Prevention of altitude-related illness in patients with COPD by acetazolamide. RCT

Furian, Michael; Buergin, Aline; Scheiwiller, Philipp M.; Mayer, Laura; Schneider, Simon; Mademilov, Maamed; Emilov, Berik; Lichtblau, Mona; Muralt, Lara; Sheraliev, Ulan; Marazhapov, Nuriddin H.; Sooronbaev, Talant; Ulrich, Silvia; Bloch, Konrad E.

doi:10.1183/13993003.congress-2019.pa3938

Cited by 5 publications

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“…Hence, patients with cardio-vascular or respiratory disorders such as pulmonary arterial and chronic thromboembolic pulmonary hypertension (PAH/CTEPH, summarized as PH) also wish to undergo high altitude journeys and air travel for various purposes. Hypobaric hypoxia (HH) increases with increasing altitude and decreasing barometric pressure (Pbar) resulting in an increasing prevalence of altitude-related adverse health effects (ARAHE) in healthy but particularly in patients with cardiorespiratory diseases [ 2 , 3 , 4 , 5 , 6 ]. The lower Pbar resulting in lower alveolar, blood- and tissue oxygenation leads to immediate hypoxic pulmonary vasoconstriction (HPV) that may put PH-patients at a particularly high risk for a further increase in pulmonary artery pressure (PAP) and vascular resistance (PVR) in response to hypoxia [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiorespiratory Adaptation to Short-Term Exposure to Altitude vs. Normobaric Hypoxia in Patients with Pulmonary Hypertension

Schneider

Lichtblau

Furian

et al. 2022

JCM

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Prediction of adverse health effects at altitude or during air travel is relevant, particularly in pre-existing cardiopulmonary disease such as pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH, PH). A total of 21 stable PH-patients (64 ± 15 y, 10 female, 12/9 PAH/CTEPH) were examined by pulse oximetry, arterial blood gas analysis and echocardiography during exposure to normobaric hypoxia (NH) (FiO2 15% ≈ 2500 m simulated altitude, data partly published) at low altitude and, on a separate day, at hypobaric hypoxia (HH, 2500 m) within 20–30 min after arrival. We compared changes in blood oxygenation and estimated pulmonary artery pressure in lowlanders with PH during high altitude simulation testing (HAST, NH) with changes in response to HH. During NH, 4/21 desaturated to SpO2 < 85% corresponding to a positive HAST according to BTS-recommendations and 12 qualified for oxygen at altitude according to low SpO2 < 92% at baseline. At HH, 3/21 received oxygen due to safety criteria (SpO2 < 80% for >30 min), of which two were HAST-negative. During HH vs. NH, patients had a (mean ± SE) significantly lower PaCO2 4.4 ± 0.1 vs. 4.9 ± 0.1 kPa, mean difference (95% CI) −0.5 kPa (−0.7 to −0.3), PaO2 6.7 ± 0.2 vs. 8.1 ± 0.2 kPa, −1.3 kPa (−1.9 to −0.8) and higher tricuspid regurgitation pressure gradient 55 ± 4 vs. 45 ± 4 mmHg, 10 mmHg (3 to 17), all p < 0.05. No serious adverse events occurred. In patients with PH, short-term exposure to altitude of 2500 m induced more pronounced hypoxemia, hypocapnia and pulmonary hemodynamic changes compared to NH during HAST despite similar exposure times and PiO2. Therefore, the use of HAST to predict physiological changes at altitude remains questionable. (ClinicalTrials.gov: NCT03592927 and NCT03637153).

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Section: Introductionmentioning

confidence: 99%

Cardiorespiratory Adaptation to Short-Term Exposure to Altitude vs. Normobaric Hypoxia in Patients with Pulmonary Hypertension

Schneider

Lichtblau

Furian

et al. 2022

JCM

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“…In this study, arterial blood samples from participants in two randomized, placebo-controlled, double-blind, parallel trials were analyzed. The initial trials evaluated effects of preventive acetazolamide treatment (375 mg/day) on the incidence of acute mountain sickness (AMS) during a stay at 3100 m in patients with COPD and in age-matched healthy controls ( Furian et al, 2019 ). The results of blood analysis by the EPOC device, the focus of the current study, has not been published.…”

