Saxer S, Bader P R, Schneider S R, Mademilov M, Sheraliev U, Appenzeller P, Müller J, Sooronbaev T M, Bloch K E, Ulrich S, Lichtblau M
Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland.
Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan.
Front Physiol. 2023 Jul 25;14:1214887. doi: 10.3389/fphys.2023.1214887. eCollection 2023.
Asthma rehabilitation at high altitude is common. Little is known about the acute and subacute cardiopulmonary acclimatization to high altitude in middle-aged asthmatics without other comorbidities. In this prospective study in lowlander subjects with mostly mild asthma who revealed an asthma control questionnaire score >0.75 and participated in a three-week rehabilitation program, we assessed systolic pulmonary artery pressure (sPAP), cardiac function, and extravascular lung water (EVLW) at 760 m (baseline) by Doppler-echocardiography and on the second (acute) and last day (subacute) at a high altitude clinic in Kyrgyzstan (3100 m). The study included 22 patients (eight male) with a mean age of 44.3 ± 12.4 years, body mass index of 25.8 ± 4.7 kg/m, a forced expiratory volume in 1 s of 92% ± 19% predicted (post-bronchodilator), and partially uncontrolled asthma. sPAP increased from 21.8 mmHg by mean difference by 7.5 [95% confidence interval 3.9 to 10.5] mmHg ( < 0.001) during acute exposure and by 4.8 [1.0 to 8.6] mmHg ( = 0.014) during subacute exposure. The right-ventricular-to-pulmonary-artery coupling expressed by TAPSE/sPAP decreased from 1.1 by -0.2 [-0.3 to -0.1] mm/mmHg ( < 0.001) during acute exposure and by -0.2 [-0.3 to -0.1] mm/mmHg ( = 0.002) during subacute exposure, accordingly. EVLW significantly increased from baseline (1.3 ± 1.8) to acute hypoxia (5.5 ± 3.5, < 0.001) but showed no difference after 3 weeks (2.0 ± 1.8). In otherwise healthy asthmatics, acute exposure to hypoxia at high altitude increases pulmonary artery pressure (PAP) and EVLW. During subacute exposure, PAP remains increased, but EVLW returns to baseline values, suggesting compensatory mechanisms that contribute to EVLW homeostasis during acclimatization.
在高海拔地区进行哮喘康复治疗很常见。对于无其他合并症的中年哮喘患者在高海拔地区的急性和亚急性心肺适应情况，人们了解甚少。在这项前瞻性研究中，研究对象为大多患有轻度哮喘的低海拔居民，他们的哮喘控制问卷评分>0.75，并参加了为期三周的康复计划。我们通过多普勒超声心动图在海拔760米（基线）以及在吉尔吉斯斯坦的一家高海拔诊所（海拔3100米）的第二天（急性）和最后一天（亚急性）评估了收缩期肺动脉压（sPAP）、心功能和血管外肺水（EVLW）。该研究纳入了22例患者（8例男性），平均年龄为44.3±12.4岁，体重指数为25.8±4.7kg/m²，1秒用力呼气量为预测值的92%±19%（支气管扩张剂后），且哮喘控制情况部分未达标。急性暴露期间，sPAP平均差值从21.8mmHg增加了7.5[95%置信区间3.9至10.5]mmHg（P<0.001），亚急性暴露期间增加了4.8[1.0至8.6]mmHg（P=0.014）。由TAPSE/sPAP表示的右心室与肺动脉耦合在急性暴露期间从1.1下降了-0.2[-0.3至-0.1]mm/mmHg（P<0.001），亚急性暴露期间下降了-0.2[-0.3至-0.1]mm/mmHg（P=0.002）。EVLW从基线（1.3±1.8）显著增加至急性缺氧时（5.5±3.5，P<0.001），但3周后无差异（2.0±1.8）。在其他方面健康的哮喘患者中，高海拔地区急性缺氧会增加肺动脉压（PAP）和EVLW。在亚急性暴露期间，PAP仍会升高，但EVLW会恢复到基线值，这表明在适应过程中存在有助于EVLW稳态的代偿机制。
