Exercise Performance of Lowlanders with COPD at 2,590 m: Data from a Randomized Trial

Furian, Michael; Hartmann, Sara E.; Latshang, Tsogyal D.; Flueck, Deborah; Murer, Christian; Scheiwiller, Philipp M.; Osmonov, Batyr; Ulrich, Silvia; Kohler, Malcolm; Poulin, Marc J.; Bloch, Konrad E.

doi:10.1159/000486450

Cited by 39 publications

(58 citation statements)

References 32 publications

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“…The higher PAP in COPD patients is most likely due to both restriction of the pulmonary vascular bed due to parenchymal destruction of the lung and a greater degree of hypoxemia with excessive hypoxic pulmonary vasoconstriction. We did not find any significant increase in breath rate or dynamic hyperinflation with altitude in the present COPD cohort [30], and changes in functional residual capacity and the TPG were not correlated. Thus, we do not think that any changes in respiratory mechanics contributed to the increase in PAP in these patients.…”

Section: Discussioncontrasting

confidence: 88%

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

et al. 2018

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Background: Changes in pulmonary hemodynamics and cardiac function in patients with chronic obstructive pulmonary disease (COPD) traveling to altitude have not been assessed despite an increasing prevalence of the disease. Objectives: We hypothesized that pulmonary artery pressure (PAP) significantly increases and cardiac function deteriorates during exposure to hypobaric hypoxia as encountered by traveling to moderate altitude or air flight. Methods: A total of 37 patients (17 female; median age [quartiles] 66 years [60; 69] with COPD GOLD grade 2–3 [FEV₁ 57% predicted (49; 71)]) living < 800 m underwent echocardiography in Zurich (490 m) and after 1 night at Davos Jakobshorn (2,590 m) in a randomized order of allocation. Results: The transtricuspid pressure gradient increased from 23 mm Hg (18; 29) to 32 mm Hg (25; 41) (p < 0.0001; Δmedian [95% CI] 7.5 [2.0; 13.0]), the right ventricular fractional area change decreased from 45% (39; 49) to 38% (33; 43) (p = 0.002), while the heart rate and systolic blood pressure increased from 70 bpm (64; 78) to 82 bpm (70; 86) (p < 0.0001) and from 133 mm Hg (123; 141) to 136 mm Hg (126; 148) (p = 0.002), respectively, and left ventricular diastolic dysfunction was more prevalent (24–54%, p = 0.02). Conclusions: This is a first study assessing changes in pulmonary hemodynamics and cardiac function in patients with COPD during a short altitude sojourn. Despite the increase in PAP and indications of change in cardiac function, the exposure was well tolerated. None of the patients had to descend to lower altitude for symptomatic altitude-related disease.

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Section: Discussioncontrasting

confidence: 88%

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

et al. 2018

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“…Some physiological outcomes evaluating gas exchange, cerebral blood flow, and cerebral and muscle tissue oxygenation as a part of the current trial have been reported recently. 4 Apart from baseline characteristics of study participants, the data presented here have not been published except previously in abstract form. The study was approved by the Cantonal Ethics Committee of Zurich (EK-2013-0088), subjects gave written informed consent, and the trial is registered at www.ClinicalTrials.gov : NCT01875133.…”

Section: Methodsmentioning

confidence: 99%

“…In a recent physiological investigation, we observed a reduction of submaximal constant load bicycle exercise by about one half due to systemic and cerebral hypoxemia in a group of COPD patients at 2,590 m compared with the performance at their low altitude residence. 4 To provide a scientific basis to counsel COPD patients planning altitude sojourns, the current study evaluated the effect of travel to altitudes of 1,650 and 2,590 m for a total of 4 days on exercise performance, general well-being, and several other outcomes in lowlanders with moderate to severe COPD.…”

Section: Introductionmentioning

confidence: 99%

Exercise performance and symptoms in lowlanders with COPD ascending to moderate altitude: randomized trial

