Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema

Joyce, Kelsey E.; Lucas, Samuel J. E.; Imray, Chris; Balanos, George M.; Wright, Alex

doi:10.1080/14656566.2018.1528228

Cited by 29 publications

(14 citation statements)

References 154 publications

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“…Exercise oxygen saturation is also altered at altitude and it is profoundly lower compared with sea level18 but it can be improved by acetazolamide,19 a carbonic anhydrase inhibitor commonly used to prevent altitude illness 20 21. By inhibiting carbonic anhydrase, a catalyst of the reversible CO 2 hydration reaction, acetazolamide promotes carbonic acid formation and dissociation of H + and bicarbonate in the blood21 which limits hypoxia-induced alkalosis and improves oxygen saturation 21.…”

Section: Introductionmentioning

confidence: 99%

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Joyce

Delamere

Bradwell

et al. 2020

BMJ Open Sport Exerc Med

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IntroductionProteinuria increases at altitude and with exercise, potentially as a result of hypoxia. Using urinary alpha-1 acid glycoprotein (α1-AGP) levels as a sensitive marker of proteinuria, we examined the impact of relative hypoxia due to high altitude and blood pressure-lowering medication on post-exercise proteinuria.MethodsTwenty individuals were pair-matched for sex, age and ACE genotype. They completed maximal exercise tests once at sea level and twice at altitude (5035 m). Losartan (100 mg/day; angiotensin-receptor blocker) and placebo were randomly assigned within each pair 21 days before ascent. The first altitude exercise test was completed within 24–48 hours of arrival (each pair within ~1 hour). Acetazolamide (125 mg two times per day) was administrated immediately after this test for 48 hours until the second altitude exercise test.ResultsWith placebo, post-exercise α1-AGP levels were similar at sea level and altitude. Odds ratio (OR) for increased resting α1-AGP at altitude versus sea level was greater without losartan (2.16 times greater). At altitude, OR for reduced post-exercise α1-AGP (58% lower) was higher with losartan than placebo (2.25 times greater, p=0.059) despite similar pulse oximetry (SpO2) (p=0.95) between groups. Acetazolamide reduced post-exercise proteinuria by approximately threefold (9.3±9.7 vs 3.6±6.0 μg/min; p=0.025) although changes were not correlated (r=−0.10) with significant improvements in SpO2 (69.1%±4.5% vs 75.8%±3.8%; p=0.001).DiscussionProfound systemic hypoxia imposed by altitude does not result in greater post-exercise proteinuria than sea level. Losartan and acetazolamide may attenuate post-exercise proteinuria, however further research is warranted.

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Section: Introductionmentioning

confidence: 99%

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Joyce

Delamere

Bradwell

et al. 2020

BMJ Open Sport Exerc Med

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“…Investigations surrounding the immune and inflammatory responses to SARS-CoV-2 among lowlanders and HA natives are required. The recent emergence of dexamethasone as a successful treatment strategy for severe COVID-19 infection ( 38 ) aligns with its common use at HA, which targets problematic inflammation and capillary leak that accompany severe HA illness (e.g., HA cerebral edema) ( 43 ). Dexamethasone therefore presents a unique method for exploring HA-associated distinctions that may mitigate (or exacerbate) inflammatory responses to SARS-CoV-2.…”

Section: Physiological Factorsmentioning

confidence: 99%

Geographic components of SARS-CoV-2 expansion: a hypothesis

Joyce

Weaver

Lucas

2020

Journal of Applied Physiology

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The emergence of COVID-19 infection (caused by the SARS-CoV-2 virus) in Wuhan, China in the latter part of 2019 has, within a relatively short time, led to a global pandemic. Amidst the initial spread of SARS-CoV-2 across Asia, an epidemiologic trend emerged in relation to high altitude (HA) populations. Compared to the rest of Asia, SARS-CoV-2 exhibited attenuated rates of expansion with limited COVID-19 infection severity along the Tibetan plateau. These characteristics were soon evident in additional HA regions across Bolivia, central Ecuador, Nepal, Bhutan, and the Sichuan province of mainland China. This mini-review presents a discussion surrounding attributes of the HA environment, aspects of HA physiology, as well as, genetic variations among HA populations which may provide clues for this pattern of SARS-CoV-2 expansion and COVID-19 infection severity. Explanations are provided in the hypothetical, albeit relevant historical evidence is provided to create a foundation for future research.

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“…Ekki er maelt með kalsíumhemlinum nífedipíni til að fyrirbyggja lungnabjúg nema fyrir þá sem áður hafa fengið haeðarlungnabjúg. 58 Þeir einstaklingar aettu að haekka sig varlega og taka langvirkandi nífedipín, 30-60 mg daglega. Nífedipín veldur víkkun á lungnaslagaeðum og dregur þannig úr aeðaherpingnum sem súrefnisskorturinn veldur, sem aftur minnkar líkur á lungnabjúg.…”

Section: Haeðarlungnabjúgurunclassified

“…67 Maelt er gegn notkun þvagraesilyfja og morfíns við haeðarlungnabjúg enda geta þvagraesilyfin aukið á vökvaskort í líkamanum. 58…”

Section: Meðferð Haeðarlungnabjúgsunclassified

Hæðarveiki og tengdir sjúkdómar

Guðbjartsson

Sigurðsson

Gottfreðsson

et al. 2019

LBL

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Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema

Cited by 29 publications

References 154 publications

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Geographic components of SARS-CoV-2 expansion: a hypothesis

Hæðarveiki og tengdir sjúkdómar

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