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Budesonide inhaler ineffective for same-day prevention of acute mountain sickness
Clinical Question
Will budesonide prevent acute mountain sickness when administered at the start of the ascent?
Bottom line
For those few people aiming to achieve great heights (over 12,000 feet [~3500 m]), the convenience of inhaled budesonide (Pulmicort) is offset by the fact that it doesn't work to prevent acute mountain sickness (AMS). For prevention of AMS associated with rapid ascent, acetazolamide (Diamox) given the day of ascent is slightly more effective than inhaled budesonide or placebo, though sickness will still occur in many hikers. Day-of acetazolamide might be an option for search-and-rescue personnel, but starting treatment earlier might be better for planned ascents. 1b-
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Outpatient (specialty)
Synopsis
These investigators enrolled 103 participants who were living at low altitude and interested and able to do strenuous hiking at high altitude. The participants were randomized, using concealed allocation, to receive placebo, the inhaled corticosteroid budesonide 180 mcg via inhaler twice daily, or acetazolaimde 125 mg orally twice daily. All patients used an inhaler and took active or placebo oral medication to assure masking. In a rapid assent, participants were driven from 4100 feet (1240 m), where they were given the treatment, to 11,300 feet (3424 m), and then hiked 2.7 miles (4.3 km) to 12,570 feet (3810 m) where they spent the night. AMS (Lake Louise Questionnaire [LLQ] score of at least 3) occurred in 63% of those receiving placebo, 43% of those receiving acetazolamide, and 73% of those receiving budesonide. Severe mountain sickness (LLQ score of at least 5) occurred in 47%: 54% with placebo, 31% with acetazolamide, and 55% with budesonide. Oxygen saturation was not affected by treatment. Using pairwise comparisons, acetazolamide was protective for both AMS and severe AMS as compared with budesonide and protected participants against severe AMS better than placebo and budesonide.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
good poem
acetazolamide has been effective in decreasing csf production I would like to review acuet mountain disease acute mountain disease to see if there any connection with increased ICP or Glucoma
In view of the pathophysiology of mountain sickness, how could a steroid inhaler possibly be helpful. Physiologically improbable .
Silly study.