Most unacclimatized persons exercising at altitudes over 2500 m develop a dry, hacking cough. With exposure to extreme altitudes for prolonged periods of time, a purulent bronchitis and a painful pharyngitis become nearly universal. These problems may not be of an infectious nature; high volumes of dry, cold air through the lungs may induce respiratory heat loss and cause purulent secretions on that basis alone. Bronchospasm may also be triggered by respiratory heat loss. Severe coughing spasms can result in cough fracture of the ribs.
Pharyngeal membranes become dry, painful, and cracked because of the dehydration and high ventilation. Mucosal cracks may be an entry for pathogens, or the erythema and dryness may cause discomfort strictly on a mechanical basis. Antibiotics generally are not helpful, supporting the concept of a noninfectious etiology. Breathing of steam, ingesting hard candies or lozenges to increase salivation, and forcing hydration may provide some benefit with systemic analgesics as necessary. A silk Balaclava or similar material across the nose and mouth that is sufficiently porous to allow large volume ventilation but trap some moisture and heat helps ameliorate these bothersome high altitude conditions.
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