Dexamethasone Improves Maximal Exercise Capacity of Individual's Susceptible to High Altitude Pulmonary Edema at 4559 m

Over the last decade, studies such as “Dexamethasone improves maximal exercise capacity of individual's susceptible to high altitude pulmonary edema at 4559 m” have highlighted the ability of dexamethasone and other drugs to improve human performance at altitude (Siebenmann et al., 2011). These studies have not only offered valuable insights into human physiology but also raise important ethical concerns.

The use of dexamethasone can be catastrophic. In a recent case study described in Wilderness and Environmental Medicine, doctors working for the Himalayan Rescue Association (HRA) described the case of a 27-year-old male who was prescribed a cocktail of three drugs (including dexamethasone) for his attempt on Mt Everest (Subedi et al., 2010). After more than three weeks on these drugs the decision was made to stop taking them. Following an ascent to Camp 3 (7010 m), the mountaineer collapsed and needed help to descend. On returning to low altitude it was clear that he had suffered a number of steroid-induced complications that not only threatened his life and those of his rescuers but had also left him with a number of long-term health problems.

The use of substances to improve performance at altitude also has wider implications. As the authors note in their discussion, the use of dexamethasone and other glucocorticoids is currently banned in athletic competitions overseen by the World Anti-Doping Agency (WADA). According to Article 4.33 “Criteria for including substances and methods on prohibited list” a substance shall be banned if it meets two of the following three criteria:

While the impact of dexamethasone on the “spirit” of mountaineering is a matter of personal conscience, the impact upon performance and health is becoming far less contentious. As researchers and clinicians we have an obligation to stress that dexamethasone fulfils a very limited role in mountaineering, and this must not extend beyond the prevention and treatment of high altitude illnesses. Given the drugs long list of side effects, it may be better to encourage the avoidance of dexamethasone in all but life-threatening conditions and encourage mountaineers to ascend slowly and choose objectives that are more suited to their experience and fitness. Whichever perspective chosen, we must be aware that the wider mountaineering public takes its lead from the scientific community and encouraging the use of dexamethasone carries considerable risks to health and ethics.