Asthma Inhalers on guided high altitude trips

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 danieleaston 17 Aug 2018

Hi,

I went with my partner on a guided trip up a 5000m peak so that she could have her first experience of high mountains with the minimum of worry. She has mild asthma.

She climbed to 4000m on an acclimatisation day, feeling fit, healthy, with no sign of altitude sickness. At around 4000m she got a bit wheezy, puffed on her inhaler, rested for about 10 seconds, then was good to go, carried on up the mountain feeling great. She was ahead of quite a few in the group and got to the high point for the day before several others.

When we got back to base camp she was told that she couldn't attempt the summit the next day, as it was too risky she could have an asthma attack at the top.

I'm disappointed- I accept that there is a risk in the high mountains but the episode was really minor, she was feeling good and I kind of feel that if guides only take people who are definitely going to summit then why do they need a guide.

What do people think? I don't think her mild asthma should preclude any future trips to high mountains, and I don't think one use of an inhaler should mean a turnaround.

 jam 17 Aug 2018
In reply to danieleaston:

Been asthmatic all my life, it's never even occurred to me that it would be a problem with mountains.  Been up 6000m with no asthma problems.

Very cold dry air might trigger it for some people, some of the time, but for me that's only occasionally when moving from a sedentary warm environment right into aerobic activity in the cold.

 

 Stairclimber 17 Aug 2018
In reply to danieleaston:

I would have expected your trip to have asked for info about existing medical conditions and so your guide should have outlined what he considered possible (or what risk he was not prepared  to take). If not, you shpuld have mentioned the asthma yourselves before contracting to go.

Personally, I suffered more from asthma before I relocated to the mountains. Indeed people come to live in Briancon to be free from the condition. However, it does flare up from time to time, due to pollen season or very cold air and exertion. I love ski touring, and asthma doesn't stop me, but I am aware that sometimes, on a day when I struggle, I could slow others. This is rare, but I do sometimes have to stop or turn back independently. Presumably, if you are hiring a guide, you do not have the capacity to make that choice. I accept that anybody can have an 'off day' or feel ill and compromise a group goal, but having an existing condition is something that you should make others aware of so that they can accept the risk or not. 

Don't miss out on all the wonderful experiences that the mountains offer, but do accept that asthma needs to be managed. Being 'determined' which is an admirable quality in itself and pushing on, could sometimes be your worst enemy. I have fortunately never had a life threatening attack, but have been in a position of responsibility for people that have (thankfully in an urban setting). I understand your frustration , but you pay a guide to make decisions not just get you to a summit.

 tistimetogo 17 Aug 2018
In reply to danieleaston:

Where did you go? A few years ago I was trying to find out how debilitating (if at all) asthma would be to someone at altitude. I was making an Alps trip with an asthmatic partner. It was the Pennine Alps (Castor etc) so quite a bit above 4000m. She managed fine with a gradual acclimatisation schedule and always carried her inhalers (occasionally used them). We concluded that the clear air might even help athletic performance as long as nothing triggered an attack.

I'm not a fan of hiring guides and I guess being told no is just one of the risks of doing so. Your partners asthma shouldn't stop her from future trips.

 Gone 17 Aug 2018
In reply to danieleaston:

Seems a bit OTT, yes. If the asthma is moderate or severe, the dose of the preventer inhalers can be upped to reduce the chance of another asthma attack requiring the reliever inhaler, but if a doctor has judged her asthma to be mild and low risk, she won’t have a preventer.  Asthma patients are supposed to be given an asthma plan for what to do if their asthma gets worse (eg mine, with mild asthma, says see a professional within 24 hours if my peak flow is below a certain figure for 48 hours). You could maybe ask the asthma nurse to come up with a version of this for areas without swift medical response - eg turn back if more than X puffs required per day, maybe even bring a peak flow meter - and tell the guide you have an asthma plan in advance. A guide will I think be far happier for you to summit if you can point at the bit of paper and say that you are following the plan.

