Response to high-altitude triggers in seasonal asthmatics on and off inhaled corticosteroid treatment

Pontus Mertsch, MD; Jeremias Götschke, MD; Julia Walter, PhD; Carlo Mümmler, MD; Alessandro Ghiani, MD; Ulrike Schürmann; Rosemarie Kiefl; Rudolf Maria Huber, MD; Jürgen Behr, MD; Nikolaus Kneidinger, MD, PhD; Katrin Milger, MD

World Allergy Organization Journal (Oct 2022)

Response to high-altitude triggers in seasonal asthmatics on and off inhaled corticosteroid treatment

Pontus Mertsch, MD,
Jeremias Götschke, MD,
Julia Walter, PhD,
Carlo Mümmler, MD,
Alessandro Ghiani, MD,
Ulrike Schürmann,
Rosemarie Kiefl,
Rudolf Maria Huber, MD,
Jürgen Behr, MD,
Nikolaus Kneidinger, MD, PhD,
Katrin Milger, MD

Affiliations

Pontus Mertsch, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
Jeremias Götschke, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
Julia Walter, PhD: Department of Medicine V, University Hospital, LMU, Munich, Germany
Carlo Mümmler, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
Alessandro Ghiani, MD: Lung Center Stuttgart – Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart, Germany; Department of Pulmonology and Respiratory Medicine, Stuttgart, Germany
Ulrike Schürmann: Department of Medicine V, University Hospital, LMU, Munich, Germany
Rosemarie Kiefl: Department of Medicine V, University Hospital, LMU, Munich, Germany
Rudolf Maria Huber, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany
Jürgen Behr, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
Nikolaus Kneidinger, MD, PhD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
Katrin Milger, MD: Department of Medicine V, University Hospital, LMU, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany; Corresponding author. Department of Medicine V, University Hospital, LMU, Marchioninistr.15, 81377 Munich, Germany.

Journal volume & issue: Vol. 15, no. 10
p. 100698

Abstract

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Background: Due to the effects of climate change, winter sport enthusiasts will be increasingly forced to stay at higher altitudes. High altitude (HA) environmental factors such as cold temperature, physical exertion, and hypoxia with subsequent hypocapnia due to hyperventilation have been shown to induce bronchoconstriction. With bronchial asthma being highly prevalent, asthmatics also will be increasingly exposed to HA environment and might experience increasing symptoms. Methods: We analysed the effects of HA factors at around 2600 m a.s.l. (metres above sea level) on lung function in mild seasonal asthmatics while they were routinely off (January) and on (March, after start of lowland pollen season) low-dose inhaled corticosteroid (ICS) treatment (n = 10), and matched healthy controls (n = 11). Results: Without inhaled corticosteroid (ICS) treatment mean FEV1 in asthmatics was 230 ml lower after exercise at HA compared to low altitude (LA, p < 0.05), while in healthy controls there was no significant difference. This decrease was mainly induced by cold and exercise at HA. During ICS treatment, this decrease was prevented. Methacholine response was reduced at HA compared to LA. Conclusions: The decrease of FEV1 in response to a combination of hypoxia, cold, and exercise is prevented by ICS treatment in mild, seasonal asthmatics. However, the FEV1 response to high altitude factors was overall small.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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