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Low-Dose CO2 Inhalation to Improve Oxygenation and Exercise Capacity at High Altitude: A Double-Blind Pilot Study.

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Τίτλος: Low-Dose CO2 Inhalation to Improve Oxygenation and Exercise Capacity at High Altitude: A Double-Blind Pilot Study.
Συγγραφείς: Liang S; State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China., Catcheside P; AISH, Flinders University, Adelaide, South Australia, Australia., Wellman A; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA., Wu L; State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China., Wang L; State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China., Steier J; Centre for Human and Applied Physiological Sciences, King's College London, London, UK., He B; State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China., Schwartz AR; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Eckert DJ; AISH, Flinders University, Adelaide, South Australia, Australia., Luo Y; State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.; AISH, Flinders University, Adelaide, South Australia, Australia.; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.; Centre for Human and Applied Physiological Sciences, King's College London, London, UK.
Πηγή: Respirology (Carlton, Vic.) [Respirology] 2026 Oct; Vol. 31 (10), pp. 1041-1049. Date of Electronic Publication: 2026 Jul 10.
Τύπος έκδοσης: Journal Article; Randomized Controlled Trial
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Blackwell Science Country of Publication: Australia NLM ID: 9616368 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1440-1843 (Electronic) Linking ISSN: 13237799 NLM ISO Abbreviation: Respirology Subsets: MEDLINE
Imprint Name(s): Original Publication: Carlton, Vic. : Blackwell Science, c1996-
Ιατρικοί όροι (MeSH): Carbon Dioxide*/administration & dosage , Exercise Tolerance*/drug effects , Exercise Tolerance*/physiology , Oxygen*/blood , Hypoxia*/physiopathology , Altitude*, Oxygen Consumption/drug effects ; Oxygen Consumption/physiology ; Exercise/physiology ; Humans ; Double-Blind Method ; Pilot Projects ; Male ; Adult ; Female ; Administration, Inhalation ; Middle Aged ; Blood Gas Analysis ; Heart Rate ; Walk Test
Περίληψη: Background and Objectives: Inhalation of CO2 might improve hypoxia and exercise performance at high altitude by increasing respiratory drive and offsetting hypocapnia. We developed a novel device with minimized dead space and respiratory resistance to deliver CO2 at precise concentrations at high altitude.
Methods: Twenty-eight healthy lowlanders (aged 38 ± 13 years, male/female: 13/15) were recruited and taken from an altitude lower than 500 m to 4505 m in Tibet by airplane. A randomized double-blind study was performed to compare blood gases and endurance shuttle walk test (ESWT) during inhalation of ambient air and 2.5% CO2 using the device. Arterial blood gases were measured within 4 h of arrival at high altitude, and the ESWT was performed on the morning of the second day after arrival.
Results: Both PaCO2 and PaO2 during CO2 inhalation were significantly higher than during ambient air breathing (PaCO2: 33.5 ± 4.0 vs. 31.4 ± 3.5 mmHg; PaO2: 42.3 ± 5.8 vs. 34.9 ± 5.1 mmHg; all p < 0.001) at high altitude. Compared with ambient air, CO2 inhalation was also associated with a lower heart rate. There was no difference in pH and respiratory rate during inhalation of 2.5% CO2 and ambient air. ESWT distance during inhaling 2.5% CO2 was significantly longer than that during inhalation of ambient air at high altitude (960.0 (713.2-1464.8) m vs. 677.0 (554.2-1026.9) m, p < 0.001).
Conclusions: Our results suggest that inhalation of 2.5% CO2 increases both PaO2 and exercise performance at 4505 m.
Trial Registration: ClinicalTrials. gov identifier: NCT05798416.
(© 2026 Asian Pacific Society of Respirology.)
References: J. Burtscher, E. R. Swenson, P. H. Hackett, G. P. Millet, and M. Burtscher, “Flying to High‐Altitude Destinations: Is the Risk of Acute Mountain Sickness Greater?,” Journal of Travel Medicine 30 (2023): d11.
S. L. Ng, “Bibliometric Analysis of Literature on Mountain Tourism in Scopus,” Journal of Outdoor Recreation and Tourism 40 (2022): 100587.
P. H. Hackett and R. C. Roach, “High‐Altitude Illness,” New England Journal of Medicine 345 (2001): 107–114.
M. Maggiorini, B. Buhler, M. Walter, and O. Oelz, “Prevalence of Acute Mountain Sickness in the Swiss Alps,” BMJ 301 (1990): 853–855.
