Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial
Background COPD may predispose to symptomatic pulmonary hypertension at high altitude. We investigated haemodynamic changes in lowlanders with COPD ascending to 3100 m and evaluated whether preventive acetazolamide treatment would attenuate the altitude-induced increase in pulmonary artery pressure...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2023-04-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/9/2/00412-2022.full |
| _version_ | 1797809366249766912 |
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| author | Mona Lichtblau Stéphanie Saxer Laura Mayer Ulan Sheraliev Maamed Mademilov Michael Furian Aline Buergin Philipp M. Schweiwiller Simon R. Schneider Felix C. Tanner Talant Sooronbaev Konrad E. Bloch Silvia Ulrich |
| author_facet | Mona Lichtblau Stéphanie Saxer Laura Mayer Ulan Sheraliev Maamed Mademilov Michael Furian Aline Buergin Philipp M. Schweiwiller Simon R. Schneider Felix C. Tanner Talant Sooronbaev Konrad E. Bloch Silvia Ulrich |
| author_sort | Mona Lichtblau |
| collection | DOAJ |
| description | Background
COPD may predispose to symptomatic pulmonary hypertension at high altitude. We investigated haemodynamic changes in lowlanders with COPD ascending to 3100 m and evaluated whether preventive acetazolamide treatment would attenuate the altitude-induced increase in pulmonary artery pressure (PAP).
Methods
In this randomised, placebo-controlled, double-blind, parallel-group trial, patients with COPD Global Initiative for Chronic Obstructive Lung Disease grades 2–3 who were living <800 m and had peripheral oxygen saturation (SpO2) >92% and arterial carbon dioxide tension <6 kPa were randomised to receive either acetazolamide (125–250 mg·day−1) or placebo capsules, starting 24 h before ascent from 760 m and during a 2-day stay at 3100 m. Echocardiography, pulse oximetry and clinical assessments were performed at 760 m and after the first night at 3100 m. Primary outcome was PAP assessed by tricuspid regurgitation pressure gradient (TRPG).
Results
112 patients (68% men, mean±sd age 59±8 years, forced expiratory volume in 1 s (FEV1) 61±12% pred, SpO2 95±2%) were included. Mean±sd TRPG increased from 22±7 to 30±10 mmHg in 54 patients allocated to placebo and from 20±5 to 24±7 mmHg in 58 patients allocated to acetazolamide (both p<0.05) resulting in a mean (95% CI) treatment effect of −5 (−9 to −1) mmHg (p=0.015). In patients assigned to placebo at 760/3100 m, mean±sd SpO2 was 95±2%/88±3%; in the acetazolamide group, the respective values were 94±2%/90±3% (both p<0.05), resulting in a treatment effect of +2 (1 to 3)% (p=0.001).
Conclusions
In lowlanders with COPD travelling to 3100 m, preventive acetazolamide treatment attenuated the altitude-induced rise in PAP and improved oxygenation. |
| first_indexed | 2024-03-13T06:51:32Z |
| format | Article |
| id | doaj.art-647a4956af014a6a960c9d472d322de1 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-13T06:51:32Z |
| publishDate | 2023-04-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-647a4956af014a6a960c9d472d322de12023-06-07T13:31:08ZengEuropean Respiratory SocietyERJ Open Research2312-05412023-04-019210.1183/23120541.00412-202200412-2022Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trialMona Lichtblau0Stéphanie Saxer1Laura Mayer2Ulan Sheraliev3Maamed Mademilov4Michael Furian5Aline Buergin6Philipp M. Schweiwiller7Simon R. Schneider8Felix C. Tanner9Talant Sooronbaev10Konrad E. Bloch11Silvia Ulrich12 Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Swiss–Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic Swiss–Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Swiss–Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic Swiss–Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland Background COPD may predispose to symptomatic pulmonary hypertension at high altitude. We investigated haemodynamic changes in lowlanders with COPD ascending to 3100 m and evaluated whether preventive acetazolamide treatment would attenuate the altitude-induced increase in pulmonary artery pressure (PAP). Methods In this randomised, placebo-controlled, double-blind, parallel-group trial, patients with COPD Global Initiative for Chronic Obstructive Lung Disease grades 2–3 who were living <800 m and had peripheral oxygen saturation (SpO2) >92% and arterial carbon dioxide tension <6 kPa were randomised to receive either acetazolamide (125–250 mg·day−1) or placebo capsules, starting 24 h before ascent from 760 m and during a 2-day stay at 3100 m. Echocardiography, pulse oximetry and clinical assessments were performed at 760 m and after the first night at 3100 m. Primary outcome was PAP assessed by tricuspid regurgitation pressure gradient (TRPG). Results 112 patients (68% men, mean±sd age 59±8 years, forced expiratory volume in 1 s (FEV1) 61±12% pred, SpO2 95±2%) were included. Mean±sd TRPG increased from 22±7 to 30±10 mmHg in 54 patients allocated to placebo and from 20±5 to 24±7 mmHg in 58 patients allocated to acetazolamide (both p<0.05) resulting in a mean (95% CI) treatment effect of −5 (−9 to −1) mmHg (p=0.015). In patients assigned to placebo at 760/3100 m, mean±sd SpO2 was 95±2%/88±3%; in the acetazolamide group, the respective values were 94±2%/90±3% (both p<0.05), resulting in a treatment effect of +2 (1 to 3)% (p=0.001). Conclusions In lowlanders with COPD travelling to 3100 m, preventive acetazolamide treatment attenuated the altitude-induced rise in PAP and improved oxygenation.http://openres.ersjournals.com/content/9/2/00412-2022.full |
| spellingShingle | Mona Lichtblau Stéphanie Saxer Laura Mayer Ulan Sheraliev Maamed Mademilov Michael Furian Aline Buergin Philipp M. Schweiwiller Simon R. Schneider Felix C. Tanner Talant Sooronbaev Konrad E. Bloch Silvia Ulrich Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial ERJ Open Research |
| title | Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial |
| title_full | Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial |
| title_fullStr | Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial |
| title_full_unstemmed | Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial |
| title_short | Effect of acetazolamide on pulmonary vascular haemodynamics in patients with COPD going to altitude: a randomised, placebo-controlled, double-blind trial |
| title_sort | effect of acetazolamide on pulmonary vascular haemodynamics in patients with copd going to altitude a randomised placebo controlled double blind trial |
| url | http://openres.ersjournals.com/content/9/2/00412-2022.full |
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