Asthma and altitude

[PaulRosedene]

I hope to be trekking in Nepal in a few weeks time. We will be heading up to nearly 5,000 metres. Has anyone found that their asthma has been affected by such altitudes ?

[Poobah]

Quite a few years back I struggled on a visit to the Alps at 2,500 metres. The air is thinner and it's hard work moving. My non-asthmatic partner was OK, but fast walking was out of the question as we just weren't acclimatised.

My niece, who doesn't have respiratory issues did Everest base camp (5,340 mtrs) and said they had to hike higher every day but come back to a lower elevation each evening in order to acclimatise the body as they hiked towards their destination. It was a respiratory challenge for everyone in the group as they got higher. People got altitude sickness too.

She's attempted Kilimanjaro (5,895 m) & Mont Blanc (4,809) - achieved Kili but MB was harder, she found and didn't quite make it. She said Nepal was the hardest. She now has a new found respect for my asthma.

[PaulRosedene in reply to Poobah]

Thank you for your comments. Did the altitude bring on asthma attacks or did your asthma just make walking harder ?

[Poobah in reply to PaulRosedene]

No attacks, but by then my asthma was controlled. Breathing at altitude didn't feel like asthma, in the sense that I didn't wheeze, but every breath was an effort; unsatisfactory (Ventolin didn't help). We walked quite a bit, didn't rush and took our time, resting at intervals. I remember having to run to catch the last cable car down the mountain and it was a very odd feeling. It was closer to having severe anaemia, which is in effect the same thing - not enough oxygen, limiting one's ability for exercise. If you're otherwise fit and your asthma is controlled with a good lung capacity then you should be able to cope. My niece did months of training in preparation, not at altitude, but in terms of uphill hiking, stamina and core strength.

[PaulRosedene in reply to Poobah]

thank you

[Poobah in reply to PaulRosedene]

Have a great trip and stay safe!

[runcyclexcski in reply to Poobah]

>>> but every breath was an effort; unsatisfactory

A simple tip I found is that when everyone feels the same thing you know it's the altitude. When it's just you it's more likely to be asthma. Also, asthma starts when one stops/during rest breaks, whereas altitude feels when one is exerting.

[Wheesy]

I have had no recent trips to this wonderful part of the world, but I suffer badly with the cold here in Yorkshre. Have a wonderful trip and enjoy yourself, try everything little by little

[PaulRosedene in reply to Wheesy]

Thank you

[Tittlemouse]

Hi there, I’ve also done quite a lot of trekking in Nepal and done various routes including base camp. Everyone feels the altitude but weirdly I found that having asthma meant the breathlessness wasn’t such a scary prospect. I’d recommend making sure you take some throat sweets as it’s easy to get a cough which can then lead to more problems. Then just try and make sure you are physically fit, slowly slowly is the best approach. The young fit guys who went storming ahead had the most problems. Good luck it’s amazing place.

[PaulRosedene in reply to Tittlemouse]

Thank you. Very reassuring. I have no plans to storm up even a hillock.

[hilary39]

I felt quite dizzy in Breckenridge, Colorado a few years ago. It's at about 3,000 meters. I adjusted after 1-2 days but taking hikes even higher up than that winded me. Can you give yourself time to a few days to adjust at the beginning and take it slowly?

[PaulRosedene in reply to hilary39]

I guess that feeling dizzy could be an indication of altitude sickness rather than asthma. I am part of a trekking group. I am hoping not to set the agenda by being the slowest.

[hilary39 in reply to PaulRosedene]

For sure. I was shorter of breath than normal during the hike like I said but adjusted overall after a few days. Do you do a lot of sports and exercise now without any issues?

[PaulRosedene in reply to hilary39]

Last spring when my asthma was bad I was getting exercise induced asthma whilst walking on the flat. On a walk up Pen Y Fan I became very wheezy and it took some time for the asthma to settle down. Walking is my main form of exercise. But I can walk for long stretches without any issues.

[runcyclexcski]

I do not think it's the altitude per se, but rather the cold and dry air that may cause trouble. I would "practice" first with more accessible places (the Alps, the California Sierras) which would have first-aiders available on a faster notice than one would expect in Nepal. Cheaper to go to, too. Shasta is 15,000 feet and one does not need a permit to climb (walk) on it. After 3-4 low-key trips you would be confident about Nepal.

