title: Altitude Sickness in Climbers and Efficacy of NSAIDs Trial (ASCENT): randomized, controlled trial of ibuprofen versus placebo for prevention of altitude illness.
abstract: OBJECTIVE
  To study the effectiveness of ibuprofen versus placebo in preventing acute mountain sickness (AMS) and high altitude headache (HAH).
  
  
  METHODS
  Double-blind, randomized, placebo-controlled trial.
  
  
  RESULTS
  Two hundred ninety-four healthy Western trekkers were recruited on the Everest approach at 4280 m or 4358 m and randomly assigned to receive either 600 mg of ibuprofen or placebo 3 times daily before and during ascent to 4928 m. One hundred eighty-three of 294 participants completed the trial. Of the participants who did not complete the trial, 62 were lost to follow-up and another 49 broke trial protocol. In an intent-to-treat analysis (232 participants), ibuprofen was found to be more effective than placebo in reducing the incidence of AMS (24.4% vs 40.4%; P = .01) and the incidence of HAH (42.3% vs 60.5%; P < .01). Ibuprofen was also superior to placebo in reducing the severity of HAH (4.9% vs 14.7%; P = .01). The end point of oxygen saturation was also higher in the ibuprofen group (80.8 % vs 82.4%; P = .035). For the 183 participants who completed the trial and conformed to the protocol, the incidence of AMS between placebo and treatment groups was not significant (32.9% vs 22.7%; P = .129 for AMS incidence, 9.6% vs 8.2%; P = .74 for AMS severity, 54.8% vs 42.7%; P = .11 for HAH incidence, and 8.2% vs 3.6%; P = .18 for HAH severity).
  
  
  CONCLUSIONS
  Ibuprofen was found to be effective in preventing AMS in the intent-to-treat analysis group but not in those who completed the trial. This loss of significance in the subjects who completed the trial may be explained by persons in the placebo group having a higher burden of illness and associated decreased compliance with the protocol. An important limitation of this study may be the possibility that ibuprofen can mask headache, which is a compulsory criterion for the diagnosis of AMS.
authors.affiliation: Department of Neurosciences, University of California-San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Gertsch
authors.forename: Bryan
authors.initials: B
authors.lastname: Corbett
authors.forename: Peter S
authors.initials: PS
authors.lastname: Holck
authors.forename: Allison
authors.initials: A
authors.lastname: Mulcahy
authors.forename: Melanie
authors.initials: M
authors.lastname: Watts
authors.forename: Nathan Thomas
authors.initials: NT
authors.lastname: Stillwagon
authors.forename: Amanda Morgan
authors.initials: AM
authors.lastname: Casto
authors.forename: Charles Hessel
authors.initials: CH
authors.lastname: Abramson
authors.forename: Charles Peter Aloysius
authors.initials: CP
authors.lastname: Vaughan
authors.forename: Christopher
authors.initials: C
authors.lastname: Macguire
authors.forename: Neda Nicole
authors.initials: NN
authors.lastname: Farzan
authors.forename: Baotran Nguyen
authors.initials: BN
authors.lastname: Vo
authors.forename: Rebecca Jean
authors.initials: RJ
authors.lastname: Norvelle
authors.forename: Kerstin
authors.initials: K
authors.lastname: May
authors.forename: Jessica Elizabeth
authors.initials: JE
authors.lastname: Holly
authors.forename: Hillary
authors.initials: H
authors.lastname: Irons
authors.forename: Aaron Michael
authors.initials: AM
authors.lastname: Stutz
authors.forename: Pradip
authors.initials: P
authors.lastname: Chapagain
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Yadav
authors.forename: Matiram
authors.initials: M
authors.lastname: Pun
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
mesh_terms: D000328:Adult; D000532:Altitude Sickness / Q000453:epidemiology / Q000517:prevention & control*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000494:pharmacology*; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D009051:Mountaineering; D010349:Patient Compliance; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen