Inhaled Budesonide Prevents Acute Mountain Sickness in Young Chinese Men

Chen, Guozhu; Zheng, Cheng‐Rong; Qin, Jun; Yu, Jie; Wang, Hong; Zhang, Jihang; Hu, Mingdong; Dong, Jun-Qing; Guo, Wenyun; Lu, Wei; Zeng, Ying; Huang, Lan

doi:10.1016/j.jemermed.2014.07.047

Cited by 22 publications

(22 citation statements)

References 31 publications

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“…In addition, safety with prolonged use at high altitude and, in particular the risk of gastrointestinal bleeding, remain unclear. Other recent studies have suggested that the inhaled steroid budesonide may have a role in AMS prophylaxis [123,124]. These studies raise important questions about lung involvement in the underlying pathophysiology of AMS [125], but have yet to be replicated and do not provide sufficient rationale for using this expensive medication in place of acetazolamide or dexamethasone.…”

Section: Pharmacological Measuresmentioning

confidence: 99%

Acute high-altitude sickness

2017

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At any point 1-5 days following ascent to altitudes ⩾2500 m, individuals are at risk of developing one of three forms of acute altitude illness: acute mountain sickness, a syndrome of nonspecific symptoms including headache, lassitude, dizziness and nausea; high-altitude cerebral oedema, a potentially fatal illness characterised by ataxia, decreased consciousness and characteristic changes on magnetic resonance imaging; and high-altitude pulmonary oedema, a noncardiogenic form of pulmonary oedema resulting from excessive hypoxic pulmonary vasoconstriction which can be fatal if not recognised and treated promptly. This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, we describe the current pharmacological and nonpharmacological approaches to the prevention and treatment of these diseases.

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Section: Pharmacological Measuresmentioning

confidence: 99%

Acute high-altitude sickness

2017

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“…Whether supplemental oxygen therapy in addition to current drugs would improve the capacity to perform daily activities or effectiveness of training in PAH/CTEPH patients with exercise-induced hypoxemia remains to be determined in future randomized trials (11). Further studies might investigate other potential therapeutic options, such as inhaled steroids, betamimetics, and other agents (6,54).…”

Section: Therapeutic Implications and Future Researchmentioning

confidence: 99%

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

Ulrich

Schneider

Bloch

2017

Journal of Applied Physiology

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Exercise performance is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension, exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects as well as in patients with pulmonary hypertension (PH) maximal performance during progressive ramp exercise and endurance of submaximal constant load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH-patients these improvements were mediated by a better arterial, muscular and cerebral oxygenation along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with pulmonary hypertension, alterations in the inspiratory PO2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen delivery to the muscles and the brain, by effects on cardiovascular and respiratory control and by alterations in pulmonary gas exchange. The understanding of these physiologic mechanisms helps counselling individuals planning altitude or air travel and prescribing oxygen therapy to patients with pulmonary hypertension. is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension (PH), exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange, and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects, as well as in patients with PH, maximal performance during progressive ramp exercise and endurance of submaximal constant-load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH patients, these improvements were mediated by a better arterial, muscular, and cerebral oxygenation, along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with PH, alterations in the inspiratory PO 2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen deliv...

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“…Forced vital capacity was higher and quality of sleep was better in the budesonide-treated subjects. These results were confirmed by a subsequent study from the same group on 80 volunteers randomised to inhaled budesonide, oral procaterol, inhaled budesonide/formoterol or placebo [3]. In that study, the authors attributed the improvement of AMS in budesonide-treated subjects to the central effects of improved oxygenation.…”

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confidence: 68%

“…One first needs to exclude methodological problems. The studies by BERGER et al [1], ZHENG et al [2] and CHEN et al [3] all were small, which could be a cause of type II or type I errors. However, sample sizes were adequate given the predictable high incidence of AMS in their experimental conditions, particularly in the study by BERGER et al [1] with its active ascent to a higher altitude than in the Chinese studies.…”

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confidence: 93%

Inhaled budesonide for acute mountain sickness

Naeije

Swenson

2017

Eur Respir J

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In the present issue of the European Respiratory Journal, BERGER et al. [1] report the lack of efficacy of inhaled budesonide for the prevention of acute mountain sickness (AMS). This small well-designed study was undertaken to verify or refute the provocative finding of robust protection with budesonide against AMS reported by Chinese colleagues in 2014 [2] and 2015 [3]. In the presently reported study, 50 healthy volunteers were randomly assigned to inhale twice daily budesonide 200 μg, budesonide 800 μg or a placebo 1 day prior and during climbing in less than 48 h to an altitude of 4559 m. Such a rapid active ascent is known to be associated with a more than 50% incidence of AMS symptomatology [4]. Accordingly, AMS indeed occurred in 53% of the subjects in the placebo group, and in 56% and 76% of the subjects assigned to the 200 μg and 800 μg budesonide groups, respectively. Between group differences were not significant. Clearly, inhaled budesonide did not prevent acute mountain sickness. This study raises two interesting questions: 1) why should a treatment targeted to the lungs be effective in AMS, which is not known as a respiratory disease, and 2) could the study by BERGER et al. [1] contradicting two previous randomised controlled trials be falsely negative?

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Inhaled Budesonide Prevents Acute Mountain Sickness in Young Chinese Men

Cited by 22 publications

References 31 publications

Acute high-altitude sickness

Acute high-altitude sickness

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

Inhaled budesonide for acute mountain sickness

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