title: Risk factors for occupational acute mountain sickness.
abstract: BACKGROUND
  Studies of occupational acute mountain sickness (AMS) have not focused on the more severe end of the spectrum to date.
  
  
  OBJECTIVE
  To examine risk factors associated with the development of occupational AMS severe enough to receive treatment in a compression chamber.
  
  
  METHODS
  A nested case referent study in a cohort of high-altitude (4000 m) mine workers, comparing cases of severe, chamber-treated AMS to matched referents. Using logistic regression, we tested potential risk factors based on premorbid surveillance examinations, including cigarette smoking (current smoking, smoking intensity and exhaled carbon monoxide [CO]).
  
  
  RESULTS
  There were 15 cases and 30 controls. In multivariate analysis including age, sex and place of residence, current smoking was associated with increased risk of severe AMS (odds ratio [OR] 10.0; 95% confidence interval [CI] 1.5-67.4), taking into account any prior, less severe AMS event, which was also a potent risk factor (OR 33.3; 95% CI 2.8-390). Smoking intensity (cigarettes per day) and exhaled CO were also statistically significantly associated with severe AMS.
  
  
  CONCLUSIONS
  Cigarette smoking is a strong, previously under-appreciated risk factor for severe AMS. Because this is a modifiable factor, these findings suggest that workplace-based smoking cessation should be tested as an intervention to prevent such morbidity.
authors.affiliation: Medical Department, Kumtor Gold Company, Bishkek 720017, Kyrgyzstan, denisvinnikov@mail.ru.
authors.forename: D
authors.initials: D
authors.lastname: Vinnikov
authors.affiliation: Chair of Internal Diseases, Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan.
authors.forename: N
authors.initials: N
authors.lastname: Brimkulov
authors.affiliation: Medical Department, Kumtor Gold Company, Bishkek 720017, Kyrgyzstan.
authors.forename: V
authors.initials: V
authors.lastname: Krasotski
authors.affiliation: Medical Department, Kumtor Gold Company, Bishkek 720017, Kyrgyzstan.
authors.forename: R
authors.initials: R
authors.lastname: Redding-Jones
authors.affiliation: Department, Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA, Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg 40530, Sweden.
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
mesh_terms: D000208:Acute Disease; D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology*; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Altitude; mining; mountain; occupation; smoking.