Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role?

Maria Chiara Maccarone, Stefano Masiero, Maria Chiara Maccarone, Stefano Masiero

Abstract

Pulmonary rehabilitation is essential in post-COVID subjects, reporting respiratory impairment after the discharge from the hospital. Because the number of patients with respiratory outcomes is high and there are few facilities available, we wonder if a spa setting could represent a valid out-of-hospital alternative. We aim to explore recent evidence related to respiratory rehabilitation in the spa environment to understand if it can represent an appropriate setting for respiratory rehabilitation interventions in post-COVID subjects. Studies were found by screening PubMed, MEDLINE, and Google Scholar databases from 2011 up to February 2021. Studies were eligible if they were reviews, randomized controlled trials (RCTs), or clinical trials, investigating respiratory interventions in the spa environment. Recent evidence has shown that inhalations and mineral-rich water immersions are effective in fighting and preventing multiple chronic respiratory tract diseases. Therefore, these treatments could also be applied to post-COVID patients with medium long-term respiratory outcomes.

Keywords: Balneotherapy; Health resort medicine; Pulmonary recovery; SARS-CoV-2.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

References

    1. Agostini F, Mangone M, Ruiu P, Paolucci T, Santilli V, Bernetti A. Rehabilitation setting during and after Covid-19: an overview on recommendations. J Rehabil Med. 2021;53(1):jrm00141. doi: 10.2340/16501977-2776.
    1. Antonelli M, Donelli D. Respiratory rehabilitation for post-COVID19 patients in spa centers: first steps from theory to practice. Int J Biometeorol. 2020;64:1811–1813. doi: 10.1007/s00484-020-01962-5.
    1. Bai AV, Rabasco J, Ceccatelli V, Floridia S, Sbardella S, Petrignani C, Agostini F, Paoloni M. (2021) Suggestions for changes in professional procedures and adaptation to COVID-19: new models of care in the rehabilitation setting. Ann Ig. 2021;33(3):299–304. doi: 10.7416/ai.2021.2434.
    1. Bernetti A, Mangone M, Alviti F, Paolucci T, Attanasi C, Murgia M, Di Sante L, Agostini F, Vitale M, Paoloni M. Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy. Int J Biometeorol. 2020;64(6):905–914. doi: 10.1007/s00484-019-01731-z.
    1. Boyer AF, Schoenberg N, Babcock H, McMullen KM, Micek ST, Kollef MH. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest. 2015;147:68–81. doi: 10.1378/chest.14-0544.
    1. Brown SM, Bose S, et al. Approaches to addressing post-intensive care syndrome among intensive care unit survivors. A narrative review Ann Am ThoracSoc. 2019;16:947–956.
    1. Cantone E, Marino A, Ferranti I, Castagna G, Maione N, Dirubbo V, Iengo M. Nasal cytological assessment after crenotherapy in the treatment of chronic rhinosinusitis in the elderly. Int J ImmunopatholPharmacol. 2014;27(4):683–687. doi: 10.1177/039463201402700427.
    1. Carubbi C, Masselli E, Calabrò E, Bonati E, Galeone C, Andreoli R, Goldoni M, Corradi M, Sverzellati N, Pozzi G, Banchini A, Pastorino U, Vitale M. Sulphurous thermal water inhalation impacts respiratory metabolic parameters in heavy smokers. Int J Biometeorol. 2019;63:1209–1216. doi: 10.1007/s00484-019-01737-7.
    1. Cohen M. Turning up the heat on COVID-19: heat as a therapeutic intervention. F1000Res. 2020;9:292. doi: 10.12688/f1000research.23299.2.
    1. Corradi M, Folesani G, Gergelova P, Goldoni M, Pinelli S, Gainotti G, de Palma G, Mutti A. Effect of salt-bromide-iodine thermal water inhalation on functional and biochemical lung parameters. ISRN Pulmonology. 2012;2012:1–8. doi: 10.5402/2012/534290.
    1. Kesiktas N, Karagülle Z, Erdogan N, Yazıcıoglu K, Yılmaz H, Paker N. The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia. J Back MusculoskeletRehabil. 2011;24(1):57–65. doi: 10.3233/BMR-2011-0276.
