High-Altitude Pulmonary Edema Treatment & Management

Updated: Dec 31, 2015
  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Medical Care

The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen, and descent to a lower altitude. If diagnosed early, recovery is rapid with a descent of only 500-1000 m. A portable hyperbaric chamber or supplemental oxygen administration immediately increases oxygen saturation and reduces pulmonary artery pressure, heart rate, respiratory rate, and symptoms. In situations where descent is difficult, these treatments can be lifesaving. [11, 12]

In one study, 11 patients at 4240 m altitude in Pheriche, Nepal were treated for HAPE with bed rest, oxygen, nifedipine, and acetazolamide. [13] Sildenafil and salmeterol were used in most, but not all patients. Seven of these had serious-to-severe HAPE (Hultgren grades 3 or 4). Oxygen saturation was improved at discharge (84% ±1.7%) compared with admission (59% ±11%), as was the ultrasound comet-tail score (11 ±4 at discharge vs 33 +/- 8.6 at admission), a measure of pulmonary edema for which admission and discharge values were obtained in 7 patients.

A randomized, double-blinded, placebo-controlled study showed that adults with previous HAPE who received prophylactic tadalafil (10 mg) or dexamethasone (8 mg) had significantly less HAPE compared with those who received placebo twice daily. The medications were administered during ascent and at a stay at 4559 m altitude. [14]

Two participants who received tadalafil developed severe acute mountain sickness upon arrival at 4559 m and withdrew from the study; they did not have HAPE at that time. HAPE developed in 7 of 9 participants who received placebo and in 1 of the remaining 8 participants who received tadalafil, but it did not develop in any of the 10 participants who received dexamethasone (P = .007 for tadalafil vs placebo; P< .001 for dexamethasone vs placebo). Eight of 9 participants who received placebo, 7 of 10 who received tadalafil, and 3 of 10 who received dexamethasone had acute mountain sickness (P = 1.0 for tadalafil vs placebo; P = .020 for dexamethasone vs placebo).

At high altitude, systolic pulmonary artery pressure increased less in participants who received dexamethasone (16 mm Hg [95% confidence interval, 9-23 mm Hg]) and tadalafil (13 mm Hg [95% confidence interval, 6-20 mm Hg]) than in those who received placebo (28 mm Hg [95% confidence interval, 20-36 mm Hg]) (P = .005 for tadalafil vs placebo; P = .012 for dexamethasone vs placebo).

The conclusion was that both dexamethasone and tadalafil decrease systolic pulmonary artery pressure and may reduce the incidence of HAPE in adults with a history of HAPE. [15] Dexamethasone prophylaxis may also reduce the incidence of acute mountain sickness in these adults.

Finally, the use of an expiratory positive airway pressure mask improves oxygenation and may be useful as a temporizing measure.

Admission to a hospital is warranted for significant arterial desaturation and clinical deterioration despite outpatient management of HAPE.



A diet rich in carbohydrates has shown to be helpful in prevention of high-altitude pulmonary edema. Alcohol and sedatives should be avoided.



The following measures may prevent further episodes of high-altitude pulmonary edema (HAPE) in patients with a history of altitude illness:

  • Avoiding heavy exertion at high altitude

  • Slow ascent

  • Avoiding abrupt ascent to sleeping elevations higher than 3000 m: If possible, spend 2 nights at altitudes of 2500-3000 m before further ascent.

  • Avoiding alcohol and sedatives