Altitude Exposure Research Articles

Altitudinal variations in forensically relevant dipterans in Trentino Region (Italy): implications for PMI estimation and forensic ecology.

This study investigates the populations of dipterans in the southeastern Prealps of Trentino, Italy, along an altitudinal gradient that exceeds 1000m. The study is important because dipterans play a significant role in crime scene analysis by helping to determine the post-mortem interval (PMI) and understand corpse relocation dynamics. Nine aerial traps were used across three sites from May to November 2023, and a total of 17,876 individuals from diverse species were captured. Statistical analyses revealed significant differences in dipteran populations across sites and exposure levels. The study identified relationships between species and environmental factors such as altitude, temperature, and sunlight exposure using Canonical Correspondence Analysis (CCA). Results demonstrated that species composition varied with environmental conditions, offering insights into potential shifts due to climate change. The presence of specific species was notably affected by temperature fluctuations, which could impact their usefulness in PMI estimation. Continuous monitoring is crucial to track dipteran population dynamics amidst changing environmental conditions. Such knowledge is important for improving accuracy in PMI estimations and enhancing forensic investigations. In conclusion, ongoing research is pivotal in adapting forensic entomological analyses to evolving ecological contexts, ensuring their reliability in forensic science applications. This study highlights the dynamic nature of dipteran ecology within forensic contexts and emphasises the need for further investigation to observe shifting population dynamics under climate change impacts.

Effects of short-term exposure to high altitude on cardiac function

Abstract Background What effect does short-term high altitude exposure have on heart function? Can people exercise in the highlands? what changes occur in heart function during exercise in highland areas? This study will explore these topics. Objectives To investigate the difference of heart function between people at sea level and at high altitude, and to study the changes of short time exercise on heart function at high altitude. Methods 36 healthy subjects were recruited to go to high altitude area after underwent exercise echocardiography on a supine bicycle at sea level. They ascended to 3600m within 24 hours by bus.Another exercise echocardiography was performed on the day of arrival.Heart rate (HR), blood pressure (BP) and blood oxygen saturation (SaO2) were monitored in real time during both examinations. Parameters such as left ventricular ejection fraction, E/ E 'and mean pulmonary artery pressure (mPAP) after rest and exercise were calculated.ΔmPAP /CO was calculated by (mean mPAP at peak -mean mPAP at rest )/(mean CO at peak-mean CO at rest). Results At peak exercise,SaO2,TRV,RVD2,SPAP,mPAP,PVR, ePLAR,RVAS,ΔMpap/CO were much higher at high altitude levels. (P < 0.001); E,A,FAC,ΔS were significantly lower than that of the sea leval; at rest, HR,TRV,sPAP,mPAP ,PVR were much higher at high altitude levels than at sea leval(P < 0.001)，SaO2,RVOT ACT, were significantly lower than that of the sea leval(P < 0.001). Conclusions When healthy people are in high altitude environment, the heart function changes obviously. Supine bicycle exercise stress echocardiography can well monitor the heart function changes and provide quantitative data, providing new technical methods for future related research.

Dietary patterns related to attention and physiological function in high-altitude migrants.

High altitude exposure negatively affects human attentional function. However, no studies have explored the regulation of attentional and physiological functions from a dietary perspective. A total of 116 Han Chinese students from Tibet University who were born and raised in a plain area and had been living in Tibet for > 2 years were recruited. All participants were male migrants. A food frequency questionnaire, complete blood count, and attention network test were performed on the participants. Pearson's correlation was applied to assess the reliability and validity of the food frequency questionnaire. Principal component analysis was utilized to extract dietary patterns. A linear mixed model was employed to account for individual differences. The results showed that the five main dietary patterns were coarse grain, alcohol, meat, protein, and snacking dietary patterns. Furthermore, individuals who adhered to the coarse grain dietary pattern and had high mean corpuscular hemoglobin showed better attentional performance. Individuals with high alcohol consumption and systemic immune-inflammation index levels exhibited worse attentional performance. These findings imply that high-altitude migrants should include more coarse grains in their daily diet and avoid excessive alcohol consumption to improve attention.

Management of central sleep apnoea: a review of non-hypercapnic causes.

Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.

