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Several interventions are available for the treatment and prevention of HAI. These therapies are broadly categorized into pharmacological and nonpharmacological approaches. Pharmacological Treatment of High-Altitude Illness Pharmacological interventions include the use of CAIs such as acetazolamide, which is primarily used for prophylaxis. A typical regimen consists of 125 mg twice daily, initiated at least 2 days before ascent. Dexamethasone is indicated for the treatment of severe AMS and HACE. A common dosing protocol involves a loading dose of 8 mg, administered orally, intramuscularly, or intravenously when available, followed by 4 mg every 6 hours. This regimen should be accompanied by descent of at least 500 to 1,000 meters and supplemental oxygen when accessible. Mild AMS may be managed with symptomatic treatment. Analgesics such as acetaminophen (1,000 mg) or ibuprofen (400 mg), along with antiemetics like metoclopramide (10 mg), may be used for relief. Supportive measures include avoiding intense physical activity, halting further ascent, and preventing dehydration through adequate fluid intake. Other pharmacologic agents, including CCBs such as nifedipine, have been employed in the management of pulmonary hypertension and HAPE. Dosing regimens include 20 mg or 30 mg every 8 or 12 hours. However, evidence for the efficacy of this agent is currently limited. In cases where ARDS is the underlying cause of HAPE, targeted management of ARDS is critical to prevent further complications.[28] Systematic reviews evaluating the effects of phosphodiesterase-5 inhibitors, including sildenafil (40, 50, or 100 mg) and tadalafil (10 mg), have shown no significant improvement in clinical outcomes among individuals affected by HAPE.[29] These agents are also associated with side effects and adverse reactions, prompting ongoing investigation into the efficacy and safety of medicinal plants for the prevention and treatment of HAI. Animal studies have demonstrated that combining conventional pharmacologic agents such as acetazolamide with medicinal plants, including Rhodiola rosea L., may enhance the prevention and treatment of HAI. This combined approach has shown particular benefit among populations residing in the Qinghai–Tibet Plateau.[30]

Systematic reviews evaluating the effects of phosphodiesterase-5 inhibitors, including sildenafil (40, 50, or 100 mg) and tadalafil (10 mg), have shown no significant improvement in clinical outcomes among individuals affected by HAPE.[29] These agents are also associated with side effects and adverse reactions, prompting ongoing investigation into the efficacy and safety of medicinal plants for the prevention and treatment of HAI. Animal studies have demonstrated that combining conventional pharmacologic agents such as acetazolamide with medicinal plants, including Rhodiola rosea L., may enhance the prevention and treatment of HAI. This combined approach has shown particular benefit among populations residing in the Qinghai–Tibet Plateau.[30] Both human and animal studies have reported promising findings with Chinese herbal medicines such as Zanthoxylum armatum (Rutaceae), which is rich in flavonoids and polyphenols with antioxidant properties that may reduce oxidative stress at the cellular level. These phytochemicals have been investigated for their role in preventing and treating HAI, particularly high-altitude pulmonary hypertension. However, further in vitro and in vivo studies are necessary to fully establish the efficacy, safety, and adverse effect profiles of these natural compounds.[31] Nonpharmacological Therapy of High-Altitude Illness Nonpharmacological interventions primarily aim to relieve symptoms of HAI through measures such as supplemental oxygen or descent to lower elevations. However, these strategies present logistical challenges due to the weight and bulk of oxygen delivery equipment (eg, oxygen bottles, cylinders, or tanks), limited access to healthcare facilities, and the difficulty of transporting both patients and equipment in remote, high-altitude, or mountainous terrain. Some studies have demonstrated that auto–positive end-expiratory pressure (auto-PEEP)—a technique similar to pursed-lip breathing—is not inferior to bottled oxygen therapy for the initial management of HAPE. A key advantage of this approach is its continuous availability without the need for external equipment.[32]

Nonpharmacological interventions primarily aim to relieve symptoms of HAI through measures such as supplemental oxygen or descent to lower elevations. However, these strategies present logistical challenges due to the weight and bulk of oxygen delivery equipment (eg, oxygen bottles, cylinders, or tanks), limited access to healthcare facilities, and the difficulty of transporting both patients and equipment in remote, high-altitude, or mountainous terrain. Some studies have demonstrated that auto–positive end-expiratory pressure (auto-PEEP)—a technique similar to pursed-lip breathing—is not inferior to bottled oxygen therapy for the initial management of HAPE. A key advantage of this approach is its continuous availability without the need for external equipment.[32] Other investigations have compared nonpharmacological strategies such as simulated short-term acclimatization and long-term physiological adaptation across different population groups residing on the Tibetan Plateau. These groups include native highlanders, native lowlanders, and recently acclimatized newcomers, highlighting variability in altitude tolerance and response to hypobaric hypoxia.[33]

Interprofessional collaboration is essential to ensure early detection, appropriate monitoring, and effective treatment of HAI. Technology-assisted approaches, such as telemedicine platforms, offer viable solutions for delivering emergency care in remote and extreme environments. An example is the e-Rés@MONT teleconsultation platform, which has been designed, developed, and implemented in 5 mountain resort huts and 3 remote outpatient clinics in the Valle d'Aosta region of the Mont Blanc massif in Italy.[34] As previously mentioned, pulse oximeters, wearable oxygen sensors such as smartwatches, and wireless cerebral oximeters have all been developed for use in high-altitude settings. Beyond their diagnostic utility, these tools may be employed for continuous physiologic monitoring, particularly during sleep or prolonged exposure, providing real-time data on oxygen saturation and cerebral oxygenation. When integrated into remote care platforms, these technologies enhance the interprofessional team’s capacity to detect early deterioration and coordinate timely intervention.[35] Air travel to high-altitude destinations presents significant challenges and increases the risk of HAI. A preflight medical evaluation is recommended, particularly for individuals with acute or chronic medical conditions. Patients and travelers should consult their healthcare provider before travel, while pilots and crew must obtain medical certification issued by an Aviation Medical Examiner (AME) prior to flight clearance. Preacclimatization strategies, including hypoxia stimulation testing and structured exercise training, should be incorporated along with other prophylactic measures outlined in this activity to mitigate the health risks associated with altitude exposure and support a safer, more comfortable travel experience.