16-3 Microalgae and thermalism: Perspectives / 日本温泉気候物理医学会雑誌

Objectives: The study and use of marine and fresh water microalgae in therapy is a very recent phenomenon. Fresh water microalgae are used in food and to a lesser extent in cosmetics, however, not much is known about the applications of marine microalgae.   The Department of Applied Physics at the University of Vigo (Spain) has developed a marine microalgae culture system, and the species obtained are used to prepare products fit for thalassotherapy and spa treatments.   The aim of this study is to develop a procedure for designing, manufacturing and characterising spa products made from marine microalgae. Method: The growing interest in natural tested quality products for use in Spas has stimulated the search for product mixtures frequently used in Spas, such as clays and medicinal-mineral waters, with laboratory cultivated microalgae to guarantee quality and optimum growth.   A review of scientific literature on the applications of marine microalgae in skin care was the first stage in this study.   Marine microalgae are a source of vitamins, pigments, proteins and other beneficial substances for the skin (Spolaore et al, 2006). Only a few microalgae species are consolidated in the skin care market, wherein the principal ones are Chlorella and Spirulina (Stolz et al, 2005). Protein rich extracts of Spirulina have been used in cosmetics for preventing stretch marks and extracts from Chlorella vulgaris have been used to stimulate collagen synthesis in skin, thereby fostering tissue regeneration and reduction of wrinkles (Stolz et al, 2005). Other microalgae used are Nannochloropsis oculata and Dunaliella salina. Tests done with an extract of Nannochloropsis oculata have shown that this microalga acts as an optimum protective sheath against oxidative stress and positively influences collagen synthesis (Stolz et al, 2005). An ingredient of Nannochloropsis oculata has excellent skin elasticity properties (short and long-term) and was already in the market in 2005 (Stolz et al, 2005).   Microalgae culture has been on the rise in the past years. This is generally done in tanks or pools using a controlled culture medium and with either natural or fluorescent light that imitates the natural solar cycle (photobioreactors).   A species of Nanocloropsis was selected to study its use in Spas. This is an alga which can be cultivated using photobioreactors such that its growth and profitability can be controlled.   Mixtures with varying proportions of clays and mineral waters and seawaters were prepared.   Research equipment was used to analyse the behaviour of the mixtures. To that end, density, specific heat and thermal conductivity, which are important thermophysical properties, were used to assess these products for heat therapy. Results and Discussion: The preliminary studies have provided results on culture conditions of the microalgae. Results of heat behaviour were also collected using varying mixtures of clays and waters.   These results show that marine microalgae can be used in Spa treatments either in baths or as poultices, thus indicating that thermal retention capacity is improved upon mixture with clays, an aspect which is important for their use in heat therapy.

07-3 Effect of different 6-day spa therapy courses on the quality of life in the knee osteoarthritis treatment / 日本温泉気候物理医学会雑誌

