Letters to the Editor
307
High Altitude and its Illness Dear Editor,
8.
The authors have stated that in the Armed Forces after an episode of HAPO, a person is not posted to HA areas. As per Draft DGAFMS Memorandum 2001, “Problems of High Altitude”, only patients with severe HAPO, recurrent HAPO (>1 episode) or with associated pulmonary arterial hypertension are made unfit for service in HAarea.
9.
The nitric oxide delivery system exists only in one service hospital in HA area and a restricted trial has been conducted. The results have been promising as mentioned. Neverthless, this modality of treatment involves expensive equipment, expendables and a well-equipped set up with specialists, available only in hospital settings, where recompression chamber facility is usually available. Thus, the use of inhaled nitric oxide is debatable considering the cost – benefit ratio, in our context.
T
he article, ‘Treatment of Acute Mountain Sickness and High Altitude Pulmonary Oedema’ (MJAFI 2004; 60:384-7) is very pertinent as a large proportion of our clientele is deployed at high altitude and there is a dearth of literature on high altitude (HA) illness. However, we would like to make the following observations : 1.
The definition of HA as >3000 meters is contestable. Various workers have used ranges from 1500m to 3000m as qualifying for high altitude [1,2]. The Armed Forces define high altitude as >2700m (AO110/80).
2.
The Lake Louise Consensus Criteria for definition of Acute Mountain Sickness (AMS) mentions a “recent gain in altitude” as an essential criterion for diagnosis of AMS[3]. It does not qualify the height of ascent as mentioned by the authors.
3.
The acclimatization schedule as followed by the Armed Forces is applicable from altitudes above 2700m and not 3000m as mentioned in the article (AO 110/80)[4]. The reference quoted is also incorrect.
4.
High Altitude Pulmonary Oedema (HAPO) occurring at moderate altitudes (
307
High Altitude and its Illness Dear Editor,
8.
The authors have stated that in the Armed Forces after an episode of HAPO, a person is not posted to HA areas. As per Draft DGAFMS Memorandum 2001, “Problems of High Altitude”, only patients with severe HAPO, recurrent HAPO (>1 episode) or with associated pulmonary arterial hypertension are made unfit for service in HAarea.
9.
The nitric oxide delivery system exists only in one service hospital in HA area and a restricted trial has been conducted. The results have been promising as mentioned. Neverthless, this modality of treatment involves expensive equipment, expendables and a well-equipped set up with specialists, available only in hospital settings, where recompression chamber facility is usually available. Thus, the use of inhaled nitric oxide is debatable considering the cost – benefit ratio, in our context.
T
he article, ‘Treatment of Acute Mountain Sickness and High Altitude Pulmonary Oedema’ (MJAFI 2004; 60:384-7) is very pertinent as a large proportion of our clientele is deployed at high altitude and there is a dearth of literature on high altitude (HA) illness. However, we would like to make the following observations : 1.
The definition of HA as >3000 meters is contestable. Various workers have used ranges from 1500m to 3000m as qualifying for high altitude [1,2]. The Armed Forces define high altitude as >2700m (AO110/80).
2.
The Lake Louise Consensus Criteria for definition of Acute Mountain Sickness (AMS) mentions a “recent gain in altitude” as an essential criterion for diagnosis of AMS[3]. It does not qualify the height of ascent as mentioned by the authors.
3.
The acclimatization schedule as followed by the Armed Forces is applicable from altitudes above 2700m and not 3000m as mentioned in the article (AO 110/80)[4]. The reference quoted is also incorrect.
4.
High Altitude Pulmonary Oedema (HAPO) occurring at moderate altitudes (
