Respiratory Muscle Function in Older Adults with Chronic Respiratory Diseases after Pulmonary Rehabilitation in Subterranean Salt Chambers.

Training the respiratory muscles is a crucial aspect of pulmonary rehabilitation. The purpose of this study was to assess the function of respiratory muscles in older adults both before and after a period of pulmonary rehabilitation and treatment stay within the underground chambers of a salt mine. A total of 50 patients aged 65 years and older with chronic respiratory conditions was enrolled in the study. These participants underwent a 3-week subterranean pulmonary rehabilitation (PR) program in the "Wieliczka" Salt Mine. Levels of sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured using the MicroRPM both before and after the outpatient PR program conducted 135 m underground. A total of 44 patients with a mean age of 68.8 ± 2.9 years who completed the PR program and tests were included in the analysis. The average changes in the parameters of pulmonary function before and after the PR were: MIP 8.8 cmH2O, MEP 7.1 cmH2O, and SNIP 11.2 cmH2O (for p < 0.05). For patients older than 70 years, beneficial changes were only observed for MEP, which increased by 9.3 cmH2O (for p < 0.05). Speleotherapy combined with pulmonary rehabilitation improves respiratory muscle function in older adults with chronic respiratory diseases, mainly in terms of MEP. Therefore, a greater emphasis on inspiratory muscle training in the rehabilitation program should be considered.

Dynamic Balance and Chest Mobility of Older Adults after Speleotherapy Combined with Pulmonary Rehabilitation, Endurance and Strength Training-A Prospective Study in Chronic Respiratory Diseases.

BACKGROUNDS: As people age, they are more likely to experience balance disturbances. Pulmonary rehabilitation is recognized as a core component in the management of older adults with chronic respiratory diseases. The aim of the study was to assess the dynamic balance and chest mobility of older adults participating in speleotherapy combined with pulmonary rehabilitation, endurance and strength training. METHODS: The study group consisted of 51 older adults with chronic respiratory disorders who participated in a 3-week pulmonary rehabilitation programme in underground salt chambers in the 'Wieliczka' Salt Mine Health Resort. These individuals underwent the Four Square Step Test (FSST) and circumferential chest mobility measurement before and after the outpatient rehabilitation programme conducted 135 m underground. RESULTS: Before rehabilitation in the underground salt chambers, half of the results (50%, 22 patients) were below the norm in the assessment of chest mobility between maximal inhale and exhale. The average time needed to perform FSST decreased significantly (p ≤ 0.05) from 10.2 ± 1.9 s before the stay to 9.1 ± 1.7 s after the stay and the average increase in chest mobility increased significantly (p ≤ 0.05) from 4.5 ± 5.5 cm to 5.4 ± 2.8 cm. CONCLUSIONS: Speleotherapy combined with pulmonary rehabilitation, endurance and strength training increased the dynamic balance and chest mobility of older adults with chronic respiratory diseases, as measured by the FSST and circumferential chest expansion assessment.

Pulmonary rehabilitation in subterranean chambers combined with neuro-orthopedic activity-dependent plasticity therapy influences patients' quality of life - A preliminary study.

OBJECTIVE: The aim of the study was to evaluate if Neuro-orthopedic Activity-dependent Plasticity (N.A.P.) therapy combined with standard subterranean pulmonary rehabilitation (SPR) conducted in the salt mine influences the health-related quality of life (HRQoL) and chest mobility in patients with asthma or chronic upper respiratory tracts diseases. METHODS: 54 patients enrolled for the study completed a 3-week SPR. The 15D questionnaire, chest mobility and back scratch flexibility tests were conducted before and after SPR. In the study group (N = 23,16 women, 7 men) the N.A.P. therapy was added to SPR, while the control group (N = 31, 21 women and 10 men) completed the SPR program. RESULTS: After the SPR statistically significant improvements were observed on the 15D dimensions of breathing and vitality dimensions, in the chest mobility and back flexibility in both groups. With the baseline gender distribution, age, generic 15D score, chest mobility and back scratch adjusted, the change in the 15D score was 0.068 greater in the study group than in the control group. This difference is clinically important and statistically significant (p = 0.022). There was no statistically significant difference in the chest mobility and back scratch flexibility between the groups. CONCLUSIONS: Adding N.A.P. therapy techniques to the SPR program in the underground part of the 'Wieliczka' Salt Mine Health Resort results in a statistically significant and clinically important improvement in the subjects' HRQoL.

Properties of Particulate Matter in the Air of the Wieliczka Salt Mine and Related Health Benefits for Tourists.

