The black lung?

Hey all,

Every time I go into the mountains in the winter more but also in the summer for that matter I get a persistent dry cough (throat doesn't hurt almost like a tickle in the lungs). It's terrible. At the end of a backpacking trip in the sierras I couldn't stop coughing for approximately 30 minutes on top of Whitney proceeded to throw up and about pass out.

This has happened since where the cough is cyclical and builds to the point of gagging. I've talked to my Dr. about it and talked to other outdoorsy folks including a woman who has climbed the seven summits. I've been told it could just be the dry air, could be the altitude "Khumbu cough" however I can't imagine that at 10-12,000 feet it would be an altitude related cough.

I've tried wearing a buff at night (helps warm & moisturize the dry air)and whenever I can stand to hiking especially if it's cold, sucking on hard candies, an inhaler (I didn't register as having asthma but my dad does), cough drops. ETC

All of these techniques help marginally it seem.s they delay the inevitable but the longer i'm out the worse the coughing gets.

Any Suggestions would be SO appreciated from others who have dealt with this.

EDIT: also strangely it doesn't typically happen when i'm moving just when I stop and typically doesn't happen too much when i'm asleep. Companions have joked they ALWAYS know when I wake up.

greggrylls wrote:Hey all, Every time I go into the mountains in the winter more but also in the summer for that matter I get a persistent dry cough (throat doesn't hurt almost like a tickle in the lungs). It's terrible. At the end of a backpacking trip in the sierras I couldn't stop coughing for approximately 30 minutes on top of Whitney proceeded to throw up and about pass out. This has happened since where the cough is cyclical and builds to the point of gagging. I've talked to my Dr. about it and talked to other outdoorsy folks including a woman who has climbed the seven summits. I've been told it could just be the dry air, could be the altitude "Khumbu cough" however I can't imagine that at 10-12,000 feet it would be an altitude related cough. I've tried wearing a buff at night (helps warm & moisturize the dry air)and whenever I can stand to hiking especially if it's cold, sucking on hard candies, an inhaler (I didn't register as having asthma but my dad does), cough drops. ETC All of these techniques help marginally it seem.s they delay the inevitable but the longer i'm out the worse the coughing gets. Any Suggestions would be SO appreciated from others who have dealt with this. EDIT: also strangely it doesn't typically happen when i'm moving just when I stop and typically doesn't happen too much when i'm asleep. Companions have joked they ALWAYS know when I wake up.

I tend to get something similar from time to time. It tends to be a very dry unproductive cough. It's odd though. I can go for a while (sometimes days) without coughing, but once I do start coughing I keep going until practically dry heaving. It usually lasts (on and off) for several months. It seems to have to do with the dry air. When I run the humidifier in my house, it tends to go away. Also it usually only occurs winter into spring. Once got it so bad I went to ER and they gave me an inhaler which seemed to help.

Sorry I haven't found a solution yet. If you find one please let me know. It sucks...

I quit smoking (after more than twenty years - too late! But better late than even later) and my grandmother also has bronchial asthma. From time to time I get a very rough cough when I am climbing. Especially when it's windy and I'am feeling cold. That sometime only stops after one day at home.

Cardiac illnesses can make cough also! I think I have some problems at least with heart rhythm disorders (one Grandfather too).

I think it is important to stay dry (breathable clothing), warm enough (cap, buff, balaclava, kidney area, not sitting on plain snow or rock), and windproof. Also make breaks (extra warm clothing), maybe slow down generally, to reduce physical stress.

That your dad has asthma means something too I guess. Close to gagging/passing out to me sounds like asthma, serious trouble and need for medication.

I've read that altitude sickness (AMS and HAPE) can occur as low as 10K. Your situation certainly sounds like that.

Edit: It might be worth trying some Diamox next time you are going to that elevation to see if your symptoms are relieved by it. See your doctor for a prescription. Not everyone has time for an acclimation regimen/schedule.

take some steroids

It sounds like exercise induced bronchospasm.

You should have spirometry done to rule out other underlying lung disorders. Then maybe a long acting bronchodilator with or without an inhaled corticosteroid would be appropriate.

Go back to your doctor and maybe ask to see a pulmonologist if they are brushing you off.

Good luck.

black lung

Ditto what Brian9 said, except I think maybe you could first try an entry-level short acting bronchodilator like albuterol or xopanex before diving into an advair or symbicort. You're unlikely to get prescribed a long acting inhaled bronchodilator that isn't combined with an inhaled steroid--and that might be overkill since the steroid could take two weeks to really have effect and your problem is situational.

Also ask your pulmonologist if a methocholine challenge is warranted. This is a more in-depth spirometric test for asthma.

Also maybe look into allergies (certain tree pollens or molds may be triggering your issues). For cough-variant asthma/allergies, albuterol can do wonders.

