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

• Published in: The World Allergy Organization journal Vol. 15; no. 10; p. 100698
• Main Authors: Mertsch, Pontus, Götschke, Jeremias, Walter, Julia, Mümmler, Carlo, Ghiani, Alessandro, Schürmann, Ulrike, Kiefl, Rosemarie, Maria Huber, Rudolf, Behr, Jürgen, Kneidinger, Nikolaus, Milger, Katrin
• Format: Journal Article
• Language: English
• Published: Milwaukee Elsevier Inc 01-10-2022; Elsevier BV; World Allergy Organization; Elsevier
• Subjects: Allergens; Allergies; Altitude; Asthma; Body mass index; Cold; Dyspnea; Ergometry; Exercise; Full-Length; High altitude; Hyperventilation; Hypoxia; Inhaled corticosteroids; Physical fitness; Seasons; Spirometry; Steroids; Triggers; United States > US; Germany; High altitude; Triggers; Inhaled corticosteroids; Asthma
• ISSN: 1939-4551; 1939-4551
• DOI: 10.1016/j.waojou.2022.100698

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.
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).
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.
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.