This study aimed to evaluate the mass concentration of size-resolved (PM1, PM2.5, PM4, PM10, PM100) particulate matter (PM) in the Wieliczka Salt Mine located in southern Poland, compare them with the concentrations of the same PM fractions in the atmospheric air, and estimate the dose of dry salt aerosol inhaled by the mine visitors. Measurements were conducted for 2 h a day, simultaneously inside (tourist route, passage to the health resort, health resort) and outside the mine (duty-room), for three days in the summer of 2017 using DustTrak DRX devices (optical method). The highest average PM concentrations were recorded on the tourist route (54-81 µg/m3), while the lowest was in the passage to the health resort (49-62 µg/m3). At the same time, the mean outdoor PM concentrations were 14-20 µg/m3. Fine particles constituting the majority of PM mass (68-80%) in the mine originated from internal sources, while the presence of coarse particles was associated with tourist traffic. High PM deposition factors in the respiratory tract of children and adults estimated for particular mine chambers (0.58-0.70), the predominance of respirable particles in PM mass, and the high content of NaCl in PM composition indicate high health benefits for mine visitors.

Inhalations with Brine Solution from the 'Wieliczka' Salt Mine Diminish Airway Hyperreactivity and Inflammation in a Murine Model of Non-Atopic Asthma.

Inhalations with brine solutions are old but underestimated add-ons to pharmacological treatments of inflammatory lung diseases. Although widely used, not all features underlying their action on the respiratory system have been explored. The aim of the present study was to elucidate the mechanism of the beneficial action of inhalations of brine solution from the 'Wieliczka' Salt Mine, a Polish health resort, in a murine model of non-atopic asthma. Asthma was induced in BALB/c mice by skin sensitization with dinitrofluorobenzene followed by an intratracheal challenge of cognate hapten. All animals underwent 12 inhalation sessions with brine solution, pure water or physiological saline. Control mice were not inhaled. We found that brine inhalations reduced, as compared to non-inhaled mice, the typical asthma-related symptoms, like airway hyperreactivity (AHR), the infiltration of pro-inflammatory cells into the bronchial tree, and the inflammation of the airways at the level of pro-inflammatory cytokines IL-1α, IL-1ß and IL-6. The level of the anti-inflammatory IL-10 was elevated in brine-inhaled mice. Inhalations with pure water increased AHR, whereas saline had no influence, either on AHR or cytokine concentrations. These observations indicate that inhalations with a brine solution from the 'Wieliczka' Salt Mine diminish the asthma-related symptoms, mostly by reducing the inflammatory status and by decreasing AHR.

The influence of speleotherapy combined with pulmonary rehabilitation on functional fitness in older adults - preliminary report.

OBJECTIVE: Our aim was to determine the influence of pulmonary rehabilitation conducted in therapeutic salt mine chambers on the functional fitness of older adults. METHODS: The study included 22 individuals of age >65 years with chronic respiratory conditions. The patients underwent the Fullerton test before and after a 3-week outpatient pulmonary rehabilitation in the "Wieliczka" Salt Mine Health Resort. RESULTS: After the rehabilitation stay, the results showed statistically significant improvements within five of the six parameters evaluated. In the Arm Curl, the mean number of repetitions within 30 s increased from 14.55 ± 3.63 to 16.68 ± 3.83 and in the Chair Stand from 11.86 ± 2.55 to 14.41 ± 2.95. Beneficial changes were observed in the Back Scratch, but without statistical significance. In Sit and Reach results increased from -2.3 ± 11.11cm to 2.14 ± 9.19 cm. Time for performing the 8-Foot Up and Go decreased from 6.63 ± 1.27 s to 5.8 ± 0.86 s and in 2-Minute Step results increased from 88.27 ± 20.64 to 96.55 ± 16.38 repetitions. CONCLUSION: Functional fitness of examined older adults with pulmonary disorders has increased after a rehabilitation and treatment stay in underground salt mine chambers. The reviews of this paper are available via the supplemental material section.

Subterranean Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease.

Pulmonary rehabilitation (PR) has been recommended as an integral part of treatment for patients with chronic obstructive pulmonary disease (COPD). Climate therapy in salt mine chambers has been found of benefit in chronic respiratory diseases. The study compares long-term effects of underground PR in the Wieliczka Salt Mine with that conducted on the surface. There were 42 COPD patients enrolled in the study, with FEV1/FVC <0.7 predicted and post-bronchodilator reversibility <12%, randomized into pulmonary rehabilitation in the mine (Group I, n = 23) and PR on the surface (Group II, n = 19). The outcomes consisted of lung function variables, exercise performance (6-min walk test - 6MWT), dyspnea (mMRC), and compliance with the disease and quality of life (COPD Assessment Test - CAT) and BODE index, compared at baseline (P0), end (P1), and 6 months after pulmonary rehabilitation (P2). The findings were that subterranean pulmonary rehabilitation significantly reduced CAT score (p < 0.001), BODE index (p = 0.004), and dyspnea (mMRC) (p = 0.001) and increased distance in 6MWT (p < 0.001), compared with its equivalent conducted on the surface. Further, beneficial effect of subterranean treatment was sustained during the following half a year as opposed to the effect noticed on patients treated on the surface. We conclude that subterranean pulmonary rehabilitative treatment reduces symptoms and improves exercise tolerance to a greater and sustained extent, compared to a similar treatment on the surface, in patients suffering from COPD.