    1. Khaltaev N, Solimene U, Vitale F, Zanasi A. Balneotherapy and hydrotherapy in chronic respiratory disease. Journal of Thoracic Disease. 2020;12(8):4459–4468. doi: 10.21037/jtd-gard-2019-009.
    1. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement TherClinPract. 2020;39:101166. doi: 10.1016/j.ctcp.2020.101166.
    1. Maccarone MC, Masiero S. The important impact of COVID-19 pandemic on the reorganization of a Rehabilitation Unit in a National Healthcare System hospital in Italy. Am J Phys Med Rehabil. 2021;100:327–330. doi: 10.1097/PHM.0000000000001707.
    1. Maccarone MC, Magro G, Solimene U, Masiero S. The effects of balneotherapy on human immune function: should baths and mud applications have a role during Covid-19 pandemic? Bulletin of rehabilitation medicine. 2020;3:22–24. doi: 10.38025/2078-1962-2020-97-3-22-24.
    1. Maccarone MC, Magro G, Solimene U, Scanu A, Masiero S (2021a) From in vitro research to real life studies: an extensive narrative review of the effects of balneotherapy on human immune response. Sport Sci Health. 10.1007/s11332-021-00778-z
    1. Maccarone MC, Magro G, Tognolo L, Masiero S (2021b) Post COVID-19 persistent fatigue: a proposal for rehabilitative interventions in the spa. Int J Biometeorol:1–3. 10.1007/s00484-021-02158-1
    1. Masiero S. Thermal rehabilitation and osteoarticular diseases of the elderly. Aging ClinExp Res. 2008;20(3):189–194. doi: 10.1007/BF03324772.
    1. Masiero S, Vittadini F, Ferroni C, Bosco A, Serra R, Frigo AC, Frizziero A. The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. Int J Biometeorol. 2018;62(2):243–252. doi: 10.1007/s00484-017-1445-7.
    1. Masiero S, Maghini I, Mantovani ME, Bakdounes L, Koutsikos K, del Felice A, Sale P. Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson's disease? A retrospective study. Int J Biometeorol. 2019;63(1):13–18. doi: 10.1007/s00484-018-1632-1.
    1. Masiero S, Maccarone MC, Agostini F. Health resort medicine can be a suitable setting to recover disabilities in patients tested negative for COVID-19 discharged from hospital? A challenge for the future Int J Biometeorol. 2020;64:1807–1809. doi: 10.1007/s00484-020-01947-4.
    1. Masiero S, Maccarone MC, Magro G. Balneotherapy and human immune function in the era of COVID-19. Int J Biometeorol. 2020;64:1433–1434. doi: 10.1007/s00484-020-01914-z.
    1. Passali D, De Corso E, Platzgummer S, et al. Spa therapy of upper respiratory tract inflammations. Eur Arch Otorhinolaryngol. 2013;270(2):565–570. doi: 10.1007/s00405-012-2024-5.
    1. Passali D, Gabelli G, Passali GC, Mösges R, Bellussi LM. Radon-enriched hot spring water therapy for upper and lower respiratory tract inflammation. Otolaryngol Pol. 2017;71(4):8–13. doi: 10.5604/01.3001.0010.2242.
    1. Siddiq M, Rathore FA, Clegg D, Rasker JJ. Pulmonary Rehabilitation in COVID-19 patients: a scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil. 2020;66(4):480–494. doi: 10.5606/tftrd.2020.6889.
    1. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken M, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF, ATS/ERS Task Force on Pulmonary Rehabilitation An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J RespirCrit Care Med. 2013;188:e13–e64. doi: 10.1164/rccm.201309-1634ST.
    1. Vermund SH, Pitzer VE. Asymptomatic transmission and the infection fatality risk for COVID-19: implications for school reopening. Clin Infect Dis. 2020;72:1493–1496. doi: 10.1093/cid/ciaa855.
    1. Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020;99(9):769–774. doi: 10.1097/PHM.0000000000001505.
    1. World Health Organisation: World Health Organisation, Coronavirus Disease 2019 (COVID19) situation dashboard (cited May 31, 2021) Avaible from:
    1. You J, Zhang L, Ni-Jia-Ti MY, Zhang J, Hu F, Chen L, et al. Anormal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J Inf Secur. 2020;81:e150–e1e2.

Source: PubMed

3
Tilaa