Dexamethasone reduces pulmonary artery pressure in lowlanders with COPD travelling to 3200 m. Randomized, placebo-controlled trial

Introduction: COPD is associated with increased pulmonary artery pressure (PAP) at lowlands and affected patients may be at risk of symptomatic pulmonary hypertension when travelling to altitude. Since dexamethasone prevents pulmonary edema due to PAP rise in susceptible subjects at high altitude1 we performed a randomized, placebo‐controlled trial evaluating the hypothesis that preventive treatment with dexamethasone mitigates the altitude‐induced PAP rise in COPD patients. Methods: Patients with COPD Gold grade 1‐2 living below 800 m, SpO2 >93%, in stable condition were included. Participants were randomized to receive dexamethasone (4 mg, bid) or placebo one day before ascent from 760m and during a sojourn to 3200 m in Tuja Ashu, Kyrgyz Republic. Echocardiography was performed at 760 m and after Sthe first night at 3200 m. The main outcome was the tricuspid pressure gradient (TPG). Results: 109 patients were randomized (mean ± SD age 56 ± 9, BMI 26 ± 4 kg/m2, FEV1 89 ± 21%pred, SpO2 95 ± 2%). The TPG and systolic PAP increased from 760 to 3200 m, dexamethasone mitigated the altitude‐induced increase in TPG vs. placebo while the increase in cardiac output was similar with dexamethasone and placebo. The smaller increase in TPG with dexamethasone was associated with a higher SpO2 at peak walk test. Regression analysis confirmed that dexamethasone was associated with a reduced altitude‐induced increase in TPG even when controlled for age and FEV1%pred (R2 = 0.58, P = 0.02). Conclusion: In lowlanders with COPD, GOLD 1‐2, travelling to 3200 m induces mild pulmonary hypertension. Dexamethasone mitigates this altitude‐induced increase in PAP while maintaining cardiac output with a favorable effect on oxygenation during exercise. (Table Presented).