Objectives: In medical spas different spa therapy courses are offered for treating knee osteoarthritis (OA). They contain approximately 10 daily sessions of 2-3 different treatments. During the last two decades, the length of the spa therapy time in Estonia has decreased from 12 days mainly to 6 days due to the changes in the economic situation. Spa therapy courses contain different treatments: massages, thermotherapies, kinesitherapies etc. Last research (Vaht et al. 2008) focused on the effect of 6-days spa therapy course in general. At the beginning and end of spa treatment HAQ-DI, VAS and Lequesne Index were used to assess the clinical status. There were no significant differences between the results of 6- and 12-day spa therapy courses. They both had positive effects by reducing pain and improving clinical status in patients suffering from OA. This study focused on mud therapy and the aim is to compare the therapeutic effect of different spa therapy courses in knee OA. Materials and methods: 374 patients with knee OA participated voluntarily in this controlled follow-up study, which included different medical spas of Estonia: Spa Hotel Laine, Värska Spa Hotel, Tervis Medical Spa Hotel, Fra Mare Thalasso Spa. Participants fulfilled the criteria of the American College of Rheumatology (ACR) and were at the age between 47-83. The patients with total knee prosthesis, and those who had received thermotherapy in the past three months or had started using analgesics or antidepressants in the past 2 weeks, were excluded.   The patients were allocated to the groups in order of their admittance: I - local mud application (40-42°C, 15-20 min, n = 52) or mud bath (41-43°C, 10 min, n = 74); massage therapy (25 min) and kinesitherapy (30 min). II - herbal bath (37-39°C, 10 min, ) and local mud application (n = 56) or mineral water bath and mud bath (n = 82) and massage. III - control group - herbal bath (n = 32) or mineral water bath (n = 78), massage therapy and kinesitherapy.   All therapies were administered once a day and six times a week. All patients were evaluated before and after 6 days of spa treatments and follow-up after 10 weeks of spa treatments (VAS, HAQ-DI, Lequesne Index). Data were analysed using SPSS statistical software. Results: After 6 days, treatment of all packages reduced pain and diminished the value of Lequesne Index. The follow-up period gave better results for the package where mineral water bath, mud bath and massage therapy were used. Conclusions: 6-day spa therapy has a good result in the treatment of knee OA reducing pain and improving the quality of life. Better results are achieved when spa therapy course contains two thermal therapies daily in the II group. This work was supported by the Regional Competence Centre Development programme, European Regional Development Fund.

06-5 Spa therapy and rheumatoid arthritis - Quality of life / 日本温泉気候物理医学会雑誌

  Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown etiology. It is characterized by symmetric, polyarticular pain, swelling, morning stiffness, and fatigue. RA has a variable course, often with periods of exacerbations and, less frequently, true remissions. Outcomes are also variable, ranging from the rarely seen remitting disease to severe disease that brings disability and in some patients premature death. Without treatment, the majority of patients will experience progressive joint damage and, in some patients, this results in significant disability within just a few years. Improvement in health related quality of life is one of the most important goals in the management of rheumatoid arthritis and therefore must be pursued as a crucial aim in clinical practice. This paper draws from 49 qualitative interviews conducted with RA patients, before starting a program of Spa Therapy and aims to get an overview of their main RA related difficulties, worries, and overall understanding of quality of life. Information on the patients’ physical function was also obtained by means of the Stanford Health Assessment Questionnaire Disability Index (HAQ). Patients present a mean HAQ score of 1.42 (SD=0.69). Main findings from the interviews highlight the importance given to being autonomous and feeling independent and healthy. In addition, underlying psychological problems (e.g. depressive signs; coping with progressive dependence) and concerns with social relationships (e.g. perceived support, loneliness) emerged as significant facets of living with the disease. Despite different treatments, RA still has many deleterious consequences which from the patients’ perspective include, among other, persistent pain, functional disability, fatigue, and depression. Along with treating RA signs and associated medical evolution, medical staff should consider and deeply understand the patients’ needs, expectations and main perceived determinants of their quality of life.

PT2-4 Assessing the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy checklist (SPAC) / 日本温泉気候物理医学会雑誌

Objectives: To assess the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy and balneotherapy checklist (SPAC), and to show the relationship between SPAC score and the characteristics of publication. Methods: We searched the following databases from 1990 up to September 30, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, Global Health Library, the Western Pacific Region Index Medicus, Psyc INFO, and the Cochrane Database of Systematic Reviews. We used the SPAC to assess the quality of reports on spa therapy and balneotherapy trials (SPAC) that was developed using the Delphi consensus method. Results: Fifty-one studies met all inclusion criteria. Forty studies (78%) were about “Diseases of the musculoskeletal system and connective”. The total SPAC score (full-mark; 19pts) was 10.8±2.3pts (mean±SD). The items for which a description was lacking (very poor; ＜50%) in many studies were as follows: “locations of spa facility where the data were collected”; “pH”; “scale of bathtub”; “presence of other facility and exposure than bathing (sauna, steam bath, etc.)”; “qualification and experience of care provider”; “Instructions about daily life” and “adherence”. We clarified that there was no relationship between the publish period, languages, and the impact factor (IF) for the SPAC score. Conclusion: In order to prevent flawed description, SPAC could provide indispensable information for researchers who are going to design a research protocol according to each disease.

