Erik R. Swenson, MD
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Requests for Single Reprints: Erik R. Swenson, MD, S-111-Pulm, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108; e-mail, email@example.com.
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Colin K Grissom
LDS Hospital and the University of Utah
November 30, 2006
tadalafil or dexamethasone for prevention of HAPE in high altitude rescue team members
I consider it premature to recommend tadalafil or dexamethasone for prevention of high altitude pulmonary edema (HAPE) in rescue team members who must ascend rapidly to high altitude as is recommended by Dr. Erik R. Swenson in his editorial "Hypoxic Lung Whiteout: Further Clearing but More Questions from on High"(1). In the study by Maggiorini and colleagues(2)on tadalafil and dexamethasone for prevention of HAPE, two of the subjects in the tadalafil group developed severe AMS after acute ascent to 4559 m and had to be evacuated. Even if these are not considered cases that would have progressed to HAPE, these two subjects were incapacitated and had to be evacuated. Therefore, the functional signifigance to a high altitude rescue team member is that 3 out of 10 subjects in the tadalafil group were incapacitated, two with severe AMS and one who developed HAPE later. The risk that tadalafil may worsen AMS makes it an unsafe choice for rapid ascent by mountain rescue personnel, and perhaps by anyone who is HAPE susceptible. Dexamethasone is an appropriate drug for prophylaxis of acute mountain sickness (AMS)in mountain rescue personnel, but the proposed mechanism for prevention of HAPE may depend on genomic changes, so it may not be protective for development of HAPE if not started one day before ascent. Therefore, dexamethasone should be combined with another drug to prevent HAPE, such as salmeterol(3) or nifedipine(4), in rescue team members who must ascend rapidly to high altitude.
1. Swenson, ER. Hypoxic lung whiteout: further clearing but more questions from on high. Ann Int Med. 2006;145:550-552.
2. Maggiorini, M, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema, a randomized trial. Ann Intern Med. 2006;145:497-506.
3. Sartori, C, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med. 2002;346:1631-6.
4.Bartsch, P, et al. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med. 1991;325:1284-9.
Swenson ER. Hypoxic Lung Whiteout: Further Clearing but More Questions from on High. Ann Intern Med. 2006;145:550–552. doi: 10.7326/0003-4819-145-7-200610030-00015
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Published: Ann Intern Med. 2006;145(7):550-552.
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