Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Cough
Published in: Cough 1/2013

Open Access 01-12-2013 | Review

Altitude-related cough

Author: Nicholas P Mason

Published in: Cough | Issue 1/2013

Login to get access

Abstract

Altitude-related cough is a troublesome condition of uncertain aetiology that affects many visitors to high altitude. The traditionally held belief that it was due solely to the inspiration of cold, dry air was refuted by observations and experiments in long duration hypobaric chamber studies. It is likely that altitude-related cough is a symptom of a number of possible perturbations in the cough reflex arc that may exist independently or together. These include loss of water from the respiratory tract; respiratory tract infections and sub-clinical high altitude pulmonary oedema. The published work on altitude-related cough is reviewed and possible aetiologies for the condition are discussed.
Appendix
Available only for authorised users
Literature
1.
Somervell T: After Everest. 1936, London: Hodder and Stoughton
2.
Tasker J: Everest the Cruel Way. 1981, London: Eyre Methuen Ltd
3.
4.
Litch JA, Tuggy M: Cough induced stress fracture and arthropathy of the ribs at extreme altitude. Int J Sports Med. 1998, 19 (3): 220-222. 10.1055/s-2007-971908.CrossRefPubMed
5.
Basnyat B, et al: Efficacy of low-dose acetazolamide (125 mg BID) for the prophylaxis of acute mountain sickness: a prospective, double-blind, randomized, placebo-controlled trial. High Alt Med Biol. 2003, 4 (1): 45-52. 10.1089/152702903321488979.CrossRefPubMed
6.
Barry PW, et al: Cough frequency and cough-receptor sensitivity are increased in man at altitude. Clin Sci (Colch). 1997, 93 (2): 181-186.CrossRef
7.
Houston CS, et al: Operation Everest II: man at extreme altitude. J Appl Physiol. 1987, 63 (2): 877-882.PubMed
8.
Mason NP, et al: Cough frequency and cough receptor sensitivity to citric acid challenge during a simulated ascent to extreme altitude. Eur Respir J. 1999, 13 (3): 508-513. 10.1183/09031936.99.13350899.CrossRefPubMed
9.
10.
Hackett PH, Rennie D: Rales, peripheral edema, retinal hemorrhage and acute mountain sickness. Am J Med. 1979, 67 (2): 214-218. 10.1016/0002-9343(79)90393-0.CrossRefPubMed
11.
West JB, Schoene RB, Milledge JS: Acute mountain sickness, in High altitude medicine and physiology. 2007, London: Arnold, 251-269.
12.
Mason NP, et al: Changes in plasma bradykinin concentration and citric acid cough threshold at altitude. Wilderness Environ Med. 2009, 2: 353-358.CrossRef
13.
Thompson AA, et al: The citric acid cough threshold and the ventilatory response to carbon dioxide on ascent to high altitude. Respir Med. 2009, 103 (8): 1182-1188. 10.1016/j.rmed.2009.02.007.CrossRefPubMed
14.
Bartsch P, Roach R, Hornbein T, Schoene R: Acute Mountain Sickness and High-Altitude Cerebral Edema. High Altitude: An Exploration of Human Adaptation. 2001, New York: Marcel Dekker, 732-740.
15.
Roach R, et al: The Lake Louise acute mountain sickness scoring system. Hypoxia and Mountain Medicine. Edited by: Sutton J, Houston C, Coates G. 1993, Burlington: Queen City Printers, 327-330.
16.
Bartsch P, et al: Physiological aspects of high-altitude pulmonary edema. J Appl Physiol. 2005, 98 (3): 1101-1110.CrossRefPubMed
17.
Hultgren HN, et al: Physiologic Studies of Pulmonary Edema at High Altitude. Circulation. 1964, 29: 393-408. 10.1161/01.CIR.29.3.393.CrossRefPubMed
18.