07-3Effect of different 6-day spa therapy courses on the quality of life in the knee osteoarthritis treatment / 日本温泉気候物理医学会雑誌

<b>Objectives: </b>In medical spas different spa therapy courses are offered for treating knee osteoarthritis (OA). They contain approximately 10 daily sessions of 2-3 different treatments. During the last two decades, the length of the spa therapy time in Estonia has decreased from 12 days mainly to 6 days due to the changes in the economic situation. Spa therapy courses contain different treatments: massages, thermotherapies, kinesitherapies etc. Last research (Vaht et al. 2008) focused on the effect of 6-days spa therapy course in general. At the beginning and end of spa treatment HAQ-DI, VAS and Lequesne Index were used to assess the clinical status. There were no significant differences between the results of 6- and 12-day spa therapy courses. They both had positive effects by reducing pain and improving clinical status in patients suffering from OA. This study focused on mud therapy and the aim is to compare the therapeutic effect of different spa therapy courses in knee OA.<BR><b>Materials and methods: </b>374 patients with knee OA participated voluntarily in this controlled follow-up study, which included different medical spas of Estonia: Spa Hotel Laine, Värska Spa Hotel, Tervis Medical Spa Hotel, Fra Mare Thalasso Spa. Participants fulfilled the criteria of the American College of Rheumatology (ACR) and were at the age between 47-83. The patients with total knee prosthesis, and those who had received thermotherapy in the past three months or had started using analgesics or antidepressants in the past 2 weeks, were excluded.<BR>  The patients were allocated to the groups in order of their admittance:<BR>I - local mud application (40-42°C, 15-20 min, n = 52) or mud bath (41-43°C, 10 min, n = 74); massage therapy (25 min) and kinesitherapy (30 min). <BR>II - herbal bath (37-39°C, 10 min, ) and local mud application (n = 56) or mineral water bath and mud bath (n = 82) and massage.<BR>III - control group - herbal bath (n = 32) or mineral water bath (n = 78), massage therapy and kinesitherapy.<BR>  All therapies were administered once a day and six times a week. All patients were evaluated before and after 6 days of spa treatments and follow-up after 10 weeks of spa treatments (VAS, HAQ-DI, Lequesne Index). Data were analysed using SPSS statistical software.<BR><b>Results: </b>After 6 days, treatment of all packages reduced pain and diminished the value of Lequesne Index. The follow-up period gave better results for the package where mineral water bath, mud bath and massage therapy were used. <BR><b>Conclusions: </b>6-day spa therapy has a good result in the treatment of knee OA reducing pain and improving the quality of life. Better results are achieved when spa therapy course contains two thermal therapies daily in the II group. This work was supported by the Regional Competence Centre Development programme, European Regional Development Fund.

