Dexamethasone Ineffective for Prevention of Acute Mountain Sickness in COPD

Dexamethasone was no more effective than placebo in reducing the incidence of acute mountain sickness and altitude-related adverse health effects in individuals with mild to moderate chronic obstructive pulmonary disease (COPD), although dexamethasone did mitigate altitude-induced hypoxemia, according to a study published in CHEST.

In this randomized, double-blind, placebo-controlled, parallel-group trial (ClinicalTrials.gov Identifier: NCT02450968), 118 adult participants with mild to moderate COPD who were living below 800 meters were given dexamethasone or placebo starting 1 day prior to ascending to a clinic at 3100 meters, where the medication or placebo was continued throughout a 2-day and 2-night stay at this high altitude. Symptoms of acute mountain sickness were measured using a 6-minute walk test, the Environmental Symptoms Questionnaire cerebral score, the Lake Louise self-assessment score, spirometry, an arterial blood gas analysis, and sniff nasal inspiratory pressure measurements. During sleep, walk tests, and in participants experiencing discomfort, arterial oxygen saturation by pulse oximetry was monitored to detect any significant hypoxemia.

Of the 118 participants, 27 (23%) experienced altitude-related adverse health effects that necessitated treatment and relocation to a lower altitude. Symptoms of acute mountain sickness occurred in 24% of participants taking placebo (14 of 58), and in 22% of participants taking dexamethasone (13 of 60). Hypoxemia was mitigated in the dexamethasone group compared with placebo, however, with a mean between-group difference of +0.4 kPa (95% CI, 0.0-0.8 kPa), P =.028. The overall findings also indicated that individuals with mild to moderate COPD are not excessively susceptible to acute mountain sickness compared with healthy participants.

The investigators concluded, “Taking into account that at least 8 patients would (theoretically) have to be treated with dexamethasone to prevent one case of [acute mountain sickness/altitude-related adverse health effect] under the conditions of the current study, and considering the risk of side effects such as severe hyperglycemia, the current results do not support the use of dexamethasone for prevention of [acute mountain sickness/altitude-related adverse health effect] in patients with mild to moderate COPD travelling to 3100 m.”

Reference

Furian M, Lichtblau M, Aeschbacher SS, et al. Efficacy of dexamethasone in preventing acute mountain sickness in COPD patients. Randomized trial [published online June 14, 2018]. CHEST. doi:10.1016/j.chest.2018.06.006