S. S. Purkayastha, U. S. Ray, B. S. Arora, et al., “Acclimatization at High Altitude in Gradual and Acute Induction,” Journal of Applied Physiology 79 (1995): 487–492.
M. Schneider, D. Bernasch, J. Weymann, R. Holle, and P. Bartsch, “Acute Mountain Sickness: Influence of Susceptibility, Preexposure, and Ascent Rate,” Medicine and Science in Sports and Exercise 34 (2002): 1886–1891.
R. M. Salgado, B. J. Ryan, A. D. Seeley, and N. Charkoudian, “Improving Endurance Exercise Performance at High Altitude: Traditional and Nontraditional Approaches,” Exercise and Sport Sciences Reviews 53 (2025): 10–22.
J. A. Silva‐Urra, C. Urizar, C. Basualto‐Alarcon, et al., “Effects of Oxygen Supplementation on Acute Mountain Sickness Symptoms and Functional Capacity During a 2‐Kilometer Walk Test on Chajnantor Plateau (5050 Meters, Northern Chile),” Wilderness & Environmental Medicine 22 (2011): 250–256.
K. E. Bradbury, B. R. Yurkevicius, K. M. Mitchell, et al., “Acetazolamide Does Not Alter Endurance Exercise Performance at 3,500‐m Altitude,” Journal of Applied Physiology 128 (2020): 390–396.
S. A. Forwand, M. Landowne, J. N. Follansbee, and J. E. Hansen, “Effect of Acetazolamide on Acute Mountain Sickness,” New England Journal of Medicine 279 (1968): 839–845.
J. A. Dempsey and H. V. Forster, “Mediation of Ventilatory Adaptations,” Physiological Reviews 62 (1982): 262–346.
S. M. Zouboules, H. C. Lafave, K. D. O'Halloran, et al., “Renal Reactivity: Acid‐Base Compensation During Incremental Ascent to High Altitude,” Journal of Physiology 596 (2018): 6191–6203.
Y. M. Luo, N. Hart, N. Mustfa, R. A. Lyall, M. I. Polkey, and J. Moxham, “Effect of Diaphragm Fatigue on Neural Respiratory Drive,” Journal of Applied Physiology 90 (2001): 1691–1699.
P. Bartsch, R. W. Baumgartner, U. Waber, M. Maggiorini, and O. Oelz, “Comparison of Carbon‐Dioxide‐Enriched, Oxygen‐Enriched, and Normal Air in Treatment of Acute Mountain Sickness,” Lancet 336 (1990): 772–775.
A. Lovis, M. De Riedmatten, D. Greiner, et al., “Effect of Added Dead Space on Sleep Disordered Breathing at High Altitude,” Sleep Medicine 13 (2012): 663–667.
C. H. Imray, S. Walsh, T. Clarke, et al., “Effects of Breathing Air Containing 3% Carbon Dioxide, 35% Oxygen or a Mixture of 3% Carbon Dioxide/35% Oxygen on Cerebral and Peripheral Oxygenation at 150 m and 3459 m,” Clinical Science (London, England) 104 (2003): 203–210.
Y. M. Luo, Y. Y. Chen, S. F. Liang, et al., “Central Sleep Apnea Treated by a Constant Low‐Dose CO(2) Supplied by a Novel Device,” Journal of Applied Physiology 135 (2023): 977–984.
R. C. Roach, P. H. Hackett, O. Oelz, et al., “The 2018 Lake Louise Acute Mountain Sickness Score,” High Altitude Medicine & Biology 19 (2018): 4–6.
S. J. Singh, M. D. Morgan, S. Scott, D. Walters, and A. E. Hardman, “Development of a Shuttle Walking Test of Disability in Patients With Chronic Airways Obstruction,” Thorax 47 (1992): 1019–1024.
S. M. Revill, M. D. Morgan, S. J. Singh, J. Williams, and A. E. Hardman, “The Endurance Shuttle Walk: A New Field Test for the Assessment of Endurance Capacity in Chronic Obstructive Pulmonary Disease,” Thorax 54 (1999): 213–222.
G. K. Batchelor, An Introduction to Fluid Dynamics (Cambridge University Press, 1967).
G. A. Borg, “Psychophysical Bases of Perceived Exertion,” Medicine and Science in Sports and Exercise 14 (1982): 377–381.