I myself would never go to Nepal and alike. Sure the mountains may have clean crisp air, but Katmandu is one of the most polluted cities in the world. I haven't been to K myself, but from the numerous documentaries I've watched they use wood and dung for cooking. Will there be fast aid if one has a life-threatening asthma attack? Not sure.

I would also talk to an exercise respiratory specialist, preferentially someone who has been a medic during such trips. Write to BMC, I am sure they can put you in touch. With the amount of cash the Nepal trip is likely to cost you, the cost of a private consultation/testing would be negligible. She/he would recommend what pills/inhalers/first aid meds to take and on an action plan. She/he can also do respiratory testing to find out your baseline and how well controlled your asthma is. I would not trust whatever a generic GP says as this is a very specific/narrow topic and GPs, in my experience, are quite bad at admitting limited knowledge and referring to a specialist.

I personally do not have issues with altitude; it could be b.c. I exercise in a respirator anyway (to keep the pollutants and allergens away). Whenever my backcountry-ski buddies had headaches and were throwing up, I felt just fine (and happy to eat their tasty snacks which they could not look at). That said, the highest I've ever mountain-skied was at 4,000-4500 meters (high passes in the Sierra Nevada), but it was in the middle of winter. A few nights were at -20C (sleeping in snow caves), I imagine the RH was at <15%. When my asthma was under control, the mountains actually felt much better than lower elevation (presumably b.c. of no allergens).

[PaulRosedene in reply to runcyclexcski]

Gosh. You have certainly spent time in the mountains. Thank you for your advice.

[Poobah]

On one trip to the Rockies I had altitude sickness and that was at 2,000m. While there a local explained that they get teams of athletes training at altitude for some time before major events as the oxygen depleted air caused their bodies to change over time, in that their blood cells adapted to carry oxygen more efficiently. This would give them the edge in competitions back at sea level. So acclimatisation is very important when trekking at such altitudes, ascending slowly in order to allow the body to adapt day by day. But even then some people will get altitude sickness (even the fittest) and knowing what protocols are in place to take people down to receive treatment will reassure you that if anything does go wrong, that you will be cared for appropriately and timely action will happen and not be delayed.

Trekking at height and mountain climbing are team efforts and, unfortunately, people have felt driven by "not wanting to let the team down" and not highlighted their symptoms when necessary, leading to very poor outcomes. It's important to remember that our cognitive abilities will also be affected by the altitude, curbing our decision making abilities. Protocols that are set before the trip are vital as they should negate poor decision making that comes from making things up on the hoof; preparation reduces the risks. Are their sufficient guides travelling with you who can accompany anyone down to receive treatment without impacting the whole trek? Even leaving people behind to be picked up later by the group when they descend is totally unacceptable.

I wouldn't recommend anyone to trek at 5,000m if they hadn't already undertaken trekking at 2,000m, 3,000m on previous trips. Even non-asthmatics need to start small and work their way up.

[PaulRosedene in reply to Poobah]

All very good questions. The trek is hopefully being run professionally. There are sherpas and porters. They should all be very familiar with the protocols for altitude sickness.

[Poobah in reply to PaulRosedene]

Just thought - Check that you can bring all your prescription meds into Nepal without a medical certificate.

[PaulRosedene in reply to Poobah]

Wow. I have never heard of problems taking prescription medications abroad. I can't see how they can take someone's meds away.

[Poobah in reply to PaulRosedene]

Unfortunately, some countries expect a certificate for certain meds to be brought into the country, even for personal use. Details are usually on the UK Gov website, or at least a link to the relevant country's website. Nepal only expects a copy of your prescription. gov.uk/foreign-travel-advic...

[Hanna222]

I do a lot of hiking and mountaineering, although I haven’t been to 5000 m yet. Personally I do not notice the altitudes at around 3000 m at all, however, this is extremely individual. I find that the cold and the exercise part sets my asthma off instead. I only do challenging hikes if my asthma is well controlled. Even if I’m in a light dip, I’ll find easy hikes much more challenging.

One tip is to try to get your meds, especially ventoline, in powder form (diskus) because it is not as affected by the cold as the MDI.

[PaulRosedene in reply to Hanna222]

Noted. Thank you.