WWW.EXPLORADUS.COM WHAT'S UP DOC: Ashish Lohani doing a clinical trial of high altitude cough at Everest Base Camp recently.

Many clinicians spend their lives telling patients to take "lamo, lamo sas " (deep breath) as we auscultate the chest. This is wonderful in the beginning when you are fresh out of medical school, but after a while this exhortation becomes dull. Lucky then is the young physician who early on realises that some medical research activity may rescue him from boredom. Ashish Lohani, who is conducting a cough research at the Everest Base Camp, may be that fortunate physician.

While many of his friends have flocked to the United States, Ashish has steadfastly decided to go the research route and take a chance. Amazingly, cough in the mountains is the single most common medical problem that porters and mountaineers face. Not much is known about the cause of this "Khumbu cough". It seems the higher you go, the more you are likely to have persistent, disabling cough. Because many at altitude are breathless and breathe through the mouth, thus bypassing the natural humidifying mechanism of the nose, cold air may be triggering the cough by "roughing up" the bronchial mucosa. Or it could also be that asthma like mechanisms are at work at high altitude which cause narrowing of the airways and cough. Another prime suspect is low oxygen at high altitude.

Whatever the cause, as there is no known effective treatment, Lohani is doing a RCT ( randomized controlled trial) to see if he can help. RCTs are the gold standard in Western medicine to prove the efficacy of drugs in clinical practice.

There are two arms in his study, a potentially useful drug arm and a placebo arm. For over two months, he has been randomly enrolling patients in the highest terrestrial research station (5300m) and conscientiously charting his results to be analysed later. Many climbers including our own Nepali civil servants who were climbing Everest this spring wish Ashish every success in his endeavour even so that future climbers may be helped. Many of these enthusiastic, high profile Nepali climbers had to say goodbye to their summit bid due to hacking, persistent cough that almost caused rib fractures and punctured lungs.

In the meantime, at Base Camp, Ashish is saying "Lamo, lamo sas linus" with more enthusiasm than we Kathmandu clinicians.