Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.

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The effects of hyperthermal stress on the coagulation and fibrinolytic systems were examined in five healthy subjects who took a 3-min 47 degrees C hot-spring bath. After a 3-min 47 degrees C bath, the sublingual temperature was transiently increased about 1.8 degrees C, returning to the baseline level within 60 min. The plasma level of plasminogen activator inhibitor-1 antigen (PAI-1) was transiently increased 15 min after the start of bathing and returned to the pre-bathing level 360 min later. The plasma levels of tissue plasminogen activator antigen, alpha 2 plasmin inhibitor activity, plasmin-antiplasmin complex, thrombin-antithrombin III complex, and thrombomodulin antigen were not influenced by the bath. The in vivo result correlated well with the in vitro result that PAI-1 was released from cultured endothelial cells by heating. These findings suggest that the increase in plasma PAI-1 level may be due to the direct hyperthermal action of the very hot hot-spring bath on the endothelial cells and that acute hyperthermal stress may decrease the fibrinolytic capacity, leading to the occurrence of thrombotic events.

Increased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

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