Spa Therapy for Elderly Patients with Respiratory Disease Evaluated by LAA (low attenuation area) of the Lungs on HRCT / 日本温泉気候物理医学会雑誌

Spa therapy which has been performed for patients with respiratory disease, particularly for those with asthma and pulmonary emphysema for last 22 years, demonstrates that spa therapy is effective for asthma and pulmonary emphysema. The characteristics of patients with respiratory disease has been changing during last 22 years.<br>The frequency and number of elderly patients with asthma, and the number of those with pulmonary emphysema has been increasing in recent years. Elderly patients with asthma and COPD including pulmonary emphysema show the narrowing of airways by mucus, and hyperinflation of the lungs as results of aging. At present time any physicians have no medication improving hyperinflation of the lungs. In the present study, evaluation of hyperinflation of the lungs by a band display procedure on HRCT and the effects of spa therapy on the hyperinflation were discussed in patients with asthma and COPD. The results show that spa therapy is important for the treatment of elderly patients with asthma and COPD, because the therapy can improve hyperinflation of the lungs without adverse side effects.

Spa Therapy for Asthma in the Elderly in Relation to Action Mechanisms and Clinical Efficacy / 日本温泉気候物理医学会雑誌

In recent years, the number of patients with respiratory disease has been increasing. In this study, pathophysiological characteristics of asthma in the elderly were discussed in relation to the action mechanisms and the clinical efficacy of spa therapy. In the action mechanisms of spa therapy for asthma, improvements of subjective and objective symptoms and ventilatory function, decrease in airway resistance, improvement of hyperinflation of the lung, and suppression of hypersecretion were observed in direct action of the therapy. Furthermore, improvement of depressed function of adrenocortical glands, psychological relaxation, and antioxidant action (increase in SOD activity) were found in indirect action of the therapy.<br>Characteristics of asthma in the elderly was expressed as weak allergic reaction, decrease in ventilatory function, DLco and bronchial hyperresponsiveness, increase in residual volume accompanied by weak bronchoconstriction, and suppressed function of adrenocortical glands, which are beneficial for clinical efficacy of spa therapy. Thus, spa therapy is more effective in elderly patients than in younger patients.

Reduction in Costs of drugs Used for the Treatment of Asthma by Spa Therapy in Relation to Disease Severity / 日本温泉気候物理医学会雑誌

Effects of long-term spa therapy on reduction of the costs of drugs used for the treatment were examined in 23 patients with asthma. The costs of drugs used per patient for 1 year when spa therapy started (1997) were compared with the costs used for 1 year after spa therapy for 3 years (2000). 1. The decrease in the total costs of all drugs was \31, 910 in patients with stage 1, \74, 900 in those with stage 2, \113, 450 in stage 3, and \180, 910 in stage 4. The % decrease of the costs of drugs used was 34.2% in stage 1, 46.3% in stage 2, 37.1% in stage 3, and 42.4% in stage 4. The results showed that the reduction in the costs of drugs tended to increase as asthma severity increased, and that the % decrease of the costs was higher in stage 2 and 4, in which the %decrease was more than 40%. 2. The reduction of costs of each drug, bronchodilators, glucocorticoids, antiallergic agents, mucolytics, and antibiotics after spa therapy, was significant in patients with stage 3 and stage 4, whose severity was considerably increased. However, the decrease in the costs of these drugs after spa therapy was not significant in patients with stage 1 and 2. The reduction of the costs more than 50% was observed in bronchodilators, antiallergic agents, mucolytics, and antibiotics in patients with stage 4, in whom the reduction of the costs of these drugs was significant. The results obtained here suggest that the costs of drugs used for asthma treatment could be reduced by spa therapy in patients with more increased severity.

