202004272212Acute altitude illness WMS 2019 update AMS/HACE prevention Inhaled budesonide 4

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Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
AMS 急性高山病
HACE 高海拔腦水腫
acute altitude illness 急性高海拔疾病
budesonide 布地奈德(Budesonide),常見商品名Pulmicort,是一種類固醇(也有人稱為腎上腺皮質激素), 下面使用吸入性類固醇代替
Inhaled budesonide 吸入性類固醇 (結論, 不建議做為預防AMS藥物)

有兩篇研究顯示吸入性類固醇每次 200 ug, 一天吸兩次, 可有效預防AMS, 但這些研究的方法學有其限制, 例如評估AMS的時間, 實驗組與對照組人數差異, 在這些研究無法得知類固醇作用的明確機轉, 但測試到呼吸道流速及血氧飽和度的少量改善, 雖然這兩個的臨床意義都不大, 但可推測吸入性類固醇的效益來自於對肺部的直接影響. 但更多近期設計良好的隨機研究無法複製這項結果, 因此不建議使用吸入性類固醇作為預防AMS的藥物. 證據等級 1C
Two studies indicated that inhaled budesonide 200 micrograms twice daily was effective at preventing AMS when compared to placebo.31,32 These studies were limited by methodological issues such as timing of the assessment for AMS31 and number of participants in each study arm.32 A clear mechanism of action was not apparent in these studies, but small improvements in spirometry and oxygen saturation, both of little clinical significance , were suggested as evidence that the benefit might derive from a direct lung effect. More recent, well-designed randomized controlled trials failed to replicate these results.33,34
Recommendation. Inhaled budesonide should not be used for altitude illness prophylaxis. Recommendation Grade: 1C