Czy smog ma wplyw na czestosc wystepowania zaostrzen przewleklego zapalenia krtani? Analiza na przykladzie mieszkanców województwa malopolskiego.

INTRODUCTION: Due to dynamic industrialisation smog became a frequent phenomenon in most developing cities. According to the last WHO report from Global Urban Ambient Air Pollution Database, Krakow has been classified in the 11th place among the most polluted cities in Europe. It seems to be an urgent issue because of the influence of air pollution on the condition of upper respiratory tract. Materials & Methods: In December 2015 there were 141 patients aged 17-91 years with upper respiratory tract diseases admitted to the phoniatric outpatient clinic in the University Hospital in Cracow. They suffered from cough, hoarseness and periodic aphonia. On the basis of the results of videolaryngostroboscopy 60 patients with exacerbation of the chronic laryngitis were selected into two numerically equal groups: from Cracow and from other places at least 60 km away. The groups were equal to each other also in three categories: sex, age and voice usage. The patients were referred to the Pedagogical University in Cracow for laryngography to evaluate the movement of the vocal folds and to trace a voice profile. Finally, there were two possible types of treatment - conventional pharmacotherapy or subterraneotherapy in the underground Health Resort in the "Wieliczka" Salt Mine. RESULTS: Pearson correlation coefficient between the distance from the place of residence to Cracow and the scale of exacerbation of inflammation of upper respiratory tract presenting as vocal fold dysfunction was observed (r= 0,617; p<0,05). CONCLUSION: The place of residence (in or out of the industrial area) and exacerbations of chronic laryngitis are highly correlated. Air pollution seems to be the main factor influencing on the condition of upper respiratory tract. In our local conditions of Lesser Poland Voivodeship subterraneotherapy may be an interesting, non-invasive method preventing from exacerbations of upper respiratory tract diseases.

Particulate Matter in the Air of the Underground Chamber Complex of the Wieliczka Salt Mine Health Resort.

This study evaluates the mass concentration and chemical composition of particulate matter (PM), collected in the chamber complex of the underground health resort located in the Wieliczka Salt Mine in southern Poland. Physical and chemical properties of PM were examined from the standpoint of their possible connection with therapeutic effects of the subterranean air in the mine. We found that in three underground spots we measured the average concentration of PM did not exceed 30 µg/m3. Chemical composition of PM was dominated by sodium chloride, making up 88 % of its mass, on average. It was shown that the underground ambient concentration of PM and its chemical composition depended mostly on the nature of the rock material present in the ventilation tunnel of the health resort, filtering the incoming air. The presence and effect of external sources of PM, including patients' activity, also had an impact on the underground PM concentration.

The influence of pulmonary rehabilitation in the Wieliczka Salt Mine on asthma control--preliminary results.

According to asthma treatment guidelines the main goal of pulmonary rehabilitation is optimum asthma control. The Asthma Control Test (ACT) is a standardised five-item questionnaire for the assessment of asthma control. The study compares the pre- and post-treatment (subterraneotherapy) ACT score with other conventional respiratory parameters. The study included 21 patients with bronchial asthma who underwent a 3-week long subterraneotherapy programme in the 'Wieliczka' Salt Mine. The patients completed the ACT questionnaire before and 2 weeks after subterraneotherapy. At the same time, they underwent testing for concentration of nitric oxide in exhaled breath (FENO), peak expiratory flow (PEF) and spirometry. Subterraneotherapy influenced significantly the change of MEF75 (p = 0.03255) and improvement of ACT score (N = 21, p = 0.0016). The differences in other parameters were not statistically important, but in the case of FEV1 and VC parameters, the differences found were close to the statistical significance (0.05 < p < 0.10). The differences of results before and after subterraneotherapy were higher in the group assigned as patient with poor or moderate asthma control (ACT score < 20, N = 10) than in the group with good control of asthma (ACT score ≥ 20, N = 11). For parameters FEV1, VC, MEF75 and ACT score the improvement was significantly higher in the poor control group. The pulmonary rehabilitation programme combined with subterraneotherapy helps to control asthma especially in patients suffering from poorly or moderate controlled asthma.