Oops--just read you've already been using your dad's inhaler.

Well, try asking for the methocholine challenge and allergy tests. You could end up like me--feeling a lot better. I use Singulair and Symbicort and had allergy shots for 5 yrs. Big commitment, but great results.

cannabis is a bronchial dilator if you want to trouble shoot before you level up on those badass doctor prescribed, lab synthesized steroids

Stagg54 Sounds like you and me have the same thing going on, you described it to a T

Hans Fimbulwinter: Warmer clothing is worth a shot I too often don't though on a puffy when I'm taking a break because I overheat so easily moving I try to cool down and usually end up shivering.

FrankPS: I can confirm altitude illness can happen that low. I live in SLC at 4,500 feet so i've never had a problem going up and sleeping at around 9,500 feet. Anything past that in a single push the symptoms start. The sickest i've been in my life was after a 2 month trip at sea level and then naively bivying the next week at 10,800 feet. Severe AMS Now I always take diamox when i'm pushing my known limits in single day ventures.\

Based on other's comments it sounds like I should take advantage of my resources (pharmacist Father with a cabinet full of various steroids) and I know he has a pulmonologist friend.

Thanks for all the comments sounds like i've got to do some trials with and without steroids up high and compare.

FrankPS wrote:I've read that altitude sickness (AMS and HAPE) can occur as low as 10K.

Medically the definition of high altitude is a elevation of 8,000ft and greater.

Taylor-B. wrote: Medically the definition of high altitude is a elevation of 8,000ft and greater.

I once took a visiting friend to the SLC valley from Alta when he started exhibiting classic altitude sickness at the base lodge - 8650'

Marc801 wrote: I once took a visiting friend to the SLC valley from Alta when he started exhibiting classic altitude sickness at the base lodge - 8650'

Yeah man, I grew up at 9500ft in Colorado and I was hospitalized when I was in grade school for re-entry HAPE after coming back from a spring break beach vacation. I had the classic cough with pink sputum.

I can go up and up just fine, but now that I live at sea level I take an oh-shit kit of meds such as Dexamethasone, Acetazolamide, and Nifedipine.

Altitude oh-shit kit

Black and white lung are both related to dust exposure... pretty rare unless you've been working in high dust environments for more than a few years.

Asthma is possible, but I have severe asthma, and the first thing I get is tension in my lungs and back muscles, and then a wheeze... the bronchial shutdown that causes the wheeze is enough to stop athletic performance long before the cough kicks in. (YMMV?)

COPD might be possible, but I think athletic performance would be even more affected. So... pulmonary edema is possible, especially above 8k'. But I would think that backpacking, you'd adapt to the altitude unless you were moving pretty fast.

Here's a weird one - Valley Fever? You mentioned the Sierras, so I'm sort of assuming you've been through the Central Valley at some point.

I have a buddy who passes out and pukes every time we go over Tioga Pass. The first time he 'forgot' to tell us what to expect. The foaming vanilla milkshake spew was a little disconcerting...
I have been on Advair for activity induced asthma since I was a kid, literally a life saver.

The same thing happened to me after spending a very cold December in Canmore, and then immidietly hopping into some Winter climbs in the PNW. 

The only thing that cured it was resting and staying out of the cold for a few months. Everything else just treats the symptoms. 

B CS wrote: It sounds like exercise induced bronchospasm. You should have spirometry done to rule out other underlying lung disorders. Then maybe a long acting bronchodilator with or without an inhaled corticosteroid would be appropriate. Go back to your doctor and maybe ask to see a pulmonologist if they are brushing you off. Good luck.

I have experienced similar symptoms on several trips to high altitude - usually once I get above 5000m.  It has led to a debilitating cough on a few trips.  As part of my experience on Mt Everest in 2011, I took part in a study being done at Basecamp (Khumbu side) for "High Altitude Cough".  I was treated with "Advair" (blind study, but the doctor said he was sure I received the drug based on the results) - "Treatment of high altitude cough (HAC) with salmeterol 50 µg and fluticasone 250 µg, one puff twice daily (bid) on Mount Everest: a randomised controlled trial".  Anyway, participating in the trial, then subsequently using Avdair afterwards, I found that my cough slowly went away over the course of a few weeks, and the cough was a non-issue on my successful ascent that season.  At the time I didn't think too much about it, but returning to Nepal in 2014, I started to develop a cough after a week at Everest Basecamp, and in 2016, again getting above 5500 meters started to trigger it - uncontrolled coughing events occurring after increased respiratory events, including some wheezing.  Have talked to some docs, I think the Exercise-Induced Bronchospasm is the likely culprit.  I plan to try Advair or something similar next time I go above 5000m.