Altitude Sickness: Travel Advice

Part of the debate – in Westminster Hall at 4:00 pm on 21 March 2023.

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Photo of Rob Roberts Rob Roberts Independent, Delyn 4:00, 21 March 2023

I beg to move,

That this House
has considered the matter of travel advice on altitude sickness.

It is a pleasure to serve under your chairmanship once again, Mr Robertson. Altitude sickness is something of a blanket term covering a variety of ailments that range from acute mountain sickness to high-altitude pulmonary oedema and high-altitude cerebral oedema. These conditions can be life-threatening, as many people find out each year and, sadly, as my own family recently discovered. I apologise and beg the indulgence of the Chair as some of the comments I will make may be distressing to hear, but it is important to convey the seriousness of the situation.

Altitude sickness is brought on by ascending to a high altitude too quickly or remaining at extreme altitudes for too long. To start with, the common and normal reaction to being at high altitude resembles that of a hangover—something I am sure we have all experienced at least once. It is not pleasant, with a headache being the most reported and common symptom. A few days on, if the headache is still occurring, someone with altitude sickness has what are referred to as category 1 symptoms, which include being out of breath when active, having difficulty sleeping and having a higher than normal heart rate. It is worth mentioning that if people are travelling to places of high altitude and do not know their normal heart rates, both at rest and during activity, they should definitely seek out advice in advance and find them out so that they can judge whether they rise.

The headache and other category 1 symptoms would be annoying or a minor irritation. They may affect the first couple of days of that person’s well-earned holiday but will normally be overlooked as just an annoyance. Those early warning signs, which would normally just mean “Drink more water” and “Take it easy on a Sunday morning”, should be treated very differently if experienced in unfamiliar conditions, especially at high altitude.

We then have what are deemed category 2 symptoms, which occur predominately when no action is taken to relieve the category 1 symptoms. They indicate that something much more significant may be happening and that individuals should seek immediate medical advice. The symptoms may include loss of appetite or nausea, weakness, dizziness or light-headedness, and ongoing fatigue. Category 3 symptoms are the most severe of all and are deemed immediately life-threatening when the aforementioned aliments start to occur.

High-altitude pulmonary oedema is just a fancy way of saying that someone has fluid on their lungs. It is often identified by symptoms such as persistently coughing or bringing up a white frothy liquid that may be tinged with blood. A person with high-altitude pulmonary oedema is deemed to be drowning from the inside, with their chest congesting, and they make abnormal sounds. They will likely experience extreme confusion, slurred speech and a cold, clammy skin. They should not lie down as that can make the situation worse, as I will discuss later.

High-altitude cerebral oedema is a fancy way of saying that someone has fluid and swelling on the brain. Cerebral oedema can be immediately recognised in someone being extremely confused, having blurred vision, being sensitive to light, having the inability to co-ordinate, walk or talk, and if their skin is turning grey.

Altitude sickness typically occurs only above 2,500 metres, or 8,000 feet, although some people are affected at lower altitudes. Risk factors include a prior episode of altitude sickness, a high degree of activity or a rapid increase in elevation. Acute mountain sickness, cerebral oedema and pulmonary oedema are all diagnosed based on clinical findings, and their severity is determined subjectively by the intensity of the symptoms that the individual reports.

Altitude sickness occurs in around 20% of people after rapidly going to 2,500 metres, and in 40% of people going to 3,000 metres. Although AMS and cerebral oedema occur equally frequently in both males and females, pulmonary oedema seems to occur more often in males. Being physically fit does not decrease the risk.

Ascending slowly is the best way to avoid altitude sickness. Avoiding strenuous activity such as skiing or hiking in the first 24 hours at high altitude may reduce symptoms. Alcohol and sleeping pills are respiratory depressants—they slow down the acclimatisation process—so should be avoided. Alcohol also tends to cause dehydration and exacerbate AMS, so the avoidance of alcohol consumption in the first 24 to 48 hours at a higher altitude is optimal.

Travel to high-altitude regions and mountainous areas has become increasingly popular for tourism, recreation, adventure activities and sometimes rescue missions. One study in America in 2018 estimated that 30 million people each year travel to mountainous regions of the western United States. That is just one part of one country.

Let me touch on pulmonary oedema in more detail. As I mentioned, my family and I have come to experience this condition at first hand. My sister-in-law, Lorraine Roberts, recently died from pulmonary oedema while on her dream holiday with her partner, visiting Machu Picchu in Peru. It had been on her bucket list for years. She followed the guidance of gradual ascent. She had rest days and did everything that she thought was right, but she was not feeling great. It was nothing too serious: she just felt generally under the weather and a bit sick, with almost hangover-type symptoms. It was nothing that would normally stop anybody who was on their holiday of a lifetime.

On the evening of 31 August, seven days before just her 52nd birthday, Lorraine went to bed at the end of an amazing day, and never woke up. Her symptoms were a sign of altitude sickness which, left untreated, turned into pulmonary oedema as she slept. It was nobody’s fault. The devasting news that took away Gill and Pete’s daughter, Dawn and Gareth’s sister, and Hannah and Joe’s mum, was a complete accident.

A similar fate befell legendary Wales rugby No. 8, and then journalist and commentator, Eddie Butler. He died in his sleep at altitude in Peru on 15 September last year, as he was taking part in one of his many fundraising efforts for the cancer charity Prostate Cymru. He was 65 years old. The condolences of the House go out to his wife and children for their loss.

Despite years of careful research, the exact causes of high-altitude pulmonary oedema remain relatively poorly understood. As I mentioned, fluid has been shown to fill up in the air pockets in the lungs, preventing oxygen from getting into the blood and causing the vicious circle of events that can kill people. As with many biological processes, many factors play a role in the disease. There is good evidence to support several theories about how the fluid gets there, but that is not the purpose of today’s debate or my remarks.

Let me move on to my call to action. On the gov.uk website, each country has travel advice, which is published and provided by the Foreign, Commonwealth and Development Office. There is a section on health for them all. On the Peru page, a number of things are listed. Regarding altitude sickness, it simply says:

“Altitude sickness is a risk in parts of Peru (including Cusco, Puno, the Colca Canyon and Kuelap).”

Then there is a link to another website for more information. It is the 11th link on the Peru health section.

It is my belief that that one line, with a link to another site, simply does not give sufficient prominence to the dangers of altitude sickness, which can prove fatal if left untreated. Plenty of studies show that the number of people who click on links on websites is nowhere even close to 100%, especially when the link in question is the 11th on a particular page. It is highly likely that the reader will have lost patience, given up clicking links or been taken off in some other direction well before that point.

I do not ask a lot of the Government—perhaps for a little more consideration with levelling-up fund bids, or a new train station in my constituency—but this request has to be one of the simplest of all for the Minister to grant. Will he please look at all the countries for which travel advice exists and make the wording much stronger for all those where there is the potential for altitude sickness, thereby giving people a much greater warning about the dangers of this condition without their having to click on a link? Tell them, in the body of the FCDO travel advice, that altitude sickness can prove fatal if untreated. Put it in capital letters.

I am not asking for a massive awareness campaign or a big marketing budget; it is of zero cost to the Government just to add a couple of lines of strongly worded text to a website. That is the only thing that I am asking for. If one person takes that advice and is saved from suffering the same wholly avoidable fate, Lorraine’s legacy will be secured.