the pathophysiology, treatment and prevention. Sports Med. Health Sci. 3, 59–69 (2021).

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Richalet, J. P., Hermand, E. & Lhuissier, F. J. Cardiovascular physiology and pathophysiology at high altitude. Nat. Rev. Cardiol. 21, 75–88 (2023). This review provides helpful recommendations to assist physicians in advising patients with cardiovascular disease who wish to travel to high-altitude destinations.

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Burtscher, J., Mallet, R. T., Pialoux, V., Millet, G. P. & Burtscher, M. Adaptive responses to hypoxia and/or hyperoxia in humans. Antioxid. Redox Signal. 37, 887–912 (2022).

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Berger, M. M. & Luks, A. M. High altitude. Semin. Respir. Crit. Care Med. 44, 681–695 (2023).

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Mallet, R. T. et al. Molecular mechanisms of high-altitude acclimatization. Int. J. Mol. Sci. 24, 1698 (2023). This review summarizes the hypoxia-stimulated cellular stress responses, particularly those related to cellular redox regulation, transcriptional orchestration of hypoxia adaptations and mitochondrial changes, and relates these adjustments to high-altitude illnesses.

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Roach, R. C. et al. The 2018 Lake Louise Acute Mountain Sickness score. High. Alt. Med. Biol. 19, 4–6 (2018).

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Luks, A. M. & Hackett, P. H. Medical conditions and high-altitude travel. N. Engl. J. Med. 386, 364–373 (2022). This review highlights the importance of careful disease assessment and pre-travel planning for people with pre-existing medical conditions, which can enable many, but not all, of these individuals to travel to high altitude.

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Berendsen, R. R. et al. Strengthening altitude knowledge: a Delphi study to define minimum knowledge of altitude illness for laypersons traveling to high altitude. High. Alt. Med. Biol. 23, 330–337 (2022). This study adopted a Delphi process to determine what laypeople travelling to high altitudes should know about altitude illnesses.

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Bartsch, P. & Swenson, E. R. Clinical practice: acute high-altitude illnesses. N. Engl. J. Med. 368, 2294–2302 (2013).

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Leon-Velarde, F. et al. Consensus statement on chronic and subacute high altitude diseases. High. Alt. Med. Biol. 6, 147–157 (2005).

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Penaloza, D. & Arias-Stella, J. The heart and pulmonary circulation at high altitudes: healthy highlanders and chronic mountain sickness. Circulation 115, 1132–1146 (2007).

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Basnyat, B. & Murdoch, D. R. High-altitude illness. Lancet 361, 1967–1974 (2003).

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Burtscher, M., Wille, M., Menz, V., Faulhaber, M. & Gatterer, H. Symptom progression in acute mountain sickness during a 12-hour exposure to normobaric hypoxia equivalent to 4500 M. High. Alt. Med. Biol. 15, 446–451 (2014).

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Berger, M. M., Sareban, M. & Bartsch, P. Acute mountain sickness: do different time courses point to different pathophysiological mechanisms? J. Appl. Physiol. 128, 952–959 (2020). In this re-evaluation of several studies, the authors observed three potentially different time courses (first, second and third day at high altitude) and pathophysiologies of acute mountain sickness development.

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Mairer, K., Wille, M., Bucher, T. & Burtscher, M. Prevalence of acute mountain sickness in the Eastern Alps. High. Alt. Med. Biol. 10, 239–245 (2009).

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Maggiorini, M., Buhler, B., Walter, M. & Oelz, O. Prevalence of acute mountain sickness in the Swiss Alps. BMJ 301, 853–855 (1990).

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Murdoch, D. R. Altitude illness among tourists flying to 3740 meters elevation in the Nepal Himalayas. J. Travel. Med. 2, 255–256 (1995).

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Lawrence, J. S. & Reid, S. A. Risk determinants of acute mountain sickness and summit success on a 6-day ascent of Mount Kilimanjaro (5895 m). Wilderness Env. Med. 27, 78–84 (2016).

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Vardy, J., Vardy, J. & Judge, K. Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya. Aviat. Space Env. Med. 77, 742–744 (2006).

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Hou, Y. P. et al. Sex-based differences in the prevalence of acute mountain sickness: a meta-analysis. Mil. Med. Res. 6, 38 (2019).

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Gianfredi, V., Albano, L., Basnyat, B. & Ferrara, P. Does age have an impact on acute mountain sickness? A systematic review. J. Travel. Med. 27, taz104 (2020).

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Small, E., Phillips, C., Marvel, J. & Lipman, G. Older age as a predictive risk factor for acute mountain sickness. Am. J. Med. 135, 386–392.e1 (2022).

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Wu, Y., Zhang, C., Chen, Y. & Luo, Y. J. Association between acute mountain sickness (AMS) and age: a meta-analysis. Mil. Med. Res. 5, 14 (2018).

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Duke, C. B. et al. Hypertension and acute mountain sickness in Himalayan trekkers in Nepal: an observational cohort study. Wilderness Env. Med. 31, 157–164 (2020).

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Kayser, B. Acute mountain sickness in western tourists around the Thorong pass (5400 m) in Nepal. J. Wilderness Med. 2, 110–117 (1991).

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Berger, M. M. et al. Prevalence and knowledge about acute mountain sickness in the Western Alps. PLoS ONE 18, e0291060 (2023).

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Richalet, J. P., Larmignat, P., Poitrine, E., Letournel, M. & Canoui-Poitrine, F. Physiological risk factors for severe high-altitude illness: a prospective cohort study. Am. J. Respir. Crit. Care Med. 185, 192–198 (2012).

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McDevitt, M. et al. Risk determinants of acute mountain sickness in trekkers in the Nepali Himalaya: a 24-year follow-up. Wilderness Env. Med. 25, 152–159 (2014).

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Gaillard, S., Dellasanta, P., Loutan, L. & Kayser, B. Awareness, prevalence, medication use, and risk factors of acute mountain sickness in tourists trekking around the Annapurnas in Nepal: a 12-year follow-up. High. Alt. Med. Biol. 5, 410–419 (2004).

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