• Xiong Zhu, Yunrui Liu, Na Li, and Qing He.
• The Third People's Hospital of Chengdu，Clinical College of Southwest Jiaotong University, Chengdu, Sichuan 610031, China.
• Am J Emerg Med. 2020 Aug 1; 38 (8): 1627-1634.

BackgroundAltitude induces acute mountain sickness (AMS), which can affect the health or limit the activities of 15 -80% of climbers and workers. Budesonide has been applied to prevent AMS. However, its prophylactic efficacy is controversial. Our purpose was to conduct a meta-analysis to assess whether budesonide qualifies as a prophylaxis for AMS.MethodsA literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library in February 2019. Only randomized controlled trials (RCTs) were selected. The main outcome, AMS, was estimated with the relative risk (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI). The statistical analysis was performed using Rev. Man 5.3.ResultsFive groups in six articles met the eligibility criteria with 304 participants, including two articles with the same participants but different measurements. Inhaled budesonide showed a potential trend towards preventing AMS, but it was not statistically significant (RR = 0.68, 95% CI: 0.41-1.13, p = 0.14). The subgroup analysis based on dosage (200 µg) did not have significant results. A similar trend was observed for severe AMS and in subgroups stratified by the Lake Louise Score (LLC). However, there was a significant improvement in heart rate (HR) (WMD = -5.41, 95% CI: -8.26 to -2.55, p = 0.0002) and pulse oxygen saturation (SPO2) (WMD = 2.36, 95% CI: 1.62-3.1, p < 0.00001) in the group with inhaled budesonide. Additionally, no side effects were reported in any included study.ConclusionThe current meta-analysis indicates that inhaled budesonide does not protect against AMS or severe AMS. However, it is successful at reducing HR and increasing SPO2 without any side effects.Copyright © 2019 Elsevier Inc. All rights reserved.

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