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

Michael Furian, Deborah Flueck, Tsogyal D Latshang, Philipp M Scheiwiller, Sebastian Daniel Segitz, Séverine Mueller-Mottet, Christian Murer, Adrian Steiner, Silvia Ulrich, Thomas Rothe, Malcolm Kohler, Konrad E Bloch, Michael Furian, Deborah Flueck, Tsogyal D Latshang, Philipp M Scheiwiller, Sebastian Daniel Segitz, Séverine Mueller-Mottet, Christian Murer, Adrian Steiner, Silvia Ulrich, Thomas Rothe, Malcolm Kohler, Konrad E Bloch

Abstract

Objective: To evaluate the effects of altitude travel on exercise performance and symptoms in lowlanders with COPD.

Design: Randomized crossover trial.

Setting: University Hospital Zurich (490 m), research facility in mountain villages, Davos Clavadel (1,650 m) and Davos Jakobshorn (2,590 m).

Participants: Forty 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).

Intervention: Two-day sojourns at 490 m, 1,650 m, and 2,590 m in randomized order.

Outcome measures: Six-minute walk distance (6MWD), cardiopulmonary exercise tests, symptoms, and other health effects.

Results: At 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.

Conclusion: During 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.

Registration: ClinicalTrials.gov: NCT01875133.

Keywords: CPET; acute mountain sickness; adverse health effects; altitude illness; arterial blood gas analysis; cardiopulmonary exercise testing; dyspnea; hypoxia; pulmonary function.

Conflict of interest statement

Disclosure SU reports grants from Swiss National Science Foundation, Zurich Lung League, grants and personal fees from Actelion SA, OrPha Swiss, personal fees from MSD, outside the submitted work. MK reports personal fees from Boehringer Ingelheim, Novartis, CSL Behring, Mundipharma grants, and personal fees from Roche, AstraZeneca, and Bayer outside the submitted work. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient flow. Notes: Of 191 eligible subjects, 40 were randomized into one of the four altitude exposure sequences (A–D) and included in the intention-to-treat analysis. Data from 32 subjects were included in the per-protocol analysis.
Figure 2
Figure 2
Altitude-induced changes. Notes: Dots represent mean differences and horizontal bars the 95% CIs, values are numerically indicated on the right. Altitude effect is significant when the zero value is not part of the 95% CI.

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