[Our experience with the application of the speleotherapeutic treatment based at the state healthcare facility "Republican Speleotherapeutic Hospital"].

The non-medicamental therapeutic modalities find an increasingly wider application for the rehabilitation and maintenance of the health status in man. Speleotherapy is one of such methods. The Republican Speleotherapeutic Hospital of Belarus exploits the underground speleocomplex in which over 42,000 petients with respiratory diseases and allergic pathologies were given the required treatment. The clinical effectiveness of speleotherapy is estimated at 97.3%. Remission persists for 7.0±0.4 months on the average within one year after a course of speleotherapy. Repeated courses are followed by even longer periods of remission (up to 2.5-3 years). It is concluded that speleotherapy is the highly efficient method for the rehabilitation of the patients presenting with respiratory diseases and allergic pathologies.

Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO® project: a multicentre randomized controlled trial.

OBJECTIVE: To evaluate whether temporary positive expiratory pressure provides benefit in patients with lung diseases and chronic hypersecretion. DESIGN: Single blind multicentre randomized trial. SETTING: Five Italian rehabilitation centres. PARTICIPANTS: Ninety-eight patients with chronic obstructive pulmonary disease and/or chronic bronchitis (n=78), or bronchiectasis (n=20), with a peak cough expiratory flow >150 l/min and sputum production >30 ml/day, randomly included into two treatment groups. INTERVENTIONS: For 10 consecutive days, the active group performed twice a day 20-minute cycles of manually assisted breathing techniques in sequence with the addition of 15 minutes of temporary positive expiratory pressure, while the control group was treated by manually assisted breathing techniques alone. MEASURES: Within and between group changes of arterial oxygenation index, lung volumes and respiratory muscles strength were recorded at enrolment and after 3 and 10 treatment sessions. Pre-to-post treatment change of sputum volume and bronchial encumbrance (Δ-visual analog scale), sputum density and purulence were compared daily within the study period. RESULTS: No significant changes were recorded for the oxygenation index, while dynamic lung volumes and respiratory muscle strength significantly (P <0.05) improved in the active group. The group comparison analysis of the pre-to-post change showed that inspiratory capacity was significantly higher in the active than in the control group (+19.5% and +2.2%, P=0.044) at day 10. A greater improvement in Δ-visual analog scale was recorded in the active group at day 3 and 8. CONCLUSIONS: These preliminary data suggest that temporary positive expiratory pressure improves lung volumes and speeds up the improvement of bronchial encumbrance in patients with lung diseases and hypersecretion.

[Medical applications of ozone for the rehabilitation of the patients presenting with chronic bronchitis and arterial hypertension].

Of paramount importance at the stage of rehabilitative treatment of the patients presenting with combined cardiorespiratory pathology are therapeutic measures aimed at eliminating the principal components of pathogenesis of a given disease and correcting the concomitant immunometabolic disturbances. Our investigations have demonstrated that ozone therapy given to the patients with chronic bronchitis and hypertension produces lipid-lowering, hypoglycemic and fibrinolytic effects. Its combination with anti-hypoxic treatment helps to normalize the functioning capabilities of all organs and systems of the body. Immunomodulatory effects of ozone therapy is attributable to the disintoxicative and anti-hypoxic actions of medical ozone as well as activation of the "lipid peroxidation--antioxidant protection" system.

[Mathematical prognostication of the efficacy of peloidotherapy in the patients with chronic bronchitis and obstructive pulmonary disease].

This study included prognostication of the results of daily application of peloids for the treatment of the patients presenting with chronic bronchitis and obstructive pulmonary disease using a mathematical model. It was shown that the individualized selection of the patients for the daily application of peloid preparations taking into consideration the results of mathematical prognostication makes it possible to significantly improve the total efficacy of the treatment (up to 97.7%), accelerate the achievement of positive outcome of peloidotherapy, reduce by a factor of 4 the frequency of moderately severe balneoreactions, and increase the duration of the remission period by 3.5-4 months.

