Effect of inhalation of thermal water on airway inflammation in chronic obstructive pulmonary disease

Abstract

Thermal water inhalations have been traditionally used in the treatment of upper and lower chronic airway diseases. However, the benefit and the mechanism of this treatment have not been properly assessed. To determine whether inhaled salt-bromide-iodine thermal water improves lung function, quality of life and airway inflammation, 39 patients with chronic obstructive pulmonary disease (COPD) were randomly assigned to receive 2-weeks inhalation treatment with thermal water (active, no. = 20) or normal saline (control, no. = 19) in single blind. Lung volumes were measured, Saint George's respiratory questionnaire (SGRQ) was administered and induced sputum was performed before and after treatment. No changes in pre- and post-salbutamol lung volumes was observed after inhalation treatment in both groups. SGRQ score showed a significant improvement in active group compared with control group at the end of the trial. The concentration of total cells in induced sputum increased significantly in both active (P < 0.05) and control groups (P < 0.05). Inhalation of thermal water induced a small but significant decrease in percentages of sputum neutrophils (P < 0.01) and a parallel increase in macrophages (P < 0.01). In contrast, normal saline inhalation was not associated with changes in differential sputum cell counts. In conclusion, treatment with inhaled salt-bromide-iodine thermal water in COPD is associated with a reduced proportion of neutrophils in induced sputum suggesting that thermal water may have a mild anti-inflammatory effect on the airways. However, the short-term improvement in some components health-related quality of life was not related with changes in lung function or with the degree of airway inflammation.

Effects of Inhalation of Thermal Water on Exhaled Breath Condensate in Chronic Obstructive Pulmonary Disease

“…This result is in line with our previous observations that variables related to health perception are more sensitive than functional indexes to detect effects of treatment with TW [4]. …”

“…We confirmed that EBC LTB 4 concentrations are elevated in COPD. However, the results do not provide evidence that the reduced proportion of neutrophils in induced sputum after TW treatment [4] is due to decreased LTB 4 concentrations. Caution should be shown in the interpretation of LTB 4 data because LTB 4 concentrations in EBC exhibited high variability.…”

“…While TW is shown to have some anti-inflammatory properties in patients with rhinitis [2], few investigations were performed in the lower respiratory tract [3]. We previously observed a reduced proportion of neutrophils in induced sputum after TW treatment, suggesting that TW may have a mild anti-inflammatory effect on the airways [4]. The measurement of markers in exhaled breath condensate (EBC) has been suggested to be a useful and relatively inexpensive method for assessing and monitoring airway inflammation [5].…”

Effect of Salt-Bromide-Iodine Thermal Water Inhalation on Functional and Biochemical Lung Parameters

“…The PEF value in patients with bronchial diseases have increased significantly (Table 2), whereas other spirometric parameters in both bronchial and alveolar diseases have been found increased not significant after treatment. Pellegrini et al [5] have found not significantly changes in lung function after 2 weeks of treatment with salt-bromide-iodine thermal water in COPD patients. In our study, when we analyzed the group of patients with objective airflow obstruction (FEV 1 /FVC < 0.7), the index FEV 1 /FVC increased significantly after thermal treatment compared to baseline values before (Table 3), but the reliability of this improvement is debatable due to the small number of subjects (N = 14).…”

“…Many scientists think that particular composition of this thermal water plays a useful anti-inflammatory and sedative purifying action on the mucous membranes of the respiratory apparatus: aerosol tiny particels are vaporized and inhaled by the subjects, pass through respiratory tract, giving relief to nose, throat, bronchus, lungs, and larynx. In the literature there are only few works that study the effect of inhalation of salt-bromideiodine thermal water on airway inflammation in patients with lung diseases such as chronic obstructive pulmonary disease (COPD) [5,6]. Moreover, despite its widespread use, much uncertainty exists about the indications and therapeutic mechanisms of thermal water inhalations in the treatment of respiratory diseases.…”