Mason NP, et al: Serial changes in spirometry during an ascent to 5,300 m in the Nepalese Himalayas. High Alt Med Biol. 2000, 1 (3): 185-195. 10.1089/15270290050144181.CrossRefPubMed
19.
Gray G, et al: Changes in the single-breath nitrogen washout curve on exposure to 17,600 ft. J Appl Physiol. 1975, 39 (4): 652-656.
20.
Coates G, et al: Changes in lung volume, lung density, and distribution of ventilation during hypobaric decompression. J Appl Physiol. 1979, 46 (4): 752-755.PubMed
21.
Cremona G, et al: Pulmonary extravascular fluid accumulation in recreational climbers: a prospective study. Lancet. 2002, 359 (9303): 303-309. 10.1016/S0140-6736(02)07496-2.CrossRefPubMed
22.
Welsh CH, et al: Operation Everest. II: Spirometric and radiographic changes in acclimatized humans at simulated high altitudes. Am Rev Respir Dis. 1993, 147 (5): 1239-1244. 10.1164/ajrccm/147.5.1239.CrossRefPubMed
23.
Mason NP, et al: Serial changes in nasal potential difference and lung electrical impedance tomography at high altitude. J Appl Physiol. 2003, 94 (5): 2043-2050.CrossRefPubMed
24.
Dehnert C, et al: No evidence for interstitial lung oedema by extensive pulmonary function testing at 4,559 m. Eur Respir J. 2010, 35 (4): 812-820. 10.1183/09031936.00185808.CrossRefPubMed
25.
Widdicombe JG: Afferent receptors in the airways and cough. Respir Physiol. 1998, 114 (1): 5-15. 10.1016/S0034-5687(98)00076-0.CrossRefPubMed
26.
27.
Staub NC, Nagano H, Pearce ML: Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs. J Appl Physiol. 1967, 22 (2): 227-240.PubMed
28.
Bonham AC, et al: Substance P contributes to rapidly adapting receptor responses to pulmonary venous congestion in rabbits. J Physiol. 1996, 493 (Pt 1): 229-238.PubMedCentralCrossRefPubMed
29.
Gunawardena S, Bravo E, Kappagoda CT: Effect of chronic mitral valve damage on activity of pulmonary rapidly adapting receptors in the rabbit. J Physiol. 1998, 511 (Pt 1): 79-88.PubMedCentralCrossRefPubMed
30.
31.
Bartsch P, et al: Prevention of high-altitude pulmonary edema by nifedipine [see comments]. N Engl J Med. 1991, 325 (18): 1284-1289. 10.1056/NEJM199110313251805.CrossRefPubMed
32.
Scherrer U, et al: Inhaled nitric oxide for high-altitude pulmonary edema. N Engl J Med. 1996, 334 (10): 624-629. 10.1056/NEJM199603073341003.CrossRefPubMed
33.
West JB, Schoene RB, Milledge JS: Ventilatory response to hypoxia and carbon dioxide, in High altitude medicine and physiology. 2007, London: Arnold, 51-66.
34.
Bolser DC, Davenport PW: Functional organization of the central cough generation mechanism. Pulm Pharmacol Ther. 2002, 15 (3): 221-225. 10.1006/pupt.2002.0361.CrossRefPubMed
35.
Bonham AC, et al: Plasticity in the nucleus tractus solitarius and its influence on lung and airway reflexes. J Appl Physiol. 2006, 101 (1): 322-327. 10.1152/japplphysiol.00143.2006.CrossRefPubMed
36.
Bonham AC, Sekizawa S, Chen CY, Joad JP: Plasticity of brainstem mechanisms of cough. Respir Physiol Neurobiol. 2006, 152: 312-319. 10.1016/j.resp.2006.02.010.CrossRefPubMed
37.
Douglas NJ: Control of breathing during sleep. Clin Sci (Lond). 1984, 67 (5): 465-471.CrossRef
38.
Gothe B, et al: Effect of quiet sleep on resting and CO2-stimulated breathing in humans. J Appl Physiol. 1981, 50 (4): 724-730.PubMed
39.
Gutstein H, Akil H: Opioid analgesics - centrally acting anti-tussive agents. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. Edited by: Brunton L. 2006, New York: McGraw-Hil, 578-579.
40.