Lower Oxygen Cost Of Absolute Workload Submaximal Exercise During Acute High Altitude Exposure

Lower Oxygen Cost Of Absolute Workload Submaximal Exercise During Acute High Altitude Exposure

The burden of suicide across different altitudes: 11-year geodemographic analysis conducted in 221 cantons in Ecuador ranging from 0 to 4300 m of elevation.

The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood. This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m. We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60-X84). A total of 11 280 cases of suicide were reported during 2011-2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000). Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.

High Altitude Exposure and Heart Rate

High Altitude Exposure and Heart Rate

The Temporal Effects of Altitude and Low Energy Availability Manipulation on Resting Metabolic Rate in Female Race Walkers.

To investigate the temporal effects of ~1,800 m altitude exposure and energy availability (EA) manipulation on resting metabolic rate (RMR). Twenty elite female race walkers underwent a 3-week training camp at an altitude of ~1,800 m. During the first two weeks, athletes consumed a high EA (HEA) diet of 45 kcal·kg fat free mass (FFM) -1 ·day -1 . During the final week, half the athletes consumed a low EA (LEA) diet of 15 kcal·kg FFM -1 ·day -1 while the others continued on a HEA diet. Athletes followed individualized training plans throughout the study. To assess the effect of altitude on RMR, athletes in the HEA group had RMR measured at baseline (~580 m) prior to altitude exposure (Pre-alt), at 36-hours (36 h-alt), 2 weeks (Wk2-alt) and 3 weeks into altitude exposure (Wk3-alt), and at 36 hours post-altitude exposure at ~580 m (36 h-post). To assess the effect of LEA exposure on RMR while at altitude, athletes in the LEA group underwent RMR measurements at Pre-alt and before (Wk2-alt) and after the 7-days of LEA (Wk3-alt). Compared to Pre-alt, the RMR of HEA athletes was increased at 36 h-alt (+5.3 ± 3.1%; p = 0.026) and Wk2-alt (+4.9 ± 4.9%; p = 0.049), but was no longer elevated at Wk3-alt (+1.7 ± 4.2%; p = 0.850). The RMR of HEA athletes at 36 h-post was lower than all timepoints at altitude (p < 0.05) but was not different from Pre-alt (-3.9 ± 7.2%; p = 0.124). The 7-day period of LEA exposure at altitude did not affect RMR (p = 0.347). RMR was transiently increased with ~1,800 m altitude exposure in female athletes and was unaffected by short-term LEA. However, the altitude-induced increase was small (~25-75 kcal/day) and was unlikely to have clinically significant implications for daily energy requirements.

Cognitive effects of altitude exposure.

It is a common misconception that cognitive function is impaired in a linear fashion by declining oxygen availability (e.g. at altitude). While this may apply for prolonged exposures to high altitudes (&amp;gt;2500 m), moderate altitude (1500–2500 m) or short intermittent hypoxic episodes can even be beneficial for the brain.

High-level performances following low altitude training and tapering in warm environments in elite racewalkers.

Current guidelines for prolonged altitude exposure suggest altitude levels ranging from 2000 to 2500m to optimize an increase in total hemoglobin mass (Hbmass). However, natural low altitude locations (<2000m) remain popular, highlighting the interest to investigate any possible benefit of low altitude camps for endurance athletes. Ten elite racewalkers (4 women and 6 men) underwent a 4-week "live high-train high" (LHTH) camp at an altitude of 1720m (PIO2=121mmHg; 20.1°C; 67% relative humidity [RH]), followed by a 3-week tapering phase (20m; PIO2=150mmHg; 28.3°C; 53% RH) in preparation for the World Athletics Championships (WC). Venous blood samples were withdrawn weekly during the entire observation period. In addition, blood volumes were determined weekly by carbon monoxide rebreathing during altitude exposure and 2weeks after return to sea level. High-level performances were achieved at the WC (five placings among the Top 10 WC races and three all-time career personal bests). A slight but significant increase in absolute (+1.7%, p=0.03) and relative Hbmass (+2.3%, p=0.02) was observed after 4-week LHTH. In addition, as usually observed during LHTH protocols, weekly training distance (+28%, p=0.02) and duration (+30%, p=0.04) significantly increased during altitude compared to the pre-LHTH period. Therefore, although direct causation cannot be inferred, these results suggest that the combination of increased training load at low altitudes with a subsequent tapering period in a warm environment is a suitable competition-preparation strategy for elite endurance athletes.