16-3Microalgae and thermalism: Perspectives / 日本温泉気候物理医学会雑誌

<b>Objectives: </b>The study and use of marine and fresh water microalgae in therapy is a very recent phenomenon. Fresh water microalgae are used in food and to a lesser extent in cosmetics, however, not much is known about the applications of marine microalgae.<BR>  The Department of Applied Physics at the University of Vigo (Spain) has developed a marine microalgae culture system, and the species obtained are used to prepare products fit for thalassotherapy and spa treatments. <BR>  The aim of this study is to develop a procedure for designing, manufacturing and characterising spa products made from marine microalgae.<BR><b>Method: </b>The growing interest in natural tested quality products for use in Spas has stimulated the search for product mixtures frequently used in Spas, such as clays and medicinal-mineral waters, with laboratory cultivated microalgae to guarantee quality and optimum growth. <BR>  A review of scientific literature on the applications of marine microalgae in skin care was the first stage in this study.<BR>  Marine microalgae are a source of vitamins, pigments, proteins and other beneficial substances for the skin (Spolaore et al, 2006). Only a few microalgae species are consolidated in the skin care market, wherein the principal ones are Chlorella and Spirulina (Stolz et al, 2005). Protein rich extracts of Spirulina have been used in cosmetics for preventing stretch marks and extracts from Chlorella vulgaris have been used to stimulate collagen synthesis in skin, thereby fostering tissue regeneration and reduction of wrinkles (Stolz et al, 2005). Other microalgae used are Nannochloropsis oculata and Dunaliella salina. Tests done with an extract of Nannochloropsis oculata have shown that this microalga acts as an optimum protective sheath against oxidative stress and positively influences collagen synthesis (Stolz et al, 2005). An ingredient of Nannochloropsis oculata has excellent skin elasticity properties (short and long-term) and was already in the market in 2005 (Stolz et al, 2005).<BR>  Microalgae culture has been on the rise in the past years. This is generally done in tanks or pools using a controlled culture medium and with either natural or fluorescent light that imitates the natural solar cycle (photobioreactors).<BR>  A species of Nanocloropsis was selected to study its use in Spas. This is an alga which can be cultivated using photobioreactors such that its growth and profitability can be controlled. <BR>  Mixtures with varying proportions of clays and mineral waters and seawaters were prepared.<BR>  Research equipment was used to analyse the behaviour of the mixtures. To that end, density, specific heat and thermal conductivity, which are important thermophysical properties, were used to assess these products for heat therapy. <BR><b>Results and Discussion: </b>The preliminary studies have provided results on culture conditions of the microalgae. Results of heat behaviour were also collected using varying mixtures of clays and waters. <BR>  These results show that marine microalgae can be used in Spa treatments either in baths or as poultices, thus indicating that thermal retention capacity is improved upon mixture with clays, an aspect which is important for their use in heat therapy.

PT2-4Assessing the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy checklist (SPAC) / 日本温泉気候物理医学会雑誌

<b>Objecti</b><b>ves:</b> To assess the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy and balneotherapy checklist (SPAC), and to show the relationship between SPAC score and the characteristics of publication.<BR><b>Methods:</b> We searched the following databases from 1990 up to September 30, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, Global Health Library, the Western Pacific Region Index Medicus, Psyc INFO, and the Cochrane Database of Systematic Reviews. We used the SPAC to assess the quality of reports on spa therapy and balneotherapy trials (SPAC) that was developed using the Delphi consensus method.<BR><b>Results: </b>Fifty-one studies met all inclusion criteria. Forty studies (78%) were about “Diseases of the musculoskeletal system and connective”. The total SPAC score (full-mark; 19pts) was 10.8±2.3pts (mean±SD). The items for which a description was lacking (very poor; ＜50%) in many studies were as follows: “locations of spa facility where the data were collected”; “pH”; “scale of bathtub”; “presence of other facility and exposure than bathing (sauna, steam bath, etc.)”; “qualification and experience of care provider”; “Instructions about daily life” and “adherence”. We clarified that there was no relationship between the publish period, languages, and the impact factor (IF) for the SPAC score.<BR><b>Conclusion:</b> In order to prevent flawed description, SPAC could provide indispensable information for researchers who are going to design a research protocol according to each disease.