Effects of Spa Therapy for Asthmatics with a Long History of Cigarette Smoking, Evaluated by Bronchial Hyperresponsiveness and Generation of Leukotrienes by Leucocytes / 日本温泉気候物理医学会雑誌

The effects of spa therapy for asthmatics with a long history of cigarette smoking were studied, compared with the effects for those without smoking history. 1. Of 22 patients with smoking history, 15 (68.2%) had definite efficacy of spa therapy (4 had marked efficacy, and 11 had moderate efficacy), and the residual 7 had slight or no efficacy. In contrast, of 36 patients without smoking history, 29 (80.6%) had definite efficacy. The effects of spa therapy for asthmatics were significantly higher in never-smokers than in ex-smokers.<br>2. A significant increase in the production of IgE antibodies, bronchial hyperresponsiveness and the generation of leukotrienes B₄ (LTB₄) and C₄ (LTC₄) by leucocytes was observed in ex-smokers compared with never-smokers. 3. The frequency of patients with a positive BAST against inhalant allergens was larger in subjects with slight or no efficacy than in those with marked or moderate efficacy in never-smokers, but not in ex-smokers. 4. Bronchial hyperresponsiveness was significantly increased in patients with slight or no efficacy than in those with marked or moderate efficacy both in ex-smokers and never-smoker. 5. The generation of LTB₄ was more increased in subjects with slight or no efficacy than in those with efficacy both in ex-smokers and never-smokers, however, the differences were not significant. 5. The generation of LTC₄ tended to be more increased in subjects with slight or no efficacy than in those with efficacy in never-smokers, but not in ex-smokers, although these were not significant. The results suggest that an increase in the production of IgE antibodies, bronchial hyperresponsiveness, and the generation of LTB₄ and LTC₄, which might be influenced by cigarette smoking, affect the effects of spa therapy for patients with asthma.

Improvement of Hyperinflation of the Lungs by Spa Therapy in Patients with Asthma / 日本温泉気候物理医学会雑誌

Effects of spa therapy on % low attenuation area (LAA)<-950 HU of the lungs on HRCT at full inspiration, CT number, a ratio of expiratory LAA to inspiratory LAA (exp LAA/ins LAA), residual volume (RV) and diffusing capacity for carbon monoxide (DLco) in asthma were compared between never-smokers and ex-smokers of asthmatics.<br>1. The % LAA of the lungs on HRCT in asthma significantly decreased after spa therapy both in never-smokers and ex-smokers of asthmatics. CT number also significantly increased in the two groups. 2. The exp LAA/ins LAA significantly decreased after spa therapy in never-smokers, but not in ex-smokers. 3. The %RV also significantly decreased by spa therapy in never-smokers, but not in ex-smokers. 4. The DLco value did not significantly change by spa therapy both in nevers-mokers and ex-smokers. 5. The values of %FVC and %FEV 1.0 tended to increased in the two groups, but the increase was not significant. The value of FEV 1.0% significantly increased after spa therapy in never-smokers, but not in ex-smokers. The results suggest that hyperinflation and destruction of terminal airspaces are stronger in ex-smokers than in never-smokers, and that spa therapy is more effective in never-smokers than in ex-smokers.

Five-year Observation of the Effects of Spa Therapy for Patients with Pulmonary Emphysema, Evaluated by %Low Attenuation Area (%LAA) of the Lungs on High-resolution CT, %DLco and %Residual Volume (RV) / 日本温泉気候物理医学会雑誌

The effects of long-term spa therapy were studied in 10 patients with pulmonary emphysema: five patients had long-term spa therapy for 5 years (group A), and another 5 patients had not spa therapy for the same 5 years (group B). There were no significant differences in %FVC, %FEV 1.0, %LAA of the lung on HRCT, %DLco and %RV between the two groups. 1. The LAA of the lung on HRCT slightly, but did not significantly increase in patients with spa therapy for 5 years. In patients without spa therapy, the %LAA of the lung significantly increased after 4-(61.1%) (p<0.01) and 5-year observation (65.5%) (p<0.001) compared with the initial value (52.2%). 2. The %DLco and %RV values slightly decreased in patients with spa therapy, but the decrease in the two parameters was not significant. 3. The %DLco significantly decreased (67.2% to 49.0%), and the %RV also significantly increased (175.4% to 230.6%) after 5-year observation in patients without spa therapy. The results obtained here suggest that spa therapy for pulmonary emphysema should start as early as possible when the diagnosis of the disease is decided, and the therapy should be continued as long as possible.