Effect of Cold vs Temperate Conditions on Physical Performance During Extended Mountain Warfare Training at Moderate Altitude.

The purpose of this study was to investigate the effect of environmental conditions on body composition, upper body power, and lower body power throughout a ∼4-week military mountain training exercise. We hypothesized that countermovement jump and ballistic push-up performance would decrease as a result of extended mountain field training and that winter (cold) conditions would result in greater decrements compared to fall (temperate) conditions. We also expected to observe a strong positive correlation between changes in performance and changes in skeletal muscle mass. Finally, we expected acute changes in performance upon altitude exposure. A total of 111 U.S. Infantry Marines (110 M; 1 F) provided written informed consent to participate in this study according to a protocol approved by the Naval Health Research Center. There were 54 participants in the fall cohort and 57 in the winter cohort. Maximum effort countermovement jump and ballistic push-up performance were assessed at different timepoints: (1) baseline at the sea level, (2) before training at ∼2100 m, (3) midpoint of training at ∼2100 m, (4) end of training at ∼2100 m, and (5) after 3 to 4 weeks of recovery at the sea level. The fall cohort trained at moderate temperatures (average day/night, 20°C/3°C), whereas the winter cohort trained under snowy winter conditions (7°C/-14°C). The results suggested that seasonal conditions did not significantly affect changes in body composition or physical performance. Furthermore, no acute effects of altitude on physical performance were detected. Training exercise did, however, cause performance decrements in countermovement jump height, countermovement jump peak power, and ballistic push-up height. Repeated measure correlation analyses suggested that there was a weak positive correlation between the decrease in skeletal muscle mass and the decrease in countermovement jump peak power throughout the training. The results of our study suggest that explosive movements are negatively affected by extended military training, seemingly independent of environmental training conditions or temperature. Planning and execution of military training should account for the likelihood that warfighter physical power will decline and may not return to pretraining levels within the month following the training event. It may also be advised to consider targeted exercises to aid in recovery of muscular strength and power. Future work should consider additional factors that likely influenced the decrease in physical performance that occurs during extended military training, such as nutrition, sleep, and psychological and cognitive stresses.

Impact of Maternal Exercise on Mice Offspring Development, Pulmonary Hypertension, and Vascular Remodeling in Chronic Hypoxia.

Chronic, high-altitude hypoxic exposure increases the risk of high-altitude pulmonary hypertension (PH). Emerging evidence shows maternal exercise may improve offspring resistance to disease throughout life. The purpose of this study is to determine if maternal exercise mitigates chronic hypoxic-induced changes in the offspring indicative of high-altitude PH development. Female adult C57BL/6J mice were randomly allocated to nonexercise or exercise conditions. Exercise consisted of voluntary running wheel exercise for 4 wk during the perinatal period. Three days after birth, the pups remained at low altitude (normoxia) or were exposed to hypobaric hypoxia of 450 mm Hg to simulate ~4500 m of altitude exposure until 8 wk of age. The study consisted of four groups: hypoxia + nonexercise pregnancy, hypoxia + exercise, or the respective normoxia conditions (normoxia + nonexercise or normoxia + exercise). Offspring body size, motor function, right ventricular systolic pressure (RVSP), and cardiopulmonary morphology were assessed after 8 wk in normoxia or hypoxia. Both hypoxic groups had smaller body sizes, reduced motor function, increased hematocrit, RVSP, muscularization in medium-sized pulmonary arteries, as well as right ventricular hypertrophy and contractility compared with the normoxic groups ( P < 0.05). Chronic hypoxia simulating 4500 m attenuated growth, lowered motor function, and elicited PH development. Voluntary maternal exercise did not significantly decrease RVSP in the offspring, which aligned with a lack of effect to attenuate abnormal body size and cardiopulmonary development due to chronic hypoxia. These findings are preliminary in nature, and more powered studies through larger group sizes are required to generalize the results to the population.

Environmental Exposures and Risks During Pregnancy.

