Treatment of high altitude diseases without drugs.

Treatments other than descent and supplemental oxygen are discussed in this short review. Exercise gives rise to physiologic responses which may enhance acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). Therefore, physical rest can be considered the principle treatment for moderate AMS and it should always accompany any treatment of severe high altitude illnesses as long as descent is not possible. Therapy with a portable fabric hyperbaric chamber has a beneficial short-term effect in subjects with AMS, HACE and HAPE. However, treatment modalities using this device which result in long-term beneficial effects need yet to be established. New technical solutions practicable under field conditions at extreme altitude are required for the removal of CO2 from the bag. Expiratory positive airway pressure (EPAP) improves arterial oxygen saturation by 10-20% in subjects with HAPE in trials of 10 min duration. Clinical studies examining longterm effects are necessary, before EPAP can be recommended as initial emergency treatment of HAPE.