Banner AS: Relationship between cough due to hypotonic aerosol and the ventilatory response to CO2 in normal subjects. Am Rev Respir Dis. 1988, 137 (3): 647-650. 10.1164/ajrccm/137.3.647.CrossRefPubMed
41.
Barry P, et al: Cough receptor sensitivity and dynamic ventilatory response to carbon dioxide in man acclimatised to high altitude (Abstract). J Physiol. 1996, 497: 29-30.
42.
Canning BJ: Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 33S-47S.CrossRefPubMed
43.
Israili ZH, Hall WD: Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. 1992, 117 (3): 234-242. 10.7326/0003-4819-117-3-234.CrossRefPubMed
44.
Bhoola KD, Figueroa CD, Worthy K: Bioregulation of kinins: kallikreins, kininogens, and kininases. Pharmacol Rev. 1992, 44 (1): 1-80.PubMed
45.
Decarie A, et al: Serum interspecies differences in metabolic pathways of bradykinin and [des-Arg9]BK: influence of enalaprilat. Am J Physiol. 1996, 271 (4 Pt 2): H1340-H1347.PubMed
46.
Swenson ER: Renal function and fluid homeostasis. High Altitude: An Exploration of Human Adaptation. Edited by: Hornbein T, Schoene R. 2001, New York: Marcel Dekker, 537-539.
47.
Ashack R, et al: Renal and hormonal responses to acute hypoxia in normal individuals. J Lab Clin Med. 1985, 106 (1): 12-16.PubMed
48.
Molteni A, et al: The effect of chronic alveolar hypoxia on lung and serum angiotensin I converting enzyme activity. Proc Soc Exp Biol Med. 1974, 147 (1): 263-265. 10.3181/00379727-147-38323.CrossRefPubMed
49.
Morrell NW, et al: Angiotensin converting enzyme expression is increased in small pulmonary arteries of rats with hypoxia-induced pulmonary hypertension. J Clin Invest. 1995, 96 (4): 1823-1833. 10.1172/JCI118228.PubMedCentralCrossRefPubMed
50.
Campbell DJ, Kladis A, Duncan AM: Bradykinin peptides in kidney, blood, and other tissues of the rat. Hypertension. 1993, 21 (2): 155-165. 10.1161/01.HYP.21.2.155.CrossRefPubMed
51.
Banner AS, Chausow A, Green J: The tussive effect of hyperpnea with cold air. Am Rev Respir Dis. 1985, 131 (3): 362-367.PubMed
52.
Banner AS, Green J, O'Connor M: Relation of respiratory water loss to coughing after exercise. N Engl J Med. 1984, 311 (14): 883-886. 10.1056/NEJM198410043111404.CrossRefPubMed
53.
Sant'Ambrogio G, Widdicombe J: Reflexes from airway rapidly adapting receptors. Respir Physiol. 2001, 125 (1–2): 33-45.CrossRefPubMed
54.
Higenbottam T: The ionic composition of airway surface liquid and coughing. Bull Eur Physiopathol Respir. 1987, 23 (Suppl 10): 25s-27s.PubMed
55.
Pugh L, et al: Muscular exercise at great altitude. J Appl Physiol. 1964, 19: 431-440.PubMed
56.
Barry PW, Mason NP, O'Callaghan C: Nasal mucociliary transport is impaired at altitude. Eur Respir J. 1997, 10 (1): 35-37. 10.1183/09031936.97.10010035.CrossRefPubMed
57.
Barry PW, Mason NP, Richalet JP: Nasal peak inspiratory flow at altitude. Eur Respir J. 2002, 19 (1): 16-19. 10.1183/09031936.02.00096902.CrossRefPubMed
58.
Svensson S, Olin AC, Hellgren J: Increased net water loss by oral compared to nasal expiration in healthy subjects. Rhinology. 2006, 44 (1): 74-77.PubMed
59.
McGarvey LP, Morice AH: Clinical cough and its mechanisms. Respir Physiol Neurobiol. 2006, 152 (3): 363-371. 10.1016/j.resp.2005.11.011.CrossRefPubMed
60.
Pratter MR: Cough and the common cold: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 72S-74S.CrossRefPubMed
61.
Basnyat B, Litch JA: Medical problems of porters and trekkers in the Nepal Himalaya. Wilderness Environ Med. 1997, 8 (2): 78-81. 10.1580/1080-6032(1997)008[0078:MPOPAT]2.3.CO;2.CrossRefPubMed