Effects of Spa Therapy Combined with Dietary Supplementation with n-3 Fatty Acids on Bronchial Asthma / 日本温泉気候物理医学会雑誌

N-3 fatty acids are reportedly effective for asthma. In addition, spa therapy has been reported to be effective for patients with asthma. In the present study, the effects of spa therapy combined with perilla seed oil-rich diet (rich in n-3 fatty acid) were examined on asthma. A total of 14 asthmatic patients had a complex spa therapy and consumed a perilla seed oil-rich diet-rich in α-linolenic acid (α-LNA) for 8 weeks. Generation of leukotriene (LT) C4 by leucocytes, respiratory function were analyzed. The generation of LTC4 by leucocytes decreased significantly for 2, 4 and 8 weeks (P<0.05). Peak expiratory flow (PEF) values increased significantly for 2, 4, 6 and 8 weeks (P<0.05). The values of ventilatory parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), forced expiratory flow after 25% of expired FVC (FEF₂₅), forced expiratory flow after 75% of expired FVC (FEF₇₅), mean expiratory flow during the middle half of the FVC (FEF_25-75)] revealed a significant increase after 4 and 8 weeks of the modified diet (P<0.05). The results suggest that spa therapy combined with a perilla seed oil-rich diet are effective in the treatment of asthma in terms of its ability to suppress LTC4 generation by leucocytes, and in inducing an improvement of pulmonary function.

Spa Therapy for Patients with Respiratory Disease Admitted at Misasa Medical Center for Last 20 Years / 日本温泉気候物理医学会雑誌

Spa therapy has been performed at our medical center for last 20 years. The changes in number and frequency of patients with respiratory disease were analyzed every 5 year for last 20 years. The total number of patients with respiratory disease who were admitted at our medical center for last 20 years was 1934, of whom the number of patients with asthma was 1226 (63.4%), and the number of those with COPD was 415 (21.5%). The number of patients with asthma treated with spa therapy showed a tendency to increase form 57 for the first 5 years (first stage) to 465 for the last 5 years (forth stage). The number of patients with COPD also increased from 26 for the first 5 years to 227 for the last 5 years. The frequency of SDIA decreased from 68.4% for the first 5 years to 29.0% for the last 5 years. In contrast, the frequency of pulmonary emphysema increased 19.2% at the first stage to 76.7% at the forth stage. The number and frequency of elderly patients with asthma and COPD over the age of 60 tended to increase for last 20 years.

Long-term Spa Therapy Prevents the Progressive Pathological Changes of the lung in Patients with Pulmonary Emphysema / 日本温泉気候物理医学会雑誌

Clinical effects of spa therapy for patients with pulmonary emphysema (PE) were evaluated by observing changes in %LAA of the lung on HRCT, %RV, %FVC, %FEV 1.0, and %DLco values after the long-term therapy. The subjects in this study 16 patients with PE. The subjects were divided into two groups according to the extent of %LAA<-950 HU of the lung on HRCT: %LAA<50% (N=6) and 50%≤%LAA (N=8). 1. Spa therapy significantly improved %LAA (42.5% at the initial stage to 36.3% 24 months after spa therapy), %RV (202.1% to 156.1%) and %DLco 71.0% to 85.7%), but not %FVC and %FEV 1.0, in patients with PE of %LAA<50%, however, significant. Improvement of these parameters was not observed in patients without spa therapy. 2. Spa therapy did not improve the values of %LAA, %RV, and %DLco, as well as %FVC and %FEV 1.0, in patients with PE of 50%≤%LAA. These parameters tended to decrease in the patients of 50%≤%LAA. These results suggest that spa therapy improves %LAA and parameters related to pulmonary function when they are at early stage of PE, however, the therapy was not remarkably effective for these parameters when they were at advanced stage of PE.

