Acetazolamide may prevent mountain sickness in COPD patients and healthy adults: NEJM

In trial 1, the primary outcome was the occurrence of the composite endpoint of altitude-related adverse health effects (ARAHE) at 3100 m. AMS and symptoms or discoveries important to well-being and safety, such as severe hypoxemia, were ARAHE criteria. The second trial included 345 healthy lowlanders. Their average age was 537 years, and 69% were female. The participants in trial 2 followed the same regimen as the COPD patients in trial 1. The primary outcome of trial 2 was the occurrence of AMS as measured by the Lake Louise questionnaire score at 3100 m.

The key findings were as follow:

1. ARAHE occurred in 68 of 90 (76%) of COPD patients getting placebo and 42 of 86 (49%) receiving acetazolamide in trial 1 (hazard ratio, 0.54).

2. The number required to treat (NNT) to prevent one ARAHE case was four.

3. In trial 2 of healthy people, 54 of 170 (32%) received a placebo and 38 of 175 (22%) received acetazolamide (hazard ratio, 0.48).

4. The NNT to avoid one occurrence of AMS was ten. There were no significant adverse effects in these studies.

In conclusion, "Acetazolamide cut the danger in half, had few side effects, and was thus more practical than oxygen treatment. At 3100 m, acetazolamide reduced the risk of AMS by about one-third compared to placebo; acetazolamide lowered the risk of AMS by about one-third," wrote the Authors.

Reference:

Acetazolamide to Prevent Adverse Altitude Effects in COPD and Healthy Adults. Michael Furian et. al. 2021, DOI:https://doi.org/10.1056/EVIDoa2100006