The Effect of Chronic Altitude Exposure on COPD Outcomes in the SPIROMICS Cohort.

RATIONALE: Individuals with COPD have airflow obstruction and maldistribution of ventilation. For those living at high altitude, any gas exchange abnormality is compounded by reduced partial pressures of inspired oxygen. OBJECTIVES: Does residence at higher-altitude exposure affect COPD outcomes, including lung function, imaging characteristics, symptoms, health status, functional exercise capacity, exacerbations, or mortality? METHODS: From the SPIROMICS cohort, we identified individuals with COPD living below 1,000 ft (305 m) elevation (n= 1,367) versus above 4,000 ft (1,219 m) elevation (n= 288). Multivariable regression models were used to evaluate associations of exposure to high altitude with COPD-related outcomes. MEASUREMENTS AND MAIN RESULTS: Living at higher altitude was associated with reduced functional exercise capacity as defined by 6MWD (-32.3 m, (-55.7 to -28.6)). There were no differences in patient-reported outcomes as defined by symptoms (CAT, mMRC), or health status (SGRQ). Higher altitude was not associated with a different rate of FEV1 decline. Higher altitude was associated with lower odds of severe exacerbations (IRR 0.65, (0.46 to 0.90)). There were no differences in small airway disease, air trapping, or emphysema. In longitudinal analyses, higher altitude was associated with increased mortality (HR 1.25, (1.0 to 1.55)); however, this association was no longer significant when accounting for air pollution. CONCLUSIONS: Chronic altitude exposure is associated with reduced functional exercise capacity in individuals with COPD, but this did not translate into differences in symptoms or health status. Additionally, chronic high-altitude exposure did not affect progression of disease as defined by longitudinal changes in spirometry.

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UNC Libraries
Published
2025-03-21
DOI
https://doi.org/10.17615/7a3b-pf63
Primary Topic
High Altitude and Hypoxia
Type
article
Field-Weighted Citation Impact
0.00

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article

The Effect of Chronic Altitude Exposure on COPD Outcomes in the SPIROMICS Cohort.

Gerard J. Criner, Eric A. Hoffman, Russell Paul Bowler, Jill Ohar et al.
UNC Libraries
High Altitude and Hypoxia
article

The Effect of Chronic Altitude Exposure on COPD Outcomes in the SPIROMICS Cohort.

Gerard J. Criner, Eric A. Hoffman, Russell Paul Bowler, Jill Ohar, R. Graham Barr, Spyridon Fortis, Mark T. Dransfield, Mehrdad Arjomandi, Jeffrey L. Curtis, Rajat Suri, Russell G. Buhr, Joel D. Kaufman, Donald P. Tashkin, Daniela Markovic, Prescott G. Woodruff, Nadia N. Hansel, Jerry A. Krishnan, Igor Z Barjaktarevic, Michael Drummond, Christopher B. Cooper, Robert Paine, Fernando J. Martínez, Victor E. Ortega, Robert J. Kaner, MeiLan K. Han, Han Woo, Xavier Soler
article en

Abstract

RATIONALE: Individuals with COPD have airflow obstruction and maldistribution of ventilation. For those living at high altitude, any gas exchange abnormality is compounded by reduced partial pressures of inspired oxygen. OBJECTIVES: Does residence at higher-altitude exposure affect COPD outcomes, including lung function, imaging characteristics, symptoms, health status, functional exercise capacity, exacerbations, or mortality? METHODS: From the SPIROMICS cohort, we identified individuals with COPD living below 1,000 ft (305 m) elevation (n= 1,367) versus above 4,000 ft (1,219 m) elevation (n= 288). Multivariable regression models were used to evaluate associations of exposure to high altitude with COPD-related outcomes. MEASUREMENTS AND MAIN RESULTS: Living at higher altitude was associated with reduced functional exercise capacity as defined by 6MWD (-32.3 m, (-55.7 to -28.6)). There were no differences in patient-reported outcomes as defined by symptoms (CAT, mMRC), or health status (SGRQ). Higher altitude was not associated with a different rate of FEV1 decline. Higher altitude was associated with lower odds of severe exacerbations (IRR 0.65, (0.46 to 0.90)). There were no differences in small airway disease, air trapping, or emphysema. In longitudinal analyses, higher altitude was associated with increased mortality (HR 1.25, (1.0 to 1.55)); however, this association was no longer significant when accounting for air pollution. CONCLUSIONS: Chronic altitude exposure is associated with reduced functional exercise capacity in individuals with COPD, but this did not translate into differences in symptoms or health status. Additionally, chronic high-altitude exposure did not affect progression of disease as defined by longitudinal changes in spirometry.

UNC Libraries
University of North Carolina at Chapel Hill (US)
U.S. Department of Defense, U.S. Department of Veterans Affairs, Gordon and Betty Moore Foundation, American Thoracic Society, Amgen, AstraZeneca, GlaxoSmithKline, Sanofi, Tobacco-Related Disease Research Program, Flight Attendant Medical Research Institute, Patient-Centered Outcomes Research Institute, Teva Pharmaceutical Industries, COPD Foundation, Sunovion, Regeneron Pharmaceuticals, Society of Hospital Medicine, Mylan, Horizon Therapeutics, University of Cambridge, Grifols, National Institutes of Health, Genentech, Gillings School of Public Health, University of North Carolina at Chapel Hill, National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences
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High Altitude and Hypoxia
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