Decrease in Low Attenuation Area(LAA) of the Lungs on High Resolution Computed Tomography(HRCT) by Long-term Spa Therapy in Patients with Asthma / 日本温泉気候物理医学会雑誌

Characteristics of low attenuation area (LAA) of the lungs on HRCT were studied in 132 patients with asthma, and long-term spa therapy on the LAA of the lungs was observed in 5 patients with asthma, whose me an %LAA was more than 30%.<br>1. The morphology of LAA of the lungs on HRCT observed in asthma was different from that in pulmonary emphysema. 2. The LAA of the lungs in asthma was closely related to residual volume (RV). 3. The mean %LAA value significantly decreased from 33.5% before spa therapy to 24.5% at 24 months after beginning of the therapy. CT number also significantly increased after long-term spa therapy. 4. %FEV1.0 value significantly improved from 52.1% before spa therapy to 72.1% at 24 months after spa therapy. The RV value also decreased by spa therapy, however, the decrease was not significant. These results suggest that LAA of the lungs in asthma is associated with hyperinflation, and the LAA of the lungs decreases after long-term spa therapy.

The Effects of Spa Therapy on Asthma. Relationship to the generation of leukotrienes B4 (LTB4) and C4 (LTC4) and bronchial hyperresponsiveness / 日本温泉気候物理医学会雑誌

Effects of spa therapy on asthma were studied in 64 patients with asthma in relation to the generation of leukotrienes B4 (LTB4) and C4 (LTC4) and bronchial hyperresponsiveness. 1. The efficacy of spa therapy was marked in 12 (18.8%), and moderate in 45 (70.3%) of 64 patients with asthma, and slight or no efficacy of the therapy was observed in the residual 7 patients (10.9%). 2. Bronchial hyperresponsiveness to methacholine was the highest in patients with slight or no efficacy of spa therapy, however, there were no significant differences among the three groups classified by clinical efficacy. 3. The generation of LTC4 by leucocytes was significantly higher in patients with slight or no efficacy compared with the generation in those with marked (p<0.01) and moderate efficacy (p<0.001). However, there were no significant differences in the generation of LTB4 among them. 4. The generation of LTC4 before spa therapy significantly decreased in patients with marked (p<0.001) and moderate efficacy (p<0.01) after spa therapy, but not in those with slight or no efficacy. The generation of LTB4 was not significantly different before and after spa therapy among patients with marked, moderate, and slight or no efficacy. These results show that the efficacy of spa therapy for patients with asthma is closely related to the generation of LTC4 by leucocytes, and that the generation of LTC4 significantly decreases after spa therapy in patients with spa efficacy.

Spa Therapy for Patients with Asthma and Pulmonary Emphysema for 9 Years from 1992 to 2000. Analysis of 1271 patients with respiratory disease / 日本温泉気候物理医学会雑誌

The patients with asthma or pulmonary emphysema who were admitted at our hospital for last 9 years (1992-2000) were examined in relation to frequency of disease, patient age, and areas where patients came.<br>1. Of 1271 patients (141.2 patients/year) with respiratory disease admitted for last 9 years, 808 (63.6%, 97.8 patients/year) were patients with asthma, and 157 (12.4%, 17.4 patients/year)) were those with pulmonary emphysema.<br>2. The frequency of patients with asthma for all patients with respiratory desease tended to decease from 82.1% in 1992 to 51.3% in 2000, while the frequency of those with pulmonary emphysema increased from 2.8% in 1992 to 24.4% in 2000.<br>3. The number of patients with asthma over the age of 70 years was larger in those inside Tottori prefecture, and the number of patients between the ages of 60 and 69 years was larger in those from distant areas. The age was more than 50 years in all patients with pulmonary emphysema.<br>4. The number of patients with asthma from distant areas (outside Tottori prefecture) was larger (456 patients; 56.4%) than the number of those inside Tottori prefecture (352 patients) for 9 years. The number of patients from Okayama, Hiroshima, Hyogo and Osaka was larger than the number from other distant areas.

