The Physiologic Basis of High-Altitude Diseases
Authors: Anil Pandit
Journal: Annals of Internal Medicine (2005)

Letters5 April 2005The Physiologic Basis of High-Altitude DiseasesAnil Pandit, MBBSAnil Pandit, MBBSFrom Mountain Medicine Society of Nepal, Kathmandu, Nepal.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-7-200504050-00022 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In his review (1), West does not mention the important role of alveolar fluid clearance in the pathophysiology of high-altitude pulmonary edema. Clearance of alveolar fluid mediated by the sodium–potassium adenosine triphosphatase (ATPase) pump present in the apical surface of the alveolar epithelium is a well-established concept (2). If this process is weakened, it may impair clearance of alveolar fluid and predispose individuals to pulmonary edema (3). Experts in high-altitude medicine have successfully attempted interventions to manipulate this process for therapeutic benefit and have put such interventions into practice.A randomized, double-blind, placebo-controlled study of mountaineers susceptible to high-altitude pulmonary edema (4) has shown that the β-adrenergic agonist salmeterol reduces incidence of high-altitude pulmonary edema by 50%. In animal models, β-agonists have been shown to upregulate the clearance of alveolar fluid and lessen pulmonary edema (5, 6). However, salmeterol may have the additional hemodynamic advantage of preventing high-altitude pulmonary edema. The same study showed that, in low altitude, nasal transepithelial sodium and water transport in the distal airway was more than 30% lower in persons who were susceptible to high-altitude pulmonary edema than in those who were not. These findings clearly support the idea that alveolar fluid clearance may have a pathogenic role in pulmonary edema.Anil Pandit, MBBSMountain Medicine Society of Nepal; Kathmandu, NepalReferences1. West JB. The physiologic basis of high-altitude diseases. Ann Intern Med. 2004;141:789-800. [PMID: 15545679] LinkGoogle Scholar2. Sartori C, Matthay MA, Scherrer U. Transepithelial sodium and water transport in the lung. Major player and novel therapeutic target in pulmonary edema. Adv Exp Med Biol. 2001;502:315-38. [PMID: 11950147] CrossrefMedlineGoogle Scholar3. Basnyat B, Murdoch DR. High-altitude illness. Lancet. 2003;361:1967-74. [PMID: 12801752] CrossrefMedlineGoogle Scholar4. Sartori C, Allemann Y, Duplain H, Lepori M, Egli M, Lipp E, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med. 2002;346:1631-6. [PMID: 12023995] CrossrefMedlineGoogle Scholar5. Berthiaume Y, Broaddus VC, Gropper MA, Tanita T, Matthay MA. Alveolar liquid and protein clearance from normal dog lungs. J Appl Physiol. 1988;65:585-93. [PMID: 3170409] CrossrefMedlineGoogle Scholar6. Berthiaume Y, Staub NC, Matthay MA. Beta-adrenergic agonists increase lung liquid clearance in anesthetized sheep. J Clin Invest. 1987;79:335-43. [PMID: 2879851] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Mountain Medicine Society of Nepal, Kathmandu, Nepal. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Physiologic Basis of High-Altitude Diseases John B. West The Physiologic Basis of High-Altitude Diseases Matiram Pun The Physiologic Basis of High-Altitude Diseases John B. West The Physiologic Basis of High-Altitude Diseases Buddha Basnyat Metrics 5 April 2005Volume 142, Issue 7Page: 591KeywordsAdenosine triphosphataseAnimal modelsEdemaEpitheliumHemodynamicsPathogensPulmonary diseasesRespiratory physiologySodium ePublished: 5 April 2005 Issue Published: 5 April 2005 CopyrightCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...