High altitude pharyngitis and bronchitis

Background

• One of the most common conditions at high altitude
• Possibly due to hyperventilation of altitude, dry & cold air of altitude

Clinical Features

• Dry, hacking cough is common at > 8000ft (~2500m)
• Purulent bronchitis/painful pharyngitis common with prolonged periods at extreme altitude
• Severe coughing spasms can result in cough fracture of ribs
• May be confused with HAPE

Differential Diagnosis

High Altitude Illnesses

• Acute mountain sickness
• Chronic mountain sickness
• High altitude cerebral edema
• High altitude pulmonary edema
• High altitude peripheral edema
• High altitude retinopathy
• High altitude pharyngitis and bronchitis
• Ultraviolet keratitis
• Pneumonia
• Viral etiology
• CHF
• COPD
• Pneumonitis

Evaluation

• Clinical diagnosis after exclusion of other etiologies (e.g. infection)
• Rule out HAPE

Expected SpO₂ and PaO₂ levels at altitude

Altitude	SpO2	PaO2 (mm Hg)
1,500 to 3,500 m (4,900 to 11,500 ft)	about 90%	55-75
3,500 to 5,500 m (11,500 to 18,000 ft)	75-85%	40-60
5,500 to 8,850 m (18,000 to 29,000 ft)	58-75%	28-40

Management

• Symptomatic treatment
• Albuterol
• Breathing steam, wearing a face mask, sucking on hard candies, forcing hydration
• Antibiotics are NOT helpful

Disposition

• Generally treated as an outpatient as long as alternative etiologies are excluded

See Also

• High Altitude Medicine