A Recent 7-years Study on 763 Patients with Chronic Obstructive Pulmonary Disease (COPD) Admitted at Misasa Medical Branch for Spa Therapy / 日本温泉気候物理医学会雑誌

The kind of respiratory disease, age, and areas where patients came from, were analyzed in 763 patients with COPD admitted at our hospital for last 7 years from 1992 to 1998. 1. For the last 7 years 886 patients with respiratory diseases were admitted at our hospital. Of these patients, 763 (86.1%) were those with COPD. Of the 763, 613 (80.3%) were patients with asthma, 27 with chronic bronchitis, 41 with obstructive bronchiolitis, and 87 with pulmonary emphysema. 2. The number of patients with pulmonary emphysema showed a tendency to increase. 3. The number of patients from distant areas was considerably larger (43.8% in 1997, 53.4% in 1998) compared to the number of patients from Tottori prefecture. The number of patients from Okayama, Hyogo, Osaka, Hiroshima, Yamaguchi, and Ehime prefectures was predominantly larger than the number of patients from other distant areas. 4. Regarding the age distribution of these patients, the number of patients over the age of 60 was predominantly larger than the number of patients under the age of 59: patients between the ages of 60 and 69 were more frequently observed in those coming from distant areas (outside Tottori prefecture), and those over the age of 70 in those coming from Tottori prefecture.

Indication of Spa Therapy on Peripheral Neuropathy / 日本温泉気候物理医学会雑誌

We observed peripheral circulation in patients suffering from peripheral neuropathy in order to quantify the effect of spa therapy on peripheral neuropathy.<br>The peripheral circulation was observed using thermography and Laser-Doppler blood flowmetry. Thirteen patients with a mean age of 71.9 years (range of 59-82) suffering from diabetic neuropathy with coldness, numbness, neuralgia in their feet or walk disturbance, and 11 patients with a mean age of 72.3 years (range of 60-84) suffering from lumbago, were examined by the methods. The blood flow, mass and velocity were measured by a Laser-Doppler blood flowmetry, after pre-loading with hot water at 36°C for 5min (hot loading), and after cold loading with cold water at 20°C for 5min. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio=[Total counts of thermography (Pixels) over 27°C after cold loading] ÷ [Initial counts over 27°C after hot loading]×100 (%).<br>The recovery ratio in diabetes mellitus was between 0-93.5% (mean=46.8%), whereas the recovery ratio in lumbago was between 0-91.3% (mean=41.3%). The blood flow in patients with diabetes mellitus was 1.11-5.36 (ml/min/100g tissue), (mean=2.44), the blood mass was 85-255 (mean=155), and the velocity was 0.447-0.784 (mean=0.591). The blood flow in patients with lumbago was 1.18-3.82, (mean=2.19), the blood mass was 89-195 (mean=144), and the velocity was 0.464-0.8 (mean=0.615). The recovery ratio and blood flow in patients with diabetes mellitus were correlated, r=0.62 and p<0.0002, as the recovery ratio and blood mass were correlated, r=0.59 and p<0.0001. However the blood flow and the velocity in these patients were not correlated, r=0.11. The recovery ratio and blood flow in patients with lumbago were not correlated, r=0.02, but the recovery ratio and blood mass showed some correlation, r=0.38. The recovery ratio and the velocity in these patients were correlated, r=0.64 and p<0.005. The blood flow in patients with diabetes mellitus was greater after hot loading (mean=2.89) than after cold loading (mean=2.44). The blood mass in patients with diabetes mellitus was greater after hot loading (mean=180) than after cold loading (mean=155). However, there was no significant change in the velocity after hot loading (mean=0.572) compared with the velocity after cold loading (mean=0.591).<br>It was revealed that patients with diabetes mellitus with low recovery ratios in thermography had low blood flow and blood mass in their peripheral circulation. Patients suffering from lumbago had different peripheral circulation compared with diabetes mellitus. Spa therapy was effective on diabetic peripheral neuropathy as the peripheral circulation improved with hot water at 36°C