[Medical rehabilitation efficiency in chronic dust bronchitis patients].

Medical examination covered 41 workers with long length of service in coal and mining industry, diagnosed as having "Chronic obstructive dust bronchitis", who received a complex of therapeutic and prophylactic measures including traditional broncholytic therapy, physical therapy and exercise therapy. 20 patients of main group received additional complex "Vobenzyme + Vitrum + herbal tea + aeration". Efficiency of medical rehabilitation was assessed through external respiration parameters--maximal effect was seen among the main group members (reliable increase of forced vital capacity, peak flow and maximal flow at 25% forced vital capacity).

[Efficiency of rehabilitation for workers having occupational respiratory diseases and engaged into non-mining materials industry].

The analysis covered contemporary approaches to rehabilitation of patients having occupational respiratory diseases (pneumoconiosis, chronic dust bronchitis and their combination). The authors evaluate efficiency of therapeutic and rehabilitation measures.

The dose effect of pulmonary rehabilitation on physical activity, perceived exertion, and quality of life.

PURPOSE: Pulmonary rehabilitation (PR) programs have been shown to improve functional status, exercise performance, and quality of life (QOL) and decrease perception of exertion in individuals with chronic obstructive pulmonary disease. The purpose of this study was to identify the dose effect of PR on the outcome variables of activity level, perceived exertion, and physical and mental QOL. METHODS: The study used a retrospective explanatory design. The sample (N = 104) included records of individuals diagnosed with chronic bronchitis and emphysema who attended a PR program from 2000 to 2005 at a Midwest inner-city, academic medical center. Participants attended rehabilitation sessions 2 to 3 days per week for approximately 90 minutes each day; maximum duration of the program was 3 months (24 sessions). The PR dose was calculated by multiplying the number of PR sessions with the number of weeks attended. RESULTS: There were 32 men and 72 women, with a mean age of 59.9 years +/- 10.2 years. All patients were retired or unemployed, and 99% used oxygen during exercise. A higher PR dose was significantly related to improvement in activity level measured by maximum metabolic equivalent (MET) level achieved. A nonsignificant but minimally clinically important difference was found on the Medical Outcomes Study Short-Form 36 (SF-36) outcomes of mental and physical QOL. CONCLUSIONS: The findings of the current study support a significant relationship between PR dose and activity level (maximum MET level achieved). Physical and mental QOL improved clinically after PR. Optimal program outcomes were related to greater patient participation in supervised PR.

[Intermittent hypoxic training in the sanatorium and spa treatment for patients with chronic obstructive pulmonary disease].

The combined examination and treatment in the course of normobaric interval hypoxic training of 550 patients with chronic obstructive pulmonary disease was performed. Characteristics of change of state of functional respiratory system, immunological reactivity, electroencephalography after adaptation to hypoxia in the course of interval hypoxic training were determined. Revealed improvement of oxygen supply on all stages of its transfer and increase of oxygen consumption in tissues resulted in normalization of electrobiological activity of cerebral cortex, correction of immunological reactivity. High efficiency of interval hypoxic training in the combined treatment for patients with chronic obstructive pulmonary disease was proved.

[Possibilities of immunomodulation in patients with chronic bronchitis during physiotherapeutic impacts on the thymic area]. / Vozmozhnost' immunomoduliatsii pri fizioterapevticheskikh vozdeistviiakh na oblast' timusa u bol'nykh khronicheskim bronkhitom.

Immune effects of galvanic current (GC) and ultrasound (US) applied on the thymic area were studied in 66 patients with chronic bronchitis (CB) on rehabilitation treatment. 64 control CB patients either receive an immunomodulating drug thymalin or were treated without immunomodulation. It was found that GC and US are effective in disorders of cellular immunity and result in closer interaction between separate components of immune system. The immunomodulating effect of GC and US was comparable with that of thymalin.

[Rehabilitation of patients with chronic bronchitis and spine diseases]. / Vosstanovitel'naia terapiia bol'nykh khronicheskim bronkhitom s zabolevaniiami pozvonochnika.

