- Emergency Medicine
Clinical Assistant Professor, Emergency Medicine
Medical Education: Tufts University School of Medicine Office of the Registrar (2012) MA
Board Certification: Emergency Medicine, American Board of Emergency Medicine (2017)
Residency: University of Washington (2016) WA
Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide.
The American journal of medicine
BACKGROUND: Acute mountain sickness is a common occurrence with travel to high altitude. Although previous studies of ibuprofen have shown efficacy for acute mountain sickness prevention, recommendations have been limited, as it has not been compared directly with acetazolamide, until this study.METHODS: Adult volunteers were randomized to ibuprofen 600 mg, three times daily, 4 hours before ascent or acetazolamide 125 mg, twice daily, started the night before ascent to 3810m in the White Mountains of California. The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS) and a modified visual analogue scale (mVAS).RESULTS: Ninety-two participants completed the study: 45 (49%) ibuprofen and 47 (51%) acetazolamide. The incidence of acute mountain sickness was 56.5%, with ibuprofen 11% greater than acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs. 51.1%, 95% CI: - 11.1% to 33.5%). No difference was found in the total LLQ scores or subgroup symptoms between drugs (p=0.8). The GSQS correlated with LLQ sleep (r=0.77, 95% CI: 0.67 to 0.84) as was the mVAS with total LLQ severity (r = 0.57, 95% CI: 0.42 to 0.7). The acetazolamide group had higher SpO2 than ibuprofen (88.5% vs. 85.6%, p=0.001).CONCLUSION: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.
View details for PubMedID 30419226
Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness.
The American journal of medicine
2018; 131 (2)
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 1240m (4100 ft) to 3810m (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%) (OR0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n=11, 31%) compared with both budesonide (n=18, 55%) (OR2.6, 95% CI 1-7.2) and placebo (n=19, 54%) (OR0.4, 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.
View details for PubMedID 28668540