06-5Spa therapy and rheumatoid arthritis - Quality of life / 日本温泉気候物理医学会雑誌

  Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown etiology. It is characterized by symmetric, polyarticular pain, swelling, morning stiffness, and fatigue. RA has a variable course, often with periods of exacerbations and, less frequently, true remissions. Outcomes are also variable, ranging from the rarely seen remitting disease to severe disease that brings disability and in some patients premature death. Without treatment, the majority of patients will experience progressive joint damage and, in some patients, this results in significant disability within just a few years. Improvement in health related quality of life is one of the most important goals in the management of rheumatoid arthritis and therefore must be pursued as a crucial aim in clinical practice. This paper draws from 49 qualitative interviews conducted with RA patients, before starting a program of Spa Therapy and aims to get an overview of their main RA related difficulties, worries, and overall understanding of quality of life. Information on the patients’ physical function was also obtained by means of the Stanford Health Assessment Questionnaire Disability Index (HAQ). Patients present a mean HAQ score of 1.42 (SD=0.69). Main findings from the interviews highlight the importance given to being autonomous and feeling independent and healthy. In addition, underlying psychological problems (e.g. depressive signs; coping with progressive dependence) and concerns with social relationships (e.g. perceived support, loneliness) emerged as significant facets of living with the disease. Despite different treatments, RA still has many deleterious consequences which from the patients’ perspective include, among other, persistent pain, functional disability, fatigue, and depression. Along with treating RA signs and associated medical evolution, medical staff should consider and deeply understand the patients’ needs, expectations and main perceived determinants of their quality of life.

Spa Therapy and Massage in France / 日本温泉気候物理医学会雑誌

  We report here on the current situation, regulations by law, and education of spa therapy and massage in France, as determined through a survey study on massage conducted by our university in France between March 19 and 28, 2012. Spa therapy is one of France natural therapies and means‘health through water’in Latin. It includes balneotherapy (le thermalisme) using thermal spring water, thalassotherapy (la thalassothérapie) using sea water, and hydrotherapy (la balnéothérapie) using water. At present in France, there are 105 balneotherapy centers (Thermés) at 89 sites with thermal spring water, located mainly in mountainous regions. National medical insurance can be used for 18-day balneotherapy treatment of 12 symptoms, provided as a 3-week stay (excluding Sundays) in sites with thermal spring water. Thalassotherapy, on the other hand, is currently regarded as a form of relaxation. Balneotherapy and thalassotherapy both include bathing with jets, showers (douche), exercise in the pool, mud therapy (mud pack and wrapping), and massage among other treatments, but there are differences between the two: balneotherapy uses thermal spring water while thalassotherapy uses sea water; the aim of balneotherapy is to treat or prevent disease while that of thalassotherapy is to promote well-being (relaxation); subjects for balneotherapy are patients, whereas those for thalassotherapy are generally healthy people.   The term‘massage’in France refers only to massage provided in medical practice, by massage therapists (masseur-kinesithérapeute) who hold a national massage therapy license. The treatment they provide is covered by national medical insurance. They work in hospitals, clinics, rehabilitation centers, and balneotherapy centers and can run their own massage clinics. In contrast, the term‘relaxation massage’(praticien bien-être), which refers to massage for well-being and is never called “massage” in order to distinguish it from medical massage, is not regulated by law. There is a self-regulatory body, that issues licenses for aestheticians, Certificat d’Aptitude Professionnelle (CAP). Their practice is known as modelage. The balneotherapy centers we visited employed licensed masseur-kinesithérapeutes, hydrotherapists who received 600 hours of training, and assistants with no licenses. The thalassotherapy centers mainly employed estheticians with CAP.

Impact of Sulphurous Water Politzer Inhalation on Audiometric Parameters in Children with Otitis Media with Effusion

OBJECTIVES: The positive effects of spa therapy on ear, nose, and throat pathology are known but robust literature in this field, is still lacking. The aim of this study was to assess through a retrospective analysis, the effects on otitis media with effusion of Politzer endotympanic inhalation of sulphurous waters in children aged 5-9 years. METHODS: A cohort of 95 patients was treated with Politzer insufflations of sulphurous water: 58 patients did a cycle consisting of a treatment of 12 days per year for three consecutive years; 37 patients followed the same procedure for 5 years consecutively. The control population was represented by untreated, age-matched children. A standard audiometric test was used before and after each cycle of treatment. RESULTS: One cycle of Politzer inhalation of sulphur-rich water improved the symptoms. Three cycles definitively stabilized the improvement of hearing function. CONCLUSION: Our results show that otitis media with effusion in children can be resolved by an appropriate non-pharmacological treatment of middle ear with sulphur-rich water.

