• Michael Furian, Mona Lichtblau, Sayaka S Aeschbacher, Bermet Estebesova, Berik Emilov, Ulan Sheraliev, Nuriddin H Marazhapov, Maamed Mademilov, Batyr Osmonov, Maya Bisang, Stefanie Ulrich, Tsogyal D Latshang, Silvia Ulrich, Talant M Sooronbaev, and Konrad E Bloch.
• 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.
• Chest. 2018 Oct 1; 154 (4): 788-797.

BackgroundPatients 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.MethodsThis 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.ResultsIn 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).ConclusionsIn 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 RegistryClinicalTrials.gov; No.: NCT02450968; URL: www.clinicaltrials.gov.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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