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Am J Med. 2018 Feb;131(2):200.e9-200.e16. doi: 10.1016/j.amjmed.2017.05.034. Epub 2017 Jun 28.

Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness.

Author information

1
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif. Electronic address: grantlip@hotmail.com.
2
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif.
3
Department of Computational Science, University of Colorado, Boulder.
4
Emergency Medicine Residency L.A. County, University of Southern California, Los Angeles.
5
Stanford-Kaiser Emergency Medicine Residency, Palo Alto, Calif.
6
Emeregency Medicine Residency, University of Chicago School of Medicine, Ill.
7
Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Palo Alto, Calif.
8
Department of Emergency Medicine, Institute for Altitude Medicine, University of Colorado, Boulder.

Abstract

BACKGROUND:

Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide.

METHODS:

This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire ≥3 and another symptom).

RESULTS:

A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups (P > .09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n = 15, 43%) developed acute mountain sickness compared with both budesonide (n = 24, 73%) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n = 22, 63%) (OR 0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n = 11, 31%) compared with both budesonide (n = 18, 55%) (OR 2.6, 95% CI 1-7.2) and placebo (n = 19, 54%) (OR 0.4, 95% CI 0.1-1), with a number needed to treat of 4.

CONCLUSION:

Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent.

KEYWORDS:

Acetazolamide; Acute mountain sickness; Budesonide; High altitude; Prevention

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