Correction of disturbed respiratory function and inhibition of progression of pulmonary inflammatory and obstructive processes is the aim of respiration rehabilitation in patients with chronic bronchitis (CB). It is known that rehabilitation in CB patients with spinal diseases meets with difficulties as dystrophic lesions of the spine entail its functional-anatomic disorders at the corresponding level. By supporting progression of dystrophic spinal and osteovertebral junction disorders, chronic bronchopulmonary inflammation participates in formation of interrelated respiratory affections. New approaches to rehabilitation of CB patients with spinal lesions lie in use of pharmacopuncture, acupuncture, deep reflex-muscular massage and therapeutic exercise in consensual sequence.

[Pelotherapy in combined aftertreatment of patients with chronic bronchitis]. / Peloidoterapiia v kompleksnom vosstanovitel'nom lechenii bol'nykh khronicheskim bronkhitom.

A therapeutic complex based on pelotherapy given as mud applications or electrophoresis of squeezed mud on the area of lung root projection (a total of 10-12 procedures, each other day) was tested in 99 patients with chronic bronchitis (CB). 68 CB controls received the above complex but no peloids. The results were assessed by clinical changes, clinical biochemical indices, immunograms, changes in external respiration function. The pelotherapy was found to have a corrective effect on CB pathogenesis and a stimulating action on sanogenic mechanisms of the body.

Branched-chain aminoacids and retraining of patients with chronic obstructive lung disease.

BACKGROUND: The aim of this work was to improve the efficacy of rehabilitation by retraining, by oral supply in branched-chain aminoacids (BCAA). Patients with chronic respiratory insufficiency mainly suffer from obstructive bronchitis due to tobacco or asthma. Nutritional assessment is one of the components of respiratory rehabilitation, with retraining. Intense physical training for several days negativates the nitrogen balance, the beginning of a training programme for sedentary patients increases their need in proteins. An additional supply in branched-chain aminoacids increases proteic anabolism, by synthesis increase and catabolism slackening of proteins. Moreover it is known that exposure to high altitude reduces lean mass by inducing a muscular atrophy, which can be avoided by the BCAA provided. This leads to wonder if extra supply of BCAA could play similar role in muscular mass loss induced by pathological chronic hypoxia. METHODS: The prospective and comparative survey carried out in Toki-Eder (private hospital in Cambo) consisted in supplying (during five weeks or more) 30 retrained patients suffering from chronic obstructive bronchitis, and in matching them with 30 witnesses (obstructive patients retrained without additional supply in BCAA). Their mean hypoxemia amounted to 7 torr for age. RESULTS: Each of them improved their reached maximal power, and their VO2 SL, very highly significantly. Each of them developed a moderate metabolic acidosis (whose possible mechanisms are discussed) and slightly increased their ventilation at rest. On the other hand only the supplied patients improved their PaO2 at rest highly significantly, a result which poses the question of the responsible mechanism, most likely a decrease of pulmonary shunt effect. The hypotheses concerning the acid load due to BCAA ingestion are discussed. Only the supplied patients developed hypocapnia expressing a gaseous alkalosis which might be due to a direct effect of BCAA on the respiratory centers. CONCLUSIONS: This observation could have practical outcomes in the management of rehabilitation of chronic respiratory insufficiency: it should be useful to systematically supplement the patients with BCAA during their retraining in order to obtain a more effective improvement of their respiratory function.

[School for patients with chronic obstructive bronchitis as a method of medico-social rehabilitation]. / Shkola dlia bol'nykh khronicheskim obstruktivnym bronkhitom kak sposob mediko-sotsial'noi reabilitatsii.

The results of investigation of 282 patients with chronic obstructive bronchitis (COB) gave the basis for design of a cycle of lectures in the school for COB patients. The curricula of the school include positive information about the disease, psychological correction (different for men and women), recommendations on the methods of enhancing social activity. Medico-social rehabilitation of COB patients must be continuous. This becomes possible only if the patient takes an active part in the process of rehabilitation.