Variations in the presentation of altitude-induced chokes

Altitude-induced decompression sickness (DCS) remains a potential risk for individuals involved in flying or altitude chamber activities. The pulmonary form of DCS, commonly referred to as chokes, although uncommon, represents the most serious manifestation of the disease. This study reports the Davis Hyperbaric Laboratory experience with altitude-induced chokes from 1 January 1966 to 31 July 1994. Age, gender, type and extent of altitude exposure, time of symptom development, type of initial symptoms, and response to treatment were reviewed for each chokes patient. There were 15 cases of chokes; all were treated with compression therapy with complete resolution. Only 2 of the 15 individuals presented with the classic triad of substernal chest pain, dyspnea, and cough. Substernal chest pain was universally present, and usually occurred very early in the course of the disease. The other classic triad symptoms were frequently absent. The etiology, pathophysiology, and treatment of chokes are discussed.