High Altitude Pulmonary Oedema (HAPE)

HAPE is due to fluid in the lungs caused by an increase in pressure in the vessels that carry blood to the lungs.  It is reversible so early recognition and treatment is vital.
It manifests as shortness of breath, chest tightness, pink frothy sputum, cough, cyanosis (blueness of lips/fingers) and fatigue. Symptoms of AMS may or not be present prior.  It commonly occurs on the second night.  HAPE can be confused with other lung conditions such as high altitude cough, pneumonia and asthma.

The most effective treatment is oxygen and consideration of rapid descent. However as exertion should be minimized potentially some patients (depending on the availability of oxygen) have delayed descent.  A hyperbaric bag is useful awaiting evacuation if advised/available.  Medications that have been shown to help include nifedipine, acetazolamide and salbutamol (Ventolin). Frusemide (Lasix) is not used commonly any more. Nifedipine is useful in prevention. Phosphodiesterase inhibitors such as Sildenafil (Viagra) and Tadalafil (Cialis) may provide an alternate for both prevention and treatment.