Efficacy of Dexamethasone in Preventing Acute Mountain Sickness in COPD Patients: Randomized Trial

Abstract

Background: Patients with COPD may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when traveling to high altitudes. This study evaluated whether dexamethasone, a drug used for the prevention of AMS in healthy individuals, would prevent AMS/ARAHE in patients with COPD.

Methods: This placebo-controlled, double-blind, parallel-design trial included patients with COPD and Global Initiative for Obstructive Lung Disease grade 1 to 2 who were living below 800 m. Patients were randomized to receive dexamethasone (8 mg/d) or placebo starting on the day before ascent and while staying in a high-altitude clinic at 3,100 m for 2 days. The primary outcome assessed during the altitude sojourn was the combined incidence of AMS/ARAHE, defined as an Environmental Symptoms Questionnaire cerebral score evaluating AMS ≥ 0.7 or ARAHE requiring descent or an intervention.

Results: In 60 patients randomized to receive dexamethasone (median [quartiles] age: 57 years [50; 60], FEV₁ 86% predicted [70; 104]; PaO₂ at 760 m: 9.6 kPa [9.2; 10.0]), the incidence of AMS/ARAHE was 22% (13 of 60). In 58 patients randomized to receive placebo (age: 60 y [53; 64]; FEV₁ 94% predicted [76; 103]; PaO₂: 10.0 kPa [9.1; 10.5]), the incidence of AMS/ARAHE was 24% (14 of 58) (χ² statistic vs dexamethasone, P = .749). Dexamethasone mitigated the altitude-induced PaO₂ reduction compared with placebo (mean between-group difference [95% CI], 0.4 kPa [0.0-0.8]; P = .028).

Conclusions: In lowlanders with mild to moderate COPD, the incidence of AMS/ARAHE at 3,100 m was moderate and not reduced by dexamethasone treatment. Based on these findings, dexamethasone cannot be recommended for the prevention of AMS/ARAHE in patients with COPD undertaking high-altitude travel, although the drug mitigated the altitude-induced hypoxemia.

Trial registry: ClinicalTrials.gov; No.: NCT02450968; URL: www.clinicaltrials.gov.

Keywords: COPD; acute mountain sickness; altitude; dexamethasone.