The Women in Wilderness Medicine Research Committee of the Wilderness Medical Society conducted a narrative review to address considerations for pregnant individuals in wilderness environments. There is limited evidence behind many opinion-based recommendations on the safety of various environmental exposures in pregnancy. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolation from physiological data, as well as evaluating expert consensus statements. The benefits of exposure to natural environments include better pregnancy outcomes and improved maternal mental and physical health. Risks are similar to nonpregnant individuals with the added risks associated with maternal-fetal physiology in wilderness environments and difficulties of evacuation. This narrative review discusses pregnancy-specific concerns in extreme environments, including high altitude, hypothermia, hyperthermia, lightning strikes, envenomations, and common outdoor exposures.

Assessment of Dynamic Cerebral Autoregulation During Long-Term Exposure to High Altitude in Normal Subjects by Ultrasonography.

To evaluate changes in dynamic cerebral autoregulation (CA) during short-term and long-term exposure to high altitude with ultrasonography, and also study the sex differences in the response of CA to altitude. We assessed the differences in dynamic CA and measured with Doppler ultrasound of the bilateral internal carotid artery (ICA), vertebral artery (VA), and middle cerebral artery (MCA) and the values of basic information within 48 hours and at 2 years after arrival at Tibet in 65 healthy Han young Chinese volunteers, meanwhile, we compared the resistance index (RI) and pulsatility index (PI) of the right MCA at inhale oxygen 8 minutes when a newcomer with 2 years after arrival at Tibet. With 2 years of altitude exposure, the SaO2 of all subjects was above 90%, the mean PEF, DAP, and HR values decreased, HGB increased compared within 48 hours in same-gender groups. Comparisons of cerebral hemodynamics between before 2 years and after 2 years within male and female groups, the mean RI and PI values of bilateral MCA after 2 years were significantly higher than before 2 years, at the same time, the mean RI and PI values of bilateral ICA were significant differences (P < .05) between male groups, with regard to female groups, showed that the mean RI and PI values of bilateral VA were significant differences (P < .05). Comparisons of Right MCA hemodynamics between after oxygen uptake 8 minutes and 2 years, the mean RI and PI values were no significant difference within male and female groups (P > .05). Acute mountain sickness could result from an alteration of dynamic autoregulation of cerebral blood flow, but the impaired autoregulation may be corrected with the extension of time, furthermore, the response of CA to altitude in males and females are different.

High altitude sojourn elicits divergent effects in aortic and carotid stiffness in healthy-young adults

High altitude exposure challenges the cardiovascular system to compensate for barometric pressure-mediated reductions in arterial oxygen content. Reductions in oxygen content elicit simultaneous increases in sympathetic nervous system activity and vasodilation that may have competing effects on changes in large artery stiffness. The objective of this study was to examine changes in aortic and carotid stiffness during high altitude sojourn in healthy, young adults. We hypothesized that short-term high-altitude sojourn would increase both aortic and carotid stiffness. 17 Generally healthy adults (23±4 yrs, 25.0±3.0 BMI, n=9 females) underwent vascular assessments in the supine position at 1400 m and after an 8-day incremental ascent to 4300 m. Aortic stiffness and carotid β-stiffness were derived from carotid-femoral pulse wave velocity (cfPWV) via applanation tonometry and right common carotid artery ultrasonography, with blood pressure assessed via oscillometry. Ascent from 1400 m to 4300 m resulted in decreased arterial oxygen saturation (-11±4 %, p&lt;0.001) and carotid β-stiffness (-4.48±2.73 au, p&lt;0.001), and increased cfPWV, (+54.98±78.10 cm/s, p=0.01) and mean arterial pressure (+4±7 mmHg, p=0.02). Changes in cfPWV, arterial oxygen saturation, and blood pressure were moderately to strongly correlated (r=-0.425-0.503, p=0.09-0.04). Our data suggest that short term exposure to high altitude has differential effects on carotid versus aortic stiffness despite increases in mean blood pressure. Increases in aortic stiffness appear related to hypoxia-induced reductions in arterial oxygen saturation and concomitant increases in blood pressure, while reductions in carotid stiffness may stem, in-part, from compensatory carotid artery dilation necessary to increase cerebral blood flow at high altitude. Additional research is necessary to further understand mechanisms underlying differential changes in large artery stiffness during high altitude sojourn. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

No sex differences in the cardiac responses during high altitude sojourn to 4300 m

