{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:51:46Z","timestamp":1791161506098,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070090"],"award-info":[{"award-number":["82070090"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Objectives<\/jats:title>\n \n Inhalation of CO\n 2<\/jats:sub>\n 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 CO\n 2<\/jats:sub>\n at precise concentrations at high altitude.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Twenty\u2010eight healthy lowlanders (aged 38\u2009\u00b1\u200913\u2009years, male\/female: 13\/15) were recruited and taken from an altitude lower than 500\u2009m to 4505\u2009m in Tibet by airplane. A randomized double\u2010blind study was performed to compare blood gases and endurance shuttle walk test (ESWT) during inhalation of ambient air and 2.5% CO\n 2<\/jats:sub>\n using the device. Arterial blood gases were measured within 4\u2009h of arrival at high altitude, and the ESWT was performed on the morning of the second day after arrival.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Both PaCO\n 2<\/jats:sub>\n and PaO\n 2<\/jats:sub>\n during CO\n 2<\/jats:sub>\n inhalation were significantly higher than during ambient air breathing (PaCO\n 2<\/jats:sub>\n : 33.5\u2009\u00b1\u20094.0 vs. 31.4\u2009\u00b1\u20093.5\u2009mmHg; PaO\n 2<\/jats:sub>\n : 42.3\u2009\u00b1\u20095.8 vs. 34.9\u2009\u00b1\u20095.1\u2009mmHg; all\n p<\/jats:italic>\n \u2009<\u20090.001) at high altitude. Compared with ambient air, CO\n 2<\/jats:sub>\n inhalation was also associated with a lower heart rate. There was no difference in pH and respiratory rate during inhalation of 2.5% CO\n 2<\/jats:sub>\n and ambient air. ESWT distance during inhaling 2.5% CO\n 2<\/jats:sub>\n was significantly longer than that during inhalation of ambient air at high altitude (960.0 (713.2\u20131464.8) m vs. 677.0 (554.2\u20131026.9) m,\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Our results suggest that inhalation of 2.5% CO\n 2<\/jats:sub>\n increases both PaO\n 2<\/jats:sub>\n and exercise performance at 4505\u2009m.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.<\/jats:styled-content>\n gov identifier: NCT05798416\n <\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/resp.70278","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:40:34Z","timestamp":1783690834000},"page":"1041-1049","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low\u2010Dose\n \n CO\n 2<\/sub>\n <\/scp>\n Inhalation to Improve Oxygenation and Exercise Capacity at High Altitude: A Double\u2010Blind Pilot Study"],"prefix":"10.1002","volume":"31","author":[{"given":"Shanfeng","family":"Liang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University Guangzhou Medical University Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Catcheside","sequence":"additional","affiliation":[{"name":"AISH Flinders University Adelaide South Australia 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