Michael Furian1, Mona Lichtblau2, Sayaka S Aeschbacher2, Bermet Estebesova3, Berik Emilov3, Ulan Sheraliev3, Nuriddin H Marazhapov3, Maamed Mademilov3, Batyr Osmonov3, Maya Bisang2, Stefanie Ulrich2, Tsogyal D Latshang2, Silvia Ulrich2, Talant M Sooronbaev3, Konrad E Bloch4. 1. Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology, Zurich, Switzerland; Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyz Republic. 2. Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyz Republic. 3. Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyz Republic; Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic. 4. Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyz Republic; Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic. Electronic address: konrad.bloch@usz.ch.
Abstract
BACKGROUND:Patients with COPD may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when traveling to high altitudes. This study evaluated whether dexamethasone, a drug used for the prevention of AMS in healthy individuals, would prevent AMS/ARAHE in patients with COPD. METHODS: This placebo-controlled, double-blind, parallel-design trial included patients with COPD and Global Initiative for Obstructive Lung Disease grade 1 to 2 who were living below 800 m. Patients were randomized to receive dexamethasone (8 mg/d) or placebo starting on the day before ascent and while staying in a high-altitude clinic at 3,100 m for 2 days. The primary outcome assessed during the altitude sojourn was the combined incidence of AMS/ARAHE, defined as an Environmental Symptoms Questionnaire cerebral score evaluating AMS ≥ 0.7 or ARAHE requiring descent or an intervention. RESULTS: In 60 patients randomized to receive dexamethasone (median [quartiles] age: 57 years [50; 60], FEV1 86% predicted [70; 104]; PaO2 at 760 m: 9.6 kPa [9.2; 10.0]), the incidence of AMS/ARAHE was 22% (13 of 60). In 58 patients randomized to receive placebo (age: 60 y [53; 64]; FEV1 94% predicted [76; 103]; PaO2: 10.0 kPa [9.1; 10.5]), the incidence of AMS/ARAHE was 24% (14 of 58) (χ2 statistic vs dexamethasone, P = .749). Dexamethasone mitigated the altitude-induced PaO2 reduction compared with placebo (mean between-group difference [95% CI], 0.4 kPa [0.0-0.8]; P = .028). CONCLUSIONS: In lowlanders with mild to moderate COPD, the incidence of AMS/ARAHE at 3,100 m was moderate and not reduced by dexamethasone treatment. Based on these findings, dexamethasone cannot be recommended for the prevention of AMS/ARAHE in patients with COPD undertaking high-altitude travel, although the drug mitigated the altitude-induced hypoxemia. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02450968; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND:Patients with COPD may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when traveling to high altitudes. This study evaluated whether dexamethasone, a drug used for the prevention of AMS in healthy individuals, would prevent AMS/ARAHE in patients with COPD. METHODS: This placebo-controlled, double-blind, parallel-design trial included patients with COPD and Global Initiative for Obstructive Lung Disease grade 1 to 2 who were living below 800 m. Patients were randomized to receive dexamethasone (8 mg/d) or placebo starting on the day before ascent and while staying in a high-altitude clinic at 3,100 m for 2 days. The primary outcome assessed during the altitude sojourn was the combined incidence of AMS/ARAHE, defined as an Environmental Symptoms Questionnaire cerebral score evaluating AMS ≥ 0.7 or ARAHE requiring descent or an intervention. RESULTS: In 60 patients randomized to receive dexamethasone (median [quartiles] age: 57 years [50; 60], FEV1 86% predicted [70; 104]; PaO2 at 760 m: 9.6 kPa [9.2; 10.0]), the incidence of AMS/ARAHE was 22% (13 of 60). In 58 patients randomized to receive placebo (age: 60 y [53; 64]; FEV1 94% predicted [76; 103]; PaO2: 10.0 kPa [9.1; 10.5]), the incidence of AMS/ARAHE was 24% (14 of 58) (χ2 statistic vs dexamethasone, P = .749). Dexamethasone mitigated the altitude-induced PaO2 reduction compared with placebo (mean between-group difference [95% CI], 0.4 kPa [0.0-0.8]; P = .028). CONCLUSIONS: In lowlanders with mild to moderate COPD, the incidence of AMS/ARAHE at 3,100 m was moderate and not reduced by dexamethasone treatment. Based on these findings, dexamethasone cannot be recommended for the prevention of AMS/ARAHE in patients with COPD undertaking high-altitude travel, although the drug mitigated the altitude-induced hypoxemia. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02450968; URL: www.clinicaltrials.gov.
Authors: Simon R Schneider; Mona Lichtblau; Michael Furian; Laura C Mayer; Charlotte Berlier; Julian Müller; Stéphanie Saxer; Esther I Schwarz; Konrad E Bloch; Silvia Ulrich Journal: J Clin Med Date: 2022-05-14 Impact factor: 4.964
Authors: Lara Muralt; Michael Furian; Mona Lichtblau; Sayaka S Aeschbacher; Ross A Clark; Bermet Estebesova; Ulan Sheraliev; Nuriddin Marazhapov; Batyr Osmonov; Maya Bisang; Stefanie Ulrich; Tsogyal D Latshang; Silvia Ulrich; Talant M Sooronbaev; Konrad E Bloch Journal: Front Physiol Date: 2018-06-22 Impact factor: 4.566
Authors: Simon R Schneider; Laura C Mayer; Mona Lichtblau; Charlotte Berlier; Esther I Schwarz; Stéphanie Saxer; Lu Tan; Michael Furian; Konrad E Bloch; Silvia Ulrich Journal: ERJ Open Res Date: 2021-10-11
Authors: Mona Lichtblau; Tsogyal D Latshang; Sayaka S Aeschbacher; Fabienne Huber; Philipp M Scheiwiller; Stefanie Ulrich; Simon R Schneider; Elisabeth D Hasler; Michael Furian; Konrad E Bloch; Stéphanie Saxer; Silvia Ulrich Journal: Front Physiol Date: 2021-07-07 Impact factor: 4.566