 Robert Durran 17 Aug 2018
In reply to danieleaston:

Having had the frightening experience of having to deal with a severe asthma attack which required helicopter evacuation a couple of months ago while leading a group in a remote area I can understand why someone might be extremely cautious in this situation.

 l21bjd 17 Aug 2018
In reply to danieleaston:

I think it's difficult to pass judgment, since the spectrum of severity is so wide. I take a combined preventer and have been ok at altitude, up to 6000 m. I've always upped my dose to my maximum some time before the trip.  On the guided trip to 6000 m (Stok Kangri) I actually managed to get a chest infection on day one after leaving Leh, for which the head guide gave me a pack of clarithromycin, and I took quite a bit of ventolin. We did discuss it at various stages, and he was happy to go with my own judgment, and I summited without problem (I was quite lucky that on my two worst days we had a descent to a lower camp and then just a 200 m ascent the next). However, given the siege tactics, there were sufficient resources that one of the guides could have come back down on the summit day without causing a problem for the other clients - it may well have been different otherwise, which seems fair enough to me. I actually did have a bit of an asthma problem in the alps last summer (when I made an acclimatisation trip up to the Aiguille dM at the start of the trip), but that was because I'd stupidly put the preventers in my hold luggage, which took two days(!) to get to Chamonix. Luckily I'd gone out a couple of days early. I have always been careful to fill in the health bits on the forms when booking trips, and to tell the insurer (which seems to result in fairly random premium additions).

Jon.

Post edited at 13:58
 rocksol 17 Aug 2018
In reply to danieleaston:

I have lifelong asthma for which I have to take several puffs before any physical exercise. I still managed to get to nearly 8000m on a new line on K2, swinging leads and no oxygen. I can manage the situation by not going into the red. What stopped me was lack of acclimatisation as I had not taken Diamox at all, so in theory it should be feasible to climb high on a first trip to altitude. I suspect fear of litigation after an attack as the prime mover for cancelling.

 Rich W Parker 17 Aug 2018
In reply to danieleaston:

In the case of mild asthma I don't believe it to be a particularly savvy guiding decision. There have been lots of studies done on this and it really doesn't appear that mild asthma increases risk due to lower atmospheric pressure at altitude. Infact I read one opinion that suggested asthmatics and smokers may have an advantage to due adaptation!

In reply to danieleaston:

Daniel,

A reputable commercial altitude expedition company should carry out pre-trip medical screening for all their clients (and leaders), often initially by a simple questionnaire. If there are any worries they should have access to an experienced mountain medicine doctor who can liaise with the client prior to departure to determine the severity of the problem and relevance to the trip. They should ensure the client and leader has a management plan and medication in case of an exacerbation. Spare medication should be carried in case of loss or theft.

This standard procedure is outlined in the advice sheet available online from the UIAA medical committee. In the UK most holders of the UIAA/ICAR/ISMM diploma of mountain medicine can advise on specific medical conditions. A list of holders is on the Medex website.

The limited evidence on Asthma at altitude dhows that many cases improve due to the presence of less allergens and the thinner air. In some cases it does get worse. Pre-trip preparation is the key

David Hillebrandt

OP danieleaston 18 Aug 2018

Thanks all for the useful input, it seems the lesson was to get a guide who you can communicate well  with and talk about the issues, risks etc.

This was in Georgia. The company had a very nice English website but it became apparent that it was a Polish expedition, with basic translation, and the guides didn't really understand English well, which became especially important when this issue arose.

Never mind, we will take this as experience and for our future adventures, perhaps on our own, or with a more reputable company.

 

OP danieleaston 18 Aug 2018

There was no medical questionnaire, but perhaps we should have told them in advance anyway, although it's been so minor it never occurred to us.

The trip was less than half the price of some of the more well known companies, so I think that says a lot. Group of 24, guiding ratio of up to 5:1. More research next time..

 

Removed User 18 Aug 2018
In reply to danieleaston:

I would expect the answer you are seeking would be in the agreed terms and conditions by both parties when you handed over the cash to them. After all is this not what you employed them for in part? 

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