Subterranean Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

Towards More Precise Targeting of Inhaled Aerosols to Different Areas of the Respiratory System

Pharmaceutical aerosols play a key role in the treatment of lung disorders, but also systemic diseases, due to their ability to target specific areas of the respiratory system (RS). This article focuses on identifying and clarifying the influence of various factors involved in the generation of aerosol micro- and nanoparticles on their regional distribution and deposition in the RS. Attention is given to the importance of process parameters during the aerosolization of liquids or powders and the role of aerosol flow dynamics in the RS. The interaction of deposited particles with the fluid environment of the lung is also pointed out as an important step in the mass transfer of the drug to the RS surface. The analysis presented highlights the technical aspects of preparing the precursors to ensure that the properties of the aerosol are suitable for a given therapeutic target. Through an analysis of existing technical limitations, selected strategies aimed at enhancing the effectiveness of targeted aerosol delivery to the RS have been identified and presented. These strategies also include the use of smart inhaling devices and systems with built-in AI algorithms.

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.

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.

Nontuberculous Mycobacteria Prevalence in Aerosol and Spiders' Webs in Karst Caves: Low Risk for Speleotherapy

A total of 152 aerosol and spider web samples were collected: 96 spider’s webs in karst areas in 4 European countries (Czech Republic, France, Italy, and Slovakia), specifically from the surface environment (n = 44), photic zones of caves (n = 26), and inside (aphotic zones) of caves (n = 26), 56 Particulate Matter (PM) samples from the Sloupsko-Sosuvsky Cave System (speleotherapy facility; n = 21) and from aerosol collected from the nearby city of Brno (n = 35) in the Czech Republic. Nontuberculous mycobacteria (NTM) were isolated from 13 (13.5%) spider’s webs: 5 isolates of saprophytic NTM (Mycobacterium gordonae, M. kumamotonense, M. terrae, and M. terrae complex) and 6 isolates of potentially pathogenic NTM (M. avium ssp. hominissuis, M. fortuitum, M. intracellulare, M. peregrinum and M. triplex). NTM were not isolated from PM collected from cave with the speleotherapy facility although mycobacterial DNA was detected in 8 (14.3%) samples. Temperature (8.2 °C, range 8.0–8.4 °C) and relative humidity (94.7%, range 93.6–96.6%) of air in this cave were relatively constant. The average PM_2.5 and PM₁₀ mass concentration was 5.49 µg m⁻³ and 11.1 µg m⁻³. Analysed anions (i.e., F⁻, Cl⁻, NO₂⁻, SO₄²⁻, PO₄³⁻ and NO₃⁻) originating largely from the burning of wood and coal for residential heating in nearby villages in the surrounding area. The air in the caves with speleotherapy facilities should be monitored with respect to NTM, PM and anions to ensure a safe environment.

Origin, distribution, and perspective health benefits of particulate matter in the air of underground salt mine: a case study from Bochnia, Poland

The composition and distribution of airborne particles in different locations in a salt mine were determined in terms of their origin, the distance from the air inlet, and the adaptation of post-mining chambers and corridors for tourists and general audience. The composition of aerosols in air was also evaluated from the perspective of human health. Air samples were collected on filters by using portable air pumps, in a historical underground salt mine in Bochnia (Poland), which is currently a touristic and recreation attraction and sanatorium. The particulate matter (PM) concentration was determined using the gravimetric method by weighing quartz filters. The content of carbon, water-soluble constituents, trace elements, and minerals was also determined. A genetic classification of the suspended matter was proposed and comprised three groups: geogenic (fragments of rock salt and associated minerals from the deposit), anthropogenic (carbon-bearing particles from tourist traffic and small amounts of fly ash, soot, and rust), and biogenic particles (occasional pollen). The total PM concentration in air varied between 21 and 79 μg/m³ (with PM₄ constituting 4-24 μg/m³). The amount of atmospheric dust components coming from the surface was low and decreased with the distance from the intake shaft, thus indicating the self-cleaning process. NaCl dominated the water-soluble constituents, while Fe, Al, Ag, Mn, and Zn dominated the trace elements, with the concentration of majority of them below 30 ng/m³. These metals are released into air from both natural sources and the wear or/and corrosion of mining and tourists facilities in the underground functional space. No potentially toxic elements or constituents were detected. The presence of salt particles and salty spray in the atmosphere of salt mine, which may have anti-inflammatory and antiallergic properties, is beneficial to human health. This study will allow for a broader look at the potential of halotherapy in underground salt mines from a medical and regulatory point of view.

Mineralogical and Chemical Tracing of Dust Variation in an Underground Historic Salt Mine

The aim of this study was to investigate the causes of the evolution of atmospheric dust composition in an open-to-public subterranean site (UNESCO-recognized historic mine) at increasing distances from the air intake. The role of the components imported with atmospheric air from the surface was compared with natural and anthropogenic sources of dust from inside the mine. Samples of deposited dust were directly collected from flat surfaces at 11 carefully selected sites. The morphological, mineralogical, and chemical characteristics were obtained using scanning electron microscopy (SEM), X-ray diffraction (XRD), and inductively coupled plasma spectroscopy (ICP). The study showed that the air in the underground salt mine was free of pollutants present in the ambient air on the surface. Most of the components sucked into the mine by the ventilation system from the surface (regular dust, particulate matter, gaseous pollutants, biogenic particles, etc.) underwent quick and instantaneous sedimentation in the close vicinity of the air inlet to the mine. The dust settled in the mine interior primarily consisted of natural geogenic particles, locally derived from the weathering of the host rock (halite, anhydrite, and aluminosilicates). This was confirmed by low values of enrichment factors (EF) calculated for minor and trace elements. Only one site, due to the tourist railroad and the associated local intensive tourist traffic, represented the anthropogenic sources of elevated concentrations of ferruginous particles and accompanied metals (P, Cr, Mn, Co, Ni, Cu, As, Mo, Cd, Sn, Sb, Pb, and W). The gravitational deposition of pollutants from these sources limits the effects of the emissions to the local range. The used methodology and the results are universal and might also apply to other mines, caves, or underground installations used for museums, tourists, or speleotherapeutic purposes.

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-1β 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.