Spa Therapy and Massage in France / 日本温泉気候物理医学会雑誌

  We report here on the current situation, regulations by law, and education of spa therapy and massage in France, as determined through a survey study on massage conducted by our university in France between March 19 and 28, 2012. Spa therapy is one of France natural therapies and means‘health through water’in Latin. It includes balneotherapy (<I>le thermalisme</I>) using thermal spring water, thalassotherapy (<I>la thalassothérapie</I>) using sea water, and hydrotherapy (<I>la balnéothérapie</I>) using water. At present in France, there are 105 balneotherapy centers (<I>Thermés</I>) at 89 sites with thermal spring water, located mainly in mountainous regions. National medical insurance can be used for 18-day balneotherapy treatment of 12 symptoms, provided as a 3-week stay (excluding Sundays) in sites with thermal spring water. Thalassotherapy, on the other hand, is currently regarded as a form of relaxation. Balneotherapy and thalassotherapy both include bathing with jets, showers (<I>douche</I>), exercise in the pool, mud therapy (mud pack and wrapping), and massage among other treatments, but there are differences between the two: balneotherapy uses thermal spring water while thalassotherapy uses sea water; the aim of balneotherapy is to treat or prevent disease while that of thalassotherapy is to promote well-being (relaxation); subjects for balneotherapy are patients, whereas those for thalassotherapy are generally healthy people.<BR>  The term‘<I>massage</I>’in France refers only to massage provided in medical practice, by massage therapists (<I>masseur-kinesithérapeute</I>) who hold a national massage therapy license. The treatment they provide is covered by national medical insurance. They work in hospitals, clinics, rehabilitation centers, and balneotherapy centers and can run their own massage clinics. In contrast, the term‘relaxation massage’(<I>praticien bien-être</I>), which refers to massage for well-being and is never called “<I>massage</I>” in order to distinguish it from medical massage, is not regulated by law. There is a self-regulatory body, that issues licenses for aestheticians, <I>Certificat d’</I><I>Aptitude Professionnelle </I>(CAP). Their practice is known as <I>modelage</I>. The balneotherapy centers we visited employed licensed <I>masseur-kinesithérapeutes</I>, hydrotherapists who received 600 hours of training, and assistants with no licenses. The thalassotherapy centers mainly employed estheticians with CAP.

Spa therapy in dermatology.

Spa therapy constitutes the use of mineral springs and thermal mud to soothe and heal various ailments. Like the mineral springs, seas and oceans are also important centers for spa therapy of which the most important is Dead Sea (DS). DS has been famous for thousands of years for its miraculous curative and cosmetic properties. Intensive research is going on using DS minerals in a wide range of dermatological conditions especially psoriasis, atopic dermatitis, vitiligo and other eczemas and several papers have been published in various international and pharmacological journals.

Effect of Spa Therapy on the Six-minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease / 日本温泉気候物理医学会雑誌

