Acetazolamide to Prevent Adverse Altitude Effects in COPD and Healthy Adults

Abstract

Furian and colleagues report on the results of two randomized controlled trials testing the use of acetazolamide to prevent the adverse effects of altitude on healthy older persons and in people with COPD. They find that acetazolamide decreased the incidence of altitude related adverse health events (primarily hypoxemia) in both populations with no evidence of adverse events.

Visuomotor performance at high altitude in COPD patients. Randomized placebo-controlled trial of acetazolamide

“…Nevertheless, reaction time could have been improved in hypoxic condition because of an enhanced alertness due to an increased sympathetic activity ( Wolfel et al, 1994 ; Tank and Lee Wong, 2015 ; Nanduri et al, 2019 ). In the main trial of this project ( Furian et al, 2022 ), an increased mean arterial pressure has been observed in the placebo group compared to the acetazolamide group, as a possible hint for increased sympathetic activity. Acetazolamide did not affect reaction time during blocks with 0° rotation.…”

“…As we did not record sleep EEG, we were unable to evaluate whether the absence of overnight memory consolidation was related to reduced slow wave activity in participants taking acetazolamide or placebo. We could not conclusively analyze the potential effect of acute mountain sickness on visuomotor performance because COPD patients who suffered from acute mountain sickness were unable to undergo MTM tests or received oxygen therapy ( Furian et al, 2022 ). Although our data demonstrate significant effects of high altitude and of acetazolamide on performance in an established visuomotor task, further studies are needed to investigate how these findings might translate into clinical outcomes and whether other doses of acetazolamide or different compounds may be more effective.…”

“…The study was carried out from June to July 2017 in Kyrgyzstan at the National Center of Cardiology and Internal Medicine in Bishkek (760 m), and at the High-Altitude Clinic Too Ashu (3100 m). Data collection was embedded in a larger project evaluating effectiveness of acetazolamide in preventing high altitude-related adverse health effects in patients with COPD ( Furian et al, 2022 ). Baseline characteristics of participants and data on acute mountain sickness have been published ( Furian et al, 2022 ), but data on visuomotor performance, the focus of the current study, have not been reported yet.…”

“…Data collection was embedded in a larger project evaluating effectiveness of acetazolamide in preventing high altitude-related adverse health effects in patients with COPD ( Furian et al, 2022 ). Baseline characteristics of participants and data on acute mountain sickness have been published ( Furian et al, 2022 ), but data on visuomotor performance, the focus of the current study, have not been reported yet. Baseline measures without application of the study drug were performed in the Kyrgyz National Center of Cardiology and Internal Medicine in Bishkek, Kyrgyzstan, at 760 m. Subsequently, patients were randomly assigned to either acetazolamide or placebo treatment.…”

“…The main outcome was the DE. No separate sample size estimation was performed for the current trial because the sample size was determined by the sample size estimation for the main trial on prevention of high altitude-related adverse health effects into which the current trial was nested ( Furian et al, 2022 ). The minimal important difference in DE and the performance in patients with COPD are unknown.…”