Effects of Spa Therapy on Psychological Factors in Patients with Bronchial Asthma / 日本温泉気候物理医学会雑誌

Effects of spa therapy on psychological factors were examined in 15 patients with bronchial asthma (10 females and 5 males, mean age 55.0 years) by CMI (Cornell Medical Index), SDS (Selfrating Depression Scale), CAI (Comprehensive Asthma Inventory) and SD (Semantic Differential). The results of these psychological examinations were compared before and after spa therapy for 1-2 months.<br>1. In CMI, mean point of physical symptoms decreased from 37.7 before spa therapy to 29.7 after the therapy. Mean improvement rate of the symptoms was 73.3%. The mean improvement rate was observed in 60.0% of respiratory symptoms, 66.7% of CIJ symptoms and 46.7% in psychical symptoms.<br>2. In SDS, many patients showed more than 40 points, suggesting that they have depressive mental state. The mean point decreased from 42.9 to 40.7 by spa therapy.<br>3. In CAI, categories of mental state, extent of conditioning, suggestion, fear of expectation, dependency, frustration and flight into illness, were clearly improved by spa therapy.<br>4. It was shown in SD that character of patients changed with beneficial trend for therapy of asthma after spa therapy.<br>These results suggest that psychological disorders of patients with bronchial asthma are improved by spa therapy.

Spa Therapy for Bronchial Asthma / 日本温泉気候物理医学会雑誌

Clinical effect and action of spa therapy on bronchial asthma were discussed in relation to the action mechanisms.<br>1. General spa therapy including swimming training in a hot spring pool, fango therapy and inhalation therapy with iodine salt solution was effective in patients with bronchial asthma.<br>2. The improvement of ventilatory function, especially in small airways was observed as direct action of spa therapy, accompanied with decrease in resistance of the airways and bronchial hypersensitivity. The function of adrenocortical glands and cardiovascular system was also improved or enhanced by indirect action of spa therapy.<br>3. Spa therapy was more effective and more valuable in cases with steroid-dependent intractable asthma, cases with Ib. bronchoconstriction+hypersecretion type and II. bronchiolar obstrction type and cases over 41 years of age.<br>4. Clinical effects of spa therapy on bronchial asthma was also found for longer than one year as distant effect, which was more predominant in cases with maintenance therapy.

Eight-year Study on Spa Therapy for Patients with Chronic Respiratory Disease. Annual changes in background and characteristics of asthmatics / 日本温泉気候物理医学会雑誌

Annual changes in age, age at onset, incidence of cases with steroiddependent intractable asthma, clinical asthma types and clinical efficacy rate were examined in 256 patients with chronic respiratory diseases, especially in 203 cases with bronchial asthma, admitted to Misasa Branch Hospital from 1982 to 1989.<br>1. A number of patients with respiratory diseases as well as asthmatics admitted each year, having spa therapy, increased from early year (1982) to later year (1989).<br>2. A number in cases with 40 year or over of age (also with 60 year or over of age) and cases with 40 year or over of age at onset showed a tendency to increase in later three years (1987-1989). A decreased frequency of cases with steroid-dependent asthma and of cases with type II (bronchiolar obstruction type) was observed in the later three years.<br>3. The clinical efficacy of spa therapy for bronchial asthma was Niger in the later three years than in early three years (1982-1984).

