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Original Research |

Exercise Induces Rapid Interstitial Lung Water Accumulation in Patients With Chronic Mountain SicknessExercise-Induced Lung Water at Altitude

Lorenza Pratali, MD, PhD; Stefano F. Rimoldi, MD; Emrush Rexhaj, MD; Damian Hutter, MD; Francesco Faita, PhD; Carlos Salinas Salmòn, MD; Mercedes Villena, MD; Rosa Sicari, MD, PhD; Eugenio Picano, MD, PhD; Yves Allemann, MD; Urs Scherrer, MD; Claudio Sartori, MD
Author and Funding Information

From the Institute of Clinical Physiology (Drs Pratali, Faita, Sicari, and Picano), Pisa, Italy; the Department of Cardiology (Drs Rimoldi, Hutter, Allemann, and Scherrer), University Hospital of Bern, Bern, Switzerland; the Department of Internal Medicine and Botnar Center for Clinical Research (Drs Rimoldi, Rexhaj, and Sartori), Lausanne, Switzerland; the Instituto Boliviano de Biologia de Altura (Drs Salinas Salmòn and Villena), La Paz, Bolivia; and the Facultad de Ciencias (Dr Scherrer), Departamento de Biología, Universidad de Tarapacá, Arica, Chile.

Correspondence to: Claudio Sartori, MD, University Hospital Lausanne, BH 10.640, 1011 Lausanne-CHUV, Switzerland; e-mail: claudio.sartori@chuv.ch


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: This work was supported by grants from the Swiss National Science Foundation, the Placide Nicod Foundation, and the Leenards Foundation.


© 2012 American College of Chest Physicians


Chest. 2012;141(4):953-958. doi:10.1378/chest.11-0084
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Background:  Chronic mountain sickness (CMS) is a major public health problem in mountainous regions of the world. In its more advanced stages, exercise intolerance is often found, but the underlying mechanism is not known. Recent evidence indicates that exercise-induced pulmonary hypertension is markedly exaggerated in CMS. We speculated that this problem may cause pulmonary fluid accumulation and aggravate hypoxemia during exercise.

Methods:  We assessed extravascular lung water (chest ultrasonography), pulmonary artery pressure, and left ventricular function in 15 patients with CMS and 20 control subjects at rest and during exercise at 3,600 m.

Results:  Exercise at high altitude rapidly induced pulmonary interstitial fluid accumulation in all patients but one (14 of 15) with CMS and further aggravated the preexisting hypoxemia. In contrast, in healthy high-altitude dwellers exercise did not induce fluid accumulation in the majority of subjects (16 of 20) (P = .002 vs CMS) and did not alter arterial oxygenation. Exercise-induced pulmonary interstitial fluid accumulation and hypoxemia in patients with CMS was accompanied by a more than two times larger increase of pulmonary artery pressure than in control subjects (P < .001), but no evidence of left ventricular dysfunction. Oxygen inhalation markedly attenuated the exercise-induced pulmonary hypertension (P < .01) and interstitial fluid accumulation (P < .05) in patients with CMS but had no detectable effects in control subjects.

Conclusions:  To our knowledge, these findings provide the first direct evidence that exercise induces rapid interstitial lung fluid accumulation and hypoxemia in patients with CMS that appear to be related to exaggerated pulmonary hypertension. We suggest that this problem contributes to exercise intolerance in patients with CMS.

Trial registry:  ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov

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