Our previous studies have shown that spa therapy can reduce subjective symptoms and improve ventilatory function in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to measure the effects of spa therapy on walking distance during the six-minute walk test in patients with COPD. Twenty-five COPD patients hospitalized for pulmonary rehabilitation at our hospital were included in this study. Twenty-two patients were male and 3 patients were female. Two patients had stage I, 9 patients had stage II, and 14 patients had stage III COPD, according to the Global Initiative for Chronic Obstructive Lung Disease. We offered complex spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution, and fango therapy) in all patients for 4 weeks. Ventilatory function, six-minute walk distance, oxygen saturation and Borg scale were measured. Vital capacity (VC) was significantly improved by spa therapy at 4 weeks (p<0.05). The values of forced vital capacity (FVC), forced expiratory volume in one second (FEV_1.0), forced expiratory flow after 75% of expired FVC (FEF₇₅), forced expiratory flow after 50% of expired FVC (FEF₅₀), forced expiratory flow after 25% of expired FVC (FEF₂₅), mean expiratory flow during the middle half of the FVC (FEF_25-75), residual volume (RV), functional residual capacity (FRC), peak expiratory flow (PEF) and diffusing capacity for carbon monoxide (DLco) showed a tendency to increase, however the increase in the 10 parameters was not significant. The values of six-minute walk distance before and after spa therapy were 288±106m and 323±114m, respectively (p<0.05). There was a significant decrease in values of maximum Borg Scale values (p<0.05). The values of minimum oxygen saturation and the values of oxygen saturation at rest slightly increased, but not significantly. The change of six-minute walk distance correlated with change of VC (r=0.545; p<0.05), with change of FVC (r=0.628; p<0.05), with change of FEV_1.0 (r=0.559; p<0.05), with change of FEF₅₀ (r=0.480; p<0.05), with change of minimum oxygen saturation (SpO₂) (r=0.554; p<0.05) and with change of SpO₂ at rest (r=0.445; p<0.05). We found that spa therapy induced improvements in ventilatory dysfunction and six-minute walk distance in patients with COPD. The results from this study reveal that spa therapy may improve disease control and exercise tolerance in patients with COPD.

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.

The Effect of Spa Therapy Combined with Dietary Supplementation with n-3 Fatty Acids on Serum Eosinophil Cationic Protein in Asthmatic Subjects / 日本温泉気候物理医学会雑誌

Recently, we have also reported that spa therapy combined with dietary supplementation of perilla seed oil would be effective for patients, and would suppress the generation of leukotriene C4 (LTC4) by peripheral leucocytes. However, it is still unclear how the combination spa therapy and dietary supplementation of perilla seed oil influences on the pathophysiology of bronchial asthma. In the present study, the effects of spa therapy combined with dietary supplementation of perilla seed oil were examined in patients with asthma in relation to the serum eosinophil cationic protein (ECP) levels to investigate the effect on bronchial asthma. Ten adult asthmatic patients with moderate type asthma in terms of severity were taken to have a complex spa therapy and consume perilla seed oil-rich diet for 4 weeks. The generation of LTC4 by peripheral leucocytes, serum ECP level and pulmonary function were measured. Significant decreases were observed for LTC4 and ECP for 4 weeks. Forced vital capacity (FVC), which was one of the pulmonary function tests, improved significantly at 4 weeks (p<0.05). The number of eosinophils decreased for 4 weeks, but the differences were not significant. The results obtained here suggest that spa therapy combined with dietary supplementation of perilla seed oil leads to decrease in LTC4 and ECP and improves pulmonary function and asthma control.

Balneotherapy in Medicine: A Review

Bathing in water (balneotherapy or spa therapy) has been frequently and widely used in classical medicine as a cure for diseases. This paper reviews the present literature on the use of balneotherapy in dermatologic, chronic musculoskeletal (inflammatory and non-inflammatory), metabolic and psychological conditions. We performed a systematic review on related papers appearing in the Medline and Cochrane Library database from 1966 to 2003 that included randomized controlled and non-randomized clinical trials using balneotherapy. We also determined to reflect where possible the chemical compositions of spas. The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis, psoriasis, rheumatoid arthritis (RA), ankylosing spondylitis, osteoarthritis and low back pain. Moreover, the effects of spa therapy on several metabolic conditions are discussed. The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical, thermal and mechanical effects. The importance of balneotherapy either alone or as complement to other therapies should be considered after, or accompanying, orthodox medical treatments.

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.

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.