Institute of Sport Sciences, University of Lausanne, Lausanne 1015, Switzerland.
Department of Biomedical Sciences, University of Lausanne, Lausanne 1005, Switzerland.
J Travel Med. 2023 Jun 23;30(4). doi: 10.1093/jtm/taad011.
Altitude sojourns increasingly attract individuals of all ages and different health statuses due to the appeal of high-altitude destinations worldwide and easy access to air travel. The risk of acute mountain sickness (AMS) when flying to high-altitude destinations remains underemphasized. Thus, this review aims to evaluate the altitude-dependent AMS incidence depending on the mode of ascending, e.g. by air vs terrestrial travel.
A literature search was performed to identify the observational studies assessing AMS incidence after acute ascent of primarily healthy adults to real high altitude. In addition, placebo arms of interventional trials evaluating the prophylactic efficacy of various drugs have been separately analysed to confirm or refute the findings from the observational studies. Linear regression analyses were used to evaluate the altitude-dependent AMS incidence.
Findings of 12 observational studies, in which the AMS incidence in 11 021 individuals ascending to 19 different altitudes (2200-4559 m) was evaluated, revealed an impressive 4.5-fold steeper increase in the AMS incidence for air travel as compared with slower ascent modes, i.e. hiking or combined car and/or air travel and hiking. The higher AMS incidence following transportation by flight vs slower means was also confirmed in placebo-treated participants in 10 studies of drug prophylaxis against AMS.
Due to the short time span in going from low to high altitude, reduced acclimatization likely is the main reason for a higher AMS risk when travelling to high-altitude destinations by flight. To avoid frustrating travel experiences and health risks, appropriate and timely medical advice on how to prepare for air travel to high altitude is of vital importance. Effective preparation options include the use of modern pre-acclimatization strategies and pharmacological prophylaxis by acetazolamide or dexamethasone, or even considering alternate itineraries with more gradual ascent.
由于世界各地高海拔目的地的吸引力以及航空旅行的便捷，越来越多不同年龄和健康状况的人选择前往高海拔地区停留。然而，飞往高海拔目的地时发生急性高原病（AMS）的风险仍被低估。因此，本综述旨在评估不同上升方式（如航空旅行与地面旅行）与海拔依赖性 AMS 发病率的相关性。
检索评估主要为健康成年人急性上升至高海拔地区后 AMS 发病率的观察性研究。此外，还分别分析了评估各种药物预防效果的干预性试验的安慰剂组，以证实或反驳观察性研究的结果。采用线性回归分析评估与海拔相关的 AMS 发病率。
12 项观察性研究的结果表明，在 11021 名个体上升至 19 个不同海拔高度（2200-4559 米）的研究中，与较慢的上升方式（如徒步旅行或汽车与徒步旅行相结合）相比，航空旅行的 AMS 发病率呈令人瞩目的 4.5 倍增加。在 10 项预防 AMS 的药物预防研究中，安慰剂治疗参与者中也证实了航空旅行与较慢方式旅行相比，AMS 发病率更高。
由于从低海拔到高海拔的时间跨度较短，因此在飞行前往高海拔目的地时，适应不良可能是 AMS 风险增加的主要原因。为避免令人沮丧的旅行体验和健康风险，提供关于如何准备航空旅行至高海拔地区的适当且及时的医学建议至关重要。有效的准备方案包括使用现代预适应策略和乙酰唑胺或地塞米松的药物预防，甚至考虑采用更渐进的替代路线。
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