62.
Murdoch DR: Symptoms of infection and altitude illness among hikers in the Mount Everest region of Nepal. Aviat Space Environ Med. 1995, 66 (2): 148-151.PubMed
63.
Birkebaek NH, et al: Bordetella pertussis and chronic cough in adults. Clin Infect Dis. 1999, 29 (5): 1239-1242. 10.1086/313448.CrossRefPubMed
64.
Hallander HO, et al: Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae and persistent cough in children. Scand J Infect Dis. 1999, 31 (3): 281-286. 10.1080/00365549950163581.CrossRefPubMed
65.
Jacoby DB: Pathophysiology of airway viral infections. Pulm Pharmacol Ther. 2004, 17 (6): 333-336. 10.1016/j.pupt.2004.09.014.CrossRefPubMed
66.
Dicpinigaitis PV: Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 75S-79S.CrossRefPubMed
67.
68.
Strauss RH, et al: Influence of heat and humidity on the airway obstruction induced by exercise in asthma. J Clin Invest. 1978, 61 (2): 433-440. 10.1172/JCI108954.PubMedCentralCrossRefPubMed
69.
Green M, Widdicombe JG: The effects of ventilation of dogs with different gas mixtures on airway calibre and lung mechanics. J Physiol. 1966, 186 (2): 363-381.PubMedCentralCrossRefPubMed
70.
Nadel JA, Widdicombe JG: Effect of changes in blood gas tensions and carotid sinus pressure on tracheal volume and total lung resistance to airflow. J Physiol. 1962, 163: 13-33.PubMedCentralCrossRefPubMed
71.
Reynolds AM, McEvoy RD: Tachykinins mediate hypocapnia-induced bronchoconstriction in guinea pigs. J Appl Physiol. 1989, 67 (6): 2454-2460.PubMed
72.
Pollard AJ, et al: Hypoxia, hypocapnia and spirometry at altitude [published erratum appears in Clin Sci (Colch) 1997 Dec;93(6):611]. Clin Sci (Colch). 1997, 92 (6): 593-598.CrossRef
73.
Pratter MR: Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 63S-71S.CrossRefPubMed
74.
Irwin RS: Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 80S-94S.CrossRefPubMed
75.
76.
Pratter MR: Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129 (1 Suppl): 59S-62S.CrossRefPubMed
77.
Barry P: The output of nebulisers at high altitude (Abstract 143). High Alt Med Biol. 2001, 2: 114-
78.
Barry P, et al: Lung deposition of therapeutic aerosols at simulated altitude (Abstract 144). High Alt Med Biol. 2001, 2: 114-
79.
Mellor A: Research at high altitudes. J R Army Med Corps. 2011, 157 (1): 5-7. 10.1136/jramc-157-01-01.CrossRefPubMed
80.
Widdicombe JG: Nasal airflow resistance at simulated altitude. Eur Respir J. 2002, 19 (1): 4-5. 10.1183/09031936.02.00282902.CrossRefPubMed
Metadata
Title
Altitude-related cough
Author
Nicholas P Mason
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Cough / Issue 1/2013
Electronic ISSN: 1745-9974
DOI
https://doi.org/10.1186/1745-9974-9-23

Other articles of this Issue 1/2013

Cough 1/2013 Go to the issue

Research

Clinical experience with low-dose itraconazole in chronic idiopathic cough

Review

Summary of papers presented at the 2012 seventh international cough symposium

Research

Dietary intervention in the treatment of patients with cough and symptoms suggestive of airways reflux as determined by Hull airways Reflux Questionnaire

Review

The larynx in cough

Research

Management of patients with chronic cough using a clinical protocol: a prospective observational study

Research

Intravenous lidocaine suppresses fentanyl-induced cough in Children
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits