Amid efforts to care for the large number of patients with coronavirus disease (COVID-19), there has been considerable speculation about whether the
lung injury seen in these patients is different than
acute respiratory distress syndrome from other causes. One idea that has garnered considerable attention, particularly on social media and in free open-access medicine, is the notion that
lung injury due to
COVID-19 is more similar to high-altitude
pulmonary edema (HAPE). Drawing on this concept, it has also been proposed that treatments typically employed in the management of HAPE and other forms of acute altitude illness-pulmonary
vasodilators and
acetazolamide-should be considered for
COVID-19. Despite some similarities in clinical features between the two entities, such as
hypoxemia, radiographic opacities, and altered lung compliance, the pathophysiological mechanisms of HAPE and
lung injury due to
COVID-19 are fundamentally different, and the entities cannot be viewed as equivalent. Although of high utility in the management of HAPE and acute
mountain sickness, systemically delivered pulmonary
vasodilators and
acetazolamide should not be used in the treatment of
COVID-19, as they carry the risk of multiple adverse consequences, including worsened ventilation-perfusion matching, impaired
carbon dioxide transport, systemic
hypotension, and increased work of breathing.