Ascent to high altitude reduces oxygen availability and provokes compensatory cardiovascular responses. Females may exhibit attenuated hypoxic ventilatory responses compared to males, which could subsequently exaggerate the cardiovascular response to high altitude among females. The purpose of this study was to examine sex differences in cardiac responses during high altitude sojourn in young, healthy males and females. We hypothesized that females would exhibit a greater reduction in arterial oxygen saturation, and greater cardiac dysfunction compared to males. 17 healthy adults (8 males, 24±4 yrs, BMI 25.7±3.1 kg/m2; 9 females, 23±4 yrs, BMI 24.5±3.0 kg/m2) underwent cardiac assessment via echocardiography at 1400 m and after an 8-day ascent to 4300 m. Left ventricular (LV) systolic function was assessed via ejection fraction and fractional shortening. Diastolic function was assessed as the ratio between early and late mitral filling velocities (E:A ratio). The subendocardial viability ratio (SEVR) was derived from carotid tonometry, and carotid pressure waves were integrated with echocardiography derived measures of left ventricular ejection to estimate a left ventricular pressure-volume loop and calculate stroke work. Ascent from 1400 m to 4300 m resulted in reduced end-tidal CO2 (-Δ8±3 [males], -Δ8±2 mmHg [females], p&lt;0.001), oxygen saturation (-Δ11±3 [males], -Δ11±5 % [females], p&lt;0.001), and LV fractional shortening (-Δ7.9±7.5% [males] -Δ1.0±6.4 % [females], p=0.028) in both groups. Despite greater stroke work among males (p=0.002), high altitude-induced changes were not statistically different compared to females (+Δ35±184 [males], +Δ3±113 mL/mmHg [females]). Changes in LV ejection fraction (-Δ1.9±14.4 [males], -Δ1.5±18.7 % [females]) mitral E:A (-Δ0.33±0.53 [males], -Δ0.09±0.64 au [females]), and SEVR (-Δ0.06±0.33 [males], +Δ0.15±0.20 au [females]) from 1400 to 4300 m were not statistically different between sexes. Ascent from 1400 to 4300 m decreased end-tidal CO2, arterial oxygen saturation, and select metrics of LV systolic function (e.g., fractional shortening), but LV diastolic function, stroke work, and SEVR was preserved in both males and females. We observed no apparent sex differences in the effects of 8-day sojourn to 4300 m on arterial oxygen saturation, or cardiac systolic and diastolic function. Additional research is necessary to confirm these results in the context of longer-term altitude exposure and acclimatization, and in older populations (middle-aged and older adults). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Acute Exposure to High-Altitude Results in Changes to Immune Cell Populations

High altitude is a challenging environment due to the reduced atmospheric pressure and oxygen availability, increased ultraviolet radiation, and reduced temperature relative to sea level. Previous studies in individuals who travel to high altitude demonstrate differential expression of genes involved in inflammation and innate immune system activation. This study aims to extend these findings by defining changes in immune cell population distributions and cell phenotypes during travel to high altitude. We hypothesized that acute high-altitude exposure would lead to shifts in immune cell populations toward a pro-inflammatory phenotype due to cellular stress caused by hypoxemia and tissue hypoxia. Participants (N=17) traveled to Barcroft Station in the White Mountain Research Center (3800 m). Whole blood was collected during fasting at sea level on the morning of ascent and each morning at high altitude for three days. Cells in whole blood were fixed and stained within 1-2 hours of collection and were processed via flow cytometry upon return to sea level. We observed a decrease in classical monocytes on the first (p=0.010) and second (p=0.003) mornings of high-altitude acclimatization to sea-level baseline, and an increase in intermediate monocytes on the first (p=0.013) and second (p=0.014) mornings at high altitude. We also observed an increase in B cells on the second (p=0.004) and third (p=0.004) mornings at high altitude compared to sea-level baseline (mean: 3.53%, SD: ±1.82). These results indicate that acute high altitude exposure results in a shift toward a pro-inflammatory monocyte phenotype and supports prior research suggesting a significant role of hypoxia in modulating B cell function. This research was supported through funding provided by a private donor. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Fitness Level- and Sex-Related Differences in Pulmonary Limitations to Maximal Exercise in Normoxia and Hypoxia.