Section: Methodsmentioning

confidence: 99%

Validation of a Portable Blood Gas Analyzer for Use in Challenging Field Conditions at High Altitude

et al. 2021

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BackgroundNovel, portable blood gas analyzers (BGAs) may serve as essential point-of-care tools in remote regions, during air travel or in ambulance services but they have not been extensively validated.Research QuestionWe compared accuracy of a portable BGA to a validated stationary device.MethodsIn healthy individuals and patients with chronic obstructive pulmonary disease participating in clinical field studies at different altitudes, arterial blood samples were obtained at rest and during exercise in a hospital at 760 m and in a high altitude clinic at 3100 m. Paired measurements by a portable BGA (EPOC, Siemens Healthcare) and a stationary BGA (Rapidpoint500, Siemens Healthcare) were performed to compute bias (mean difference) and limits of agreement (95% CI of bias).ResultsOf 105 individuals, 248 arterial blood samples were analyzed, 108 at 760 m, 140 at 3100 m. Ranges of values measured by portable BGA were: pH 7.241−7.473, PaCO2 21.5−52.5 mmHg, and PaO2 45.5−107.1 mmHg. Bias (95% CI) between devices were: pH 0.007 (−0.029 to 0.044), PaCO2 −0.3 mmHg (−4.8 to 4.2), and PaO2 −0.2 mmHg (−9.1 to 4.7). For pH, agreement between devices was improved by the equation to correct pH by portable BGA = −1.37 + pHmeasured × 1.19; bias after correction −0.007 (−0.023 to 0.009). The portable BGA was easily handled and worked reliably.InterpretationAccuracy of blood gas analysis by the portable BGA in comparison to the reference BGA was adequate for clinical use. Because of portability and ease of handling, portable BGA are valuable diagnostic tools for use in everyday practice as well as under challenging field conditions.

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“…The load of the stationary cycle ergometer was set at 75% of the individually estimated maximum work rate using an approach similar to that proposed by Luxton et al based on studies in 22 COPD patients ( 18 , 24 ). Thus, we estimated the individual maximal work rate by a regression model fitted to data from a previous study in 134 COPD patients ( 25 ) using sex, age (coefficient in men −1.12, in women −0.71) FEV 1 % predicted (coefficient in men 0.76, in women 0.19), body mass index (coefficient in men 1.56, in women 0.97), 6-min walk distance (coefficient in men 0.11, in women 0.14) and a constant (in men 34.8, in women 16.0) into account. After a 2-min resting period on the ergometer, patients started exercise.…”

Section: Methodsmentioning

confidence: 99%

Effect of High-Flow Oxygen on Exercise Performance in COPD Patients. Randomized Trial

et al. 2021

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Background: High-flow oxygen therapy (HFOT) provides oxygen-enriched, humidified, and heated air at high flow rates via nasal cannula. It could be an alternative to low-flow oxygen therapy (LFOT) which is commonly used by patients with chronic obstructive pulmonary disease (COPD) during exercise training.Research Question: We evaluated the hypothesis that HFOT improves exercise endurance in COPD patients compared to LFOT.Methods: Patients with stable COPD, FEV1 40–80% predicted, resting pulse oximetry (SpO2) ≥92%, performed two constant-load cycling exercise tests to exhaustion at 75% of maximal work rate on two different days, using LFOT (3 L/min) and HFOT (60 L/min, FiO2 0.45) in randomized order according to a crossover design. Primary outcome was exercise endurance time, further outcomes were SpO2, breath rate and dyspnea.Results: In 79 randomized patients, mean ± SD age 58 ± 9 y, FEV1 63 ± 9% predicted, GOLD grades 2-3, resting PaO2 9.4 ± 1.0 kPa, intention-to-treat analysis revealed an endurance time of 688 ± 463 s with LFOT and 773 ± 471 s with HFOT, mean difference 85 s (95% CI: 7 to 164, P = 0.034), relative increase of 13% (95% CI: 1 to 28). At isotime, patients had lower respiratory rate and higher SpO2 with HFOT. At end-exercise, SpO2 was higher by 2% (95% CI: 2 to 2), and Borg CR10 dyspnea scores were lower by 0.8 points (95% CI: 0.3 to 1.2) compared to LFOT.Interpretation: In mildly hypoxemic patients with COPD, HFOT improved endurance time in association with higher arterial oxygen saturation, reduced respiratory rate and less dyspnea compared to LFOT. Therefore, HFOT is promising for enhancing exercise performance in COPD.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03955770.

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Prevention of altitude-related illness in patients with COPD by acetazolamide. RCT

Cited by 5 publications

References 0 publications

Cardiorespiratory Adaptation to Short-Term Exposure to Altitude vs. Normobaric Hypoxia in Patients with Pulmonary Hypertension

Cardiorespiratory Adaptation to Short-Term Exposure to Altitude vs. Normobaric Hypoxia in Patients with Pulmonary Hypertension

Validation of a Portable Blood Gas Analyzer for Use in Challenging Field Conditions at High Altitude

Effect of High-Flow Oxygen on Exercise Performance in COPD Patients. Randomized Trial

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