altitude.org | High Altitude Cough

Many people who travel to high altitude complain of cough. It is a dry debilitating cough and its consequences, aside from interfering with climbing and sleeping can be severe. On the 1971 International Himalayan Expedition no less than four members suffered rib fractures because of their cough.

“All was not well with my body...My worst problem, though was my chest: the dry hack I'd picked up some weeks earlier in Lobuje (4800m) had gotten so bad that I'd torn some thoracic cartilage during an especially robust bout of coughing at Camp Three. The coughing had continued unabated and each hack felt like a stiff kick in the ribs."
Jon Krakauer at Everest Base Camp. Into Thin Air. MacMillan 1997.

Altitude cough may be due to bronchoconstriction (the narrowing of the airways that commonly occurs in asthma) or infections, but research has shown that the cough can occur with any evidence of infection or airway narrowing.

Cough could be caused by breathing cold dry air on the mountains, but studies of cough in hypobaric chambers that controlled the ambient temperature and humidity suggest that the receptors in the airways that provoke cough are actually more sensitive at altitude.

What might make cough receptors more sensitive? Three possible theories exist. Firstly, inflammation in the airways at high altitude may increase the receptor sensitivity. Secondly, changes in the brain caused by acclimatisation could sensitise the receptors that cause cough or thirdly, there could be a build up of fluid in the lungs. Some scientists think that a small amount fluid leaks out into the air spaces in many people who go to high altitude without actually causing the symptoms and signs of HAPE. Nevertheless, a severe cough and breathlessness could represent HAPE and if suspected, urgent descent is necessary (see tutorial on HAPE).

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High Altitude Cough