Both maximal-intensity exercise and altitude exposure challenge the pulmonary system that may reach its maximal capacities. Expiratory flow limitation (EFL) and exercise-induced hypoxemia (EIH) are common in endurance-trained athletes. Furthermore, because of their smaller airways and lung size, women, independently of their fitness level, may be more prone to pulmonary limitations during maximal-intensity exercise, particularly when performed in hypoxic conditions. The objective of this study was to investigate the impact of sex and fitness level on pulmonary limitations during maximal exercise in normoxia and their consequences in acute hypoxia. Fifty-one participants were distributed across four different groups according to sex and fitness level. Participants visited the laboratory on three occasions to perform maximal incremental cycling tests in normoxia and hypoxia (inspired oxygen fraction = 0.14) and two hypoxic chemosensitivity tests. Pulmonary function and ventilatory capacities were evaluated at each visit. EIH was more prevalent (62.5% vs 22.2%, P = 0.004) and EFL less common (37.5% vs 70.4%, P = 0.019) in women than men. EIH prevalence was different ( P = 0.004) between groups of trained men (41.7%), control men (6.7%), trained women (50.0%), and control women (75.0%). All EIH men but only 40% of EIH women exhibited EFL. EFL individuals had higher slope ratio ( P = 0.029), higher ventilation (V̇ E ) ( P < 0.001), larger ΔVO 2max ( P = 0.019), and lower hypoxia-related V̇ E increase ( P < 0.001). Women reported a higher EIH prevalence than men, regardless of their fitness level, despite a lower EFL prevalence. EFL seems mainly due to the imbalance between ventilatory demands and capacities. It restricts ventilation, leading to a larger performance impairment during maximal exercise in hypoxic conditions.

The Effect of Chronic Altitude Exposure on Chronic Obstructive Pulmonary Disease Outcomes in the SPIROMICS Cohort: An Observational Cohort Study.

Rationale: Individuals with chronic obstructive pulmonary disease (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, and mortality? Methods: From the SPIROMICS (Subpopulation and Intermediate Outcome Measures in COPD Study) 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 6-minute-walk distance (-32.3 m [95% confidence interval, -49.8 to -14.8 m]). There were no differences in patient-reported outcomes as defined by symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scale), or health status (St. George's Respiratory Questionnaire). Higher altitude was not associated with a different rate of FEV1 decline. Higher altitude was associated with lower odds of severe exacerbations (incidence rate ratio, 0.65 [95% confidence interval, 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 (hazard ratio, 1.25 [95% confidence interval, 1.0 to 1.55]); however, this association was no longer significant when accounting for air pollution. Conclusions: Long-term 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. In addition, long-term high-altitude exposure did not affect progression of disease as defined by longitudinal changes in spirometry. Clinical trial registered with www.clinicaltrials.gov (NCT01969344).

Association of altitude and frailty in Chinese older adults: using a cumulative frailty index model.

The population is aging exponentially and the resulting frailty is becoming increasingly evident. We aimed to explore the association between altitude and frailty, and to identify associated factors for frailty. This is a community-based cross-sectional survey. 1,298 participants aged ≥60 years from three different altitudes were included in the study. To quantify frailty, we constructed a frailty index (FI) and a frailty score (FS). The FI was divided into non-frailty, prefrailty, and frailty. The Odds Ratios and confidence intervals (ORs, 95%CIs) were used to evaluate the association between altitude and FI and FS in multivariate ordinal logistic regression and linear regression. There were 560 (53.1%) participants in the prefrailty and 488 (37.6%) in the frailty group. The FS increased with higher altitude (P for trend <0.001). Multivariate ordinal logistic regression analysis revealed an association between altitude and frailty, OR = 1.91 (95% CI: 1.38-2.64) in mid-high altitude and 2.49 (95% CI:1.40-4.45) in high altitude. The same trend of association was found in the univariate analysis. The FS increased by 1.69 (95% CI: 0.78-2.60) at mid-high altitude and 3.24 (95%CI:1.66-4.81) at high altitude compared to medium altitude. The study indicates that high altitude exposure is an associated factor for frailty in older adults. This association become stronger with higher altitudes. As a result, it is essential to conduct early frailty screening for residents living at high altitudes.