Spa therapy for respiratory diseases. Allergological studies on patients with respiratory diseases / 日本温泉気候物理医学会雑誌

Allergological characteristics were studied on 36 patients with respiratory diseases (30 cases of bronchial asthma, 3 cases of diffuse panbronchiolitis, 3 cases of allergic granulomatous angitis, and 1 case of bronchiectasia) who received spa therapy at Misasa Branch Hospital.<br>1. The results obtained in patients with bronchial asthma were as follows:<br>Serum IgE levels were generally low, and many cases with less than 301IU/ml were observed (185±184/ml in female patients and 469±532IU/ml in male patients). The rate of positive skin reactions to various allergens was low in these asthma cases. A rather low rate of positive skin reaction to house dust, in particular, was characteristic. In regard to the rate of releasing chemical mediators such as bistamine and leukotrienes from leukocytes stimulated by Ca ionophore A 23187, a wide variety of cases were observed (histamine, 3.4-51.1%; LT B₄ 9.8-119.8ng/10⁶ cell; LT C₄, 3.5-43.8ng/10⁶ cells). By analyzing cell components in bronchoalveolar lavage fluids (BALF), notable increase in the number of eosinophils were observed especially in male patients, although no other significant differences were shown between the two groups.<br>2. In those patients with respiratory diseases other than asthma, a remarkable increase in the number of neutrophils in BALF was seen in diffuse panbronchiolitis cases and a remarkable increase in the number of eosinophils in BALF was seen in the cases of allergic granulomatous angities. Serum IgE levels were low in both of these cases.

Spa therapy for respiratory diseases. Characteristics of patients with spatherapy / 日本温泉気候物理医学会雑誌

Factors of spa therapy in relation to clinical effects were studied on 36 patients, who were admitted to Misasa Branch Hospital in 1987 with respiratory diseases.<br>1. The patients who received the spa therapy comprised 30 cases of bronchial asthma, 3 cases of diffuse panbronchiolitis, 3 cases of allergic granulomatous angitis, and 1 case of bronchiectasia.<br>2. Most bronchial asthma patients were over 40 years old, and 16 cases (53.3%) of 30 patients had long-term glucocorticoids. The serum cortisol level was generally low and was especially low in the cases with glucocorticoids therapy (4.9±5.6mcg/dl in female patients and 3.5±3.2mcg/dl in male patients). The incidence of each clinical type of asthma was as follows: 12 cases (66.7%) of bronchospasm type (Ia), 6 cases (33.3%) of bronchospasm plus hypersecresion type (Ib), and no case (0%) of bronchiolar obstruction type (II) out of 18 female patients. For male patients, there were 5 cases (41.7%) of Ia, 5 cases (41.7%) of Ib, and 2 cases (16.7%) of II. Spa therapy was obviously effective in 25 out of 30 cases (83.3%).<br>3. Spa therapy was also effective for respiratory diseases other than asthma, especially for diffuse panbronchiolitis.

Five-year study of spa therapy for inpatients with bronchial asthma. Annual changes of characteristcs of asthmatics / 日本温泉気候物理医学会雑誌

Examinations to some extent were made on yearly transitions of 52 patients with bronchial asthma who were hospitalized in Misasa Medical Branch, Okayama University Medical School and received spa therapy during the five years from 1982 to 1986.<br>1) In the first two years (1982 to 1983), we had many patients from Okayama Prefecture. The majority of them had suffered from severe asthma attacks. They included a higher rate of cases of dependency on steroid-therapy as compared to those patients in the last three years (1984 to 1986). Some cases exhibited a remarkable airways obstruction in spite of high dosage of steroid hormone.<br>2) From 1984 to 1986, the patients with bronchial asthma from Tottori Prefecture increased. Their involvements were less severe with a lower dependency on steroid-therapy as compared to those hospitalized during the first two years.<br>3) Terms of hospitalization were generally reduced in the last two years as compared to the preceding three years. The average term was about two months from 1985 to 1986.<br>4) No difference in clinical symptoms based on the patient's age, age at onset, or asthma types was found between the first two years and the last three years.