R. Mirro, L. Lowery‐Smith, W. M. Armstead, M. Shibata, S. L. Zuckerman, and C. W. Leffler, “Cerebral Vasoconstriction in Response to Hypocapnia Is Maintained After Ischemia/Reperfusion Injury in Newborn Pigs,” Stroke 23 (1992): 1613–1616.
S. B. Childs, H. Hamlin, and Y. Henderson, “Possible Value of Inhalation of Carbon Dioxide in Climbing Great Altitudes,” Nature 135 (1935): 457–458.
T. C. Harvey, M. E. Raichle, M. H. Winterborn, et al., “Effect of Carbon Dioxide in Acute Mountain Sickness: A Rediscovery,” Lancet 2 (1988): 639–641.
D. F. Horrobin, “Carbon Dioxide and Acute Mountain Sickness,” Lancet 2 (1988): 1020.
P. Erba, S. Anastasi, O. Senn, M. Maggiorirni, and K. E. Bloch, “Acute Mountain Sickness Is Related to Nocturnal Hypoxemia but Not to Hypoventilation,” European Respiratory Journal 24 (2004): 303–308.
R. R. Bechbache, H. H. Chow, J. Duffin, and E. C. Orsini, “The Effects of Hypercapnia, Hypoxia, Exercise and Anxiety on the Pattern of Breathing in Man,” Journal of Physiology 293 (1979): 285–300.
M. J. Tipton, A. Harper, J. F. R. Paton, and J. T. Costello, “The Human Ventilatory Response to Stress: Rate or Depth?,” Journal of Physiology 595 (2017): 5729–5752.
T. Chatterjee, D. Bhattacharyya, A. Pramanik, M. Pal, D. Majumdar, and D. Majumdar, “Soldiers' Load Carriage Performance in High Mountains: A Physiological Study,” Military Medical Research 4 (2017): 6.
G. Valli, A. Cogo, C. Passino, et al., “Exercise Intolerance at High Altitude (5050 m): Critical Power and W,” Respiratory Physiology & Neurobiology 177 (2011): 333–341.
A. M. Posch, S. Dandorf, and D. C. Hile, “The Effects of Acetazolamide on Exercise Performance at Sea Level and in Hypoxic Environments: A Review,” Wilderness & Environmental Medicine 29 (2018): 541–545.
G. Shen, X. Wu, C. Tang, et al., “An Oxygen Enrichment Device for Lowlanders Ascending to High Altitude,” Biomedical Engineering Online 12 (2013): 100.
R. S. A. L. J. West, High Altitude Medicine and Physiology 5E, 5th ed. (CRC Press, 2012).
K. McLaughlin, S. Roy, M. Falla, et al., “Pharmacological Prophylaxis and Supplemental Oxygen for Unacclimatized Rescuers at Very High Altitude: Scoping Review and 2025 Joint Recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine,” High Altitude Medicine & Biology 27 (2026): 60–77.
T. Seiler, C. T. Nakas, A. K. Brill, et al., “Do Cardiopulmonary Exercise Tests Predict Summit Success and Acute Mountain Sickness? A Prospective Observational Field Study at Extreme Altitude,” British Journal of Sports Medicine 57 (2023): 906–913.
A. B. Cobb, D. Levett, K. Mitchell, et al., “Physiological Responses During Ascent to High Altitude and the Incidence of Acute Mountain Sickness,” Physiological Reports 9 (2021): e14809.
H. M. Karinen, J. E. Peltonen, M. Kahonen, and H. O. Tikkanen, “Prediction of Acute Mountain Sickness by Monitoring Arterial Oxygen Saturation During Ascent,” High Altitude Medicine & Biology 11 (2010): 325–332.
Grant Information: 2023C-GX02 Guangzhou Municipal Health Commission Major Technical Project; SKLRD-L-202401 the Clinical and Epidemiological Research Project of State Key Laboratory of Respiratory Disease; 82070090 National Natural Science Foundation of China; SKLRD-Z-202413 Independent Project of State Key Laboratory of Respiratory Disease
Contributed Indexing: Keywords: CO2 inhalation; exercise; high altitude; novel device
Molecular Sequence: ClinicalTrials.gov NCT05798416
Substance Nomenclature: 142M471B3J (Carbon Dioxide)
S88TT14065 (Oxygen)
Entry Date(s): Date Created: 20260710 Date Completed: 20261004 Latest Revision: 20261006
Update Code: 20261006
DOI: 10.1002/resp.70278
PMID: 42429551
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1440-1843
DOI:10.1002/resp.70278