Furian¹,

Flueck²,

Latshang³

et al. 2018

COPD

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ObjectiveTo evaluate the effects of altitude travel on exercise performance and symptoms in lowlanders with COPD.DesignRandomized crossover trial.SettingUniversity Hospital Zurich (490 m), research facility in mountain villages, Davos Clavadel (1,650 m) and Davos Jakobshorn (2,590 m).ParticipantsForty COPD patients, Global Initiative for Obstructive Lung Disease (GOLD) grade 2–3, living below 800 m, median (quartiles) age 67 y (60; 69), forced expiratory volume in 1 second 57% predicted (49; 70).InterventionTwo-day sojourns at 490 m, 1,650 m, and 2,590 m in randomized order.Outcome measuresSix-minute walk distance (6MWD), cardiopulmonary exercise tests, symptoms, and other health effects.ResultsAt 490 m, days 1 and 2, median (quartiles) 6MWD were 558 m (477; 587) and 577 m (531; 629). At 2,590 m, days 1 and 2, mean changes in 6MWD from corresponding day at 490 m were −41 m (95% CI −51 to −31) and −40 m (−53 to −27), n=40, P<0.05, both changes. At 1,650 m, day 1, 6MWD had changed by −22 m (−32 to −13), maximal oxygen uptake during bicycle exercise by −7% (−13 to 0) vs 490 m, P<0.05, both changes. At 490 m, 1,650 m, and 2,590 m, day 1, resting PaO2 were 9.0 (8.4; 9.4), 8.1 (7.5; 8.6), and 6.8 (6.3; 7.4) kPa, respectively, P<0.05 higher altitudes vs 490 m. While staying at higher altitudes, nine patients (24%) experienced symptoms or adverse health effects requiring oxygen therapy or relocation to lower altitude.ConclusionDuring sojourns at 1,650 m and 2,590 m, lowlanders with moderate to severe COPD experienced a mild reduction in exercise performance and nearly one quarter required oxygen therapy or descent to lower altitude because of adverse health effects. The findings may help to counsel COPD patients planning altitude travel.RegistrationClinicalTrials.gov: NCT01875133

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“…In a previous study in PH patients assessed during short-term exposure to normobaric hypoxia during right heart catheterization (15 min, FiO 2 15%), we also found that the pulmonary vascular resistance was similar to ambient air breathing. In accordance with healthy volunteers and patients with cardiovascular diseases or COPD, exercise performance as assessed by the 6 MWD was reduced at altitude and irrespective of whether NOT or placebo were applied during the nights ( 11 , 24 ).…”

Section: Discussionmentioning

confidence: 63%

“…In our previous short-duration study with normobaric hypoxia, PH patients revealed an even smaller fall in arterial oxygen tension compared to unaffected controls while breathing hypoxia during 15′, related to increased hyperventilation as indicated by the significant decrease in arterial partial pressure of carbon dioxide (PaCO 2 ) ( 8 ). In healthy volunteers, exercise performance is gradually impaired with increasing hypoxia/altitude ( 9 ) and even more in patients with COPD ( 10 , 11 ) and improves with adaptation ( 12 ). Data on PH patients exercising at altitude is completely lacking.…”

Section: Introductionmentioning

confidence: 99%

Altitude Travel in Patients With Pulmonary Hypertension: Randomized Pilot-Trial Evaluating Nocturnal Oxygen Therapy

et al. 2020

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Introduction: Stable patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension (PH) wish to undergo altitude sojourns or air travel but fear disease worsening. This pilot study investigates health effects of altitude sojourns and potential benefits of nocturnal oxygen therapy (NOT) in PH patients. Methods: Nine stable PH patients, age 65 (47; 71) years, 5 women, in NYHA class II, on optimized medication, were investigated at 490 m and during two sojourns of 2 days/nights at 2,048 m, once using NOT, once placebo (ambient air), 3 L/min per nasal cannula, according to a randomized crossover design with 2 weeks washout at <800 m. Assessments included safety, nocturnal pulse oximetry (SpO 2 ), 6-min walk distance (6 MWD), and echocardiography. Results: At 2,048 m, two of nine patients required medical intervention, one for exercise-induced syncope, one for excessive nocturnal hypoxemia (SpO 2 < 75% for >30 min). Both recovered immediately with oxygen therapy. Two patients suffered from acute mountain sickness. In 6 patients with complete data, nocturnal mean SpO 2 and cyclic SpO 2 dips reflecting sleep apnea significantly differed from 490 to 2,048 m with placebo, and 2,048 m with NOT (medians, quartiles): SpO 2 93 (91; 95)%, 89 (85; 90)%, 97 (95; 97)%; SpO 2 dips 10.4/h (3.1; 26.9), 34.0/h (5.3; 81.3), 0.3/h (0.1; 2.3). 6 MWD at 490, 2,048 m without and with NOT was 620 m (563; 720), 583 m (467; 696), and 561 m (501; 688). Echocardiographic indices of heart function and PH were unchanged at 2,048 m with/without NOT vs. 490 m. Conclusions: 7/9 PH patients stayed safely at 2,048 m but revealed hypoxemia, sleep apnea, and reduced 6 MWD. Hemodynamic changes were trivial. NOT improved oxygenation and sleep apnea. The current pilot trial is important for designing further studies on altitude tolerance of PH patients.

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Exercise Performance of Lowlanders with COPD at 2,590 m: Data from a Randomized Trial

Cited by 39 publications

References 32 publications

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

Exercise performance and symptoms in lowlanders with COPD ascending to moderate altitude: randomized trial

Altitude Travel in Patients With Pulmonary Hypertension: Randomized Pilot-Trial Evaluating Nocturnal Oxygen Therapy

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