Children's Hospital Colorado

High-Altitude Pulmonary Edema

What is high-altitude pulmonary edema?

High-altitude pulmonary edema (HAPE) is a condition in which a child’s lungs fill with fluid at high elevation (or rarely, moderate elevation). Children complain of trouble breathing, and they have a cough that starts out dry and becomes wet. They may also cough up blood. Their oxygen levels are also low.

There are three types of HAPE:

  • Classic HAPE occurs in children who live at a lower elevation and develop symptoms after traveling to high elevation.
  • Re-entry HAPE occurs in children who live at high elevation, travel to low elevation and then develop symptoms after they return home.
  • High-altitude resident pulmonary edema (HARPE) occurs in children who live at high elevation and develop symptoms without a change in elevation.

HAPE can happen more than once in many children. At Children’s Hospital Colorado, we have vast experience helping children who are affected by altitude and can provide helpful advice on preventing it in the future.

What causes high-altitude pulmonary edema?

There is less oxygen at high altitude, which causes blood vessels in the lungs to constrict or tighten. This leads to fluid leaking into the lungs.

Who gets high-altitude pulmonary edema?

HAPE appears to run in some families and is more common in males before puberty. Children with certain underlying heart or lung conditions, such as obstructive sleep apnea, pulmonary hypertension, atrial septal defect and ventricular septal defect, are more likely to develop HAPE. Respiratory infections often trigger HAPE in children.

What are the signs and symptoms of high-altitude pulmonary edema?

Children may have one or more of the following signs and symptoms:

  • Cough that starts out dry and becomes wet
  • Coughing up blood
  • Shortness of breath
  • Blue or purple lips

What tests are used to diagnose high-altitude pulmonary edema?

Typically, we do a chest X-ray to confirm pulmonary edema and to evaluate for other lung diseases. A pediatric chest X-ray is a test that provides a picture of a child's heart, lungs and bones in the chest. Less commonly, a chest ultrasound may be done at some of our locations. A chest ultrasound uses sound waves to produce pictures of the inside of the chest.

How do we diagnose high-altitude pulmonary edema?

Our providers diagnose a child with HAPE when they have signs and symptoms of pulmonary edema and they have had a recent change to high elevation, or they live at a high elevation and then develop symptoms.

How is high-altitude pulmonary edema treated?

We treat HAPE by giving your child supplemental oxygen and/or moving them to a lower elevation. Sometimes medicines can help lower blood pressure in the blood vessels of the lungs. It is also important that we evaluate your child for any underlying heart disease. Our experts in high-altitude pulmonary edema can help determine if your child needs any additional testing or treatments.

Prevention of HAPE includes a slow ascent to high elevation, using oxygen during sleep at home and/or medicines.

Why choose Children’s Colorado for treatment of high-altitude pulmonary edema?

Our Breathing Institute and Heart Institute are among the best at what they do and have multiple experts who can treat high-altitude pulmonary edema. We have pediatric pulmonologists and pediatric cardiologists who have specialized expertise in treating high-altitude pulmonary edema. These pediatric specialists often partner together to take care of children with HAPE, ensuring they receive the most complete care. We also conduct ongoing research to better understand HAPE.


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