title: Wilderness medicine at high altitude: recent developments in the field.
abstract: Travel to high altitude is increasingly popular. With this comes an increased incidence of high-altitude illness and therefore an increased need to improve our strategies to prevent and accurately diagnose these. In this review, we provide a summary of recent advances of relevance to practitioners who may be advising travelers to altitude. Although the Lake Louise Score is now widely used as a diagnostic tool for acute mountain sickness (AMS), increasing evidence questions the validity of doing so, and of considering AMS as a single condition. Biomarkers, such as brain natriuretic peptide, are likely correlating with pulmonary artery systolic pressure, thus potential markers of the development of altitude illness. Established drug treatments include acetazolamide, nifedipine, and dexamethasone. Drugs with a potential to reduce the risk of developing AMS include nitrate supplements, propagators of nitric oxide, and supplemental iron. The role of exercise in the development of altitude illness remains hotly debated, and it appears that the intensity of exercise is more important than the exercise itself. Finally, despite copious studies demonstrating the value of preacclimatization in reducing the risk of altitude illness and improving performance, an optimal protocol to preacclimatize an individual remains elusive.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, UK.
authors.forename: Neeraj M
authors.initials: NM
authors.lastname: Shah
authors.affiliation: School of Medicine, University College London, London, UK.
authors.forename: Sidra
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Cooke
authors.affiliation: Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: O'Hara
authors.affiliation: Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK ; Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Mellor
keywords: acclimatization; acute mountain sickness; biomarkers; hypoxia; preacclimatization