Effects of long-term spa therapy on reduction of the costs of drugs used for the treatment were examined in 23 patients with asthma. The costs of drugs used per patient for 1 year when spa therapy started (1997) were compared with the costs used for 1 year after spa therapy for 3 years (2000). 1. The decrease in the total costs of all drugs was \31, 910 in patients with stage 1, \74, 900 in those with stage 2, \113, 450 in stage 3, and \180, 910 in stage 4. The % decrease of the costs of drugs used was 34.2% in stage 1, 46.3% in stage 2, 37.1% in stage 3, and 42.4% in stage 4. The results showed that the reduction in the costs of drugs tended to increase as asthma severity increased, and that the % decrease of the costs was higher in stage 2 and 4, in which the %decrease was more than 40%. 2. The reduction of costs of each drug, bronchodilators, glucocorticoids, antiallergic agents, mucolytics, and antibiotics after spa therapy, was significant in patients with stage 3 and stage 4, whose severity was considerably increased. However, the decrease in the costs of these drugs after spa therapy was not significant in patients with stage 1 and 2. The reduction of the costs more than 50% was observed in bronchodilators, antiallergic agents, mucolytics, and antibiotics in patients with stage 4, in whom the reduction of the costs of these drugs was significant. The results obtained here suggest that the costs of drugs used for asthma treatment could be reduced by spa therapy in patients with more increased severity.

Recently, we have also reported that spa therapy combined with dietary supplementation of perilla seed oil would be effective for patients, and would suppress the generation of leukotriene C4 (LTC4) by peripheral leucocytes. However, it is still unclear how the combination spa therapy and dietary supplementation of perilla seed oil influences on the pathophysiology of bronchial asthma. In the present study, the effects of spa therapy combined with dietary supplementation of perilla seed oil were examined in patients with asthma in relation to the serum eosinophil cationic protein (ECP) levels to investigate the effect on bronchial asthma. Ten adult asthmatic patients with moderate type asthma in terms of severity were taken to have a complex spa therapy and consume perilla seed oil-rich diet for 4 weeks. The generation of LTC4 by peripheral leucocytes, serum ECP level and pulmonary function were measured. Significant decreases were observed for LTC4 and ECP for 4 weeks. Forced vital capacity (FVC), which was one of the pulmonary function tests, improved significantly at 4 weeks (p<0.05). The number of eosinophils decreased for 4 weeks, but the differences were not significant. The results obtained here suggest that spa therapy combined with dietary supplementation of perilla seed oil leads to decrease in LTC4 and ECP and improves pulmonary function and asthma control.

Purpose: We examined the effects of foot baths containing artificial carbon dioxide (CO₂) on peripheral circulation. Our goal was to obtain quantitative results bearing on the treatment and preservation of refractory leg ulcers and gangrene, which would occur in arteriosclerosis obliterans (ASO) and diabetic peripheral circulation disorders.
Procedures: The lower legs of six healthy volunteers were placed for 10min into a 42°C bath of 10l in which 45g of artificial CO₂ “BUB” was dissolved. A laser Doppler blood-flowmeter was firmly attached. The measurements of blood flow were taken before, during, and 5, 15, 25, and 35min after each subject took a foot bath. Next, in order to examine the effects of peripheral blood flow on the whole body during the foot baths, each laser Doppler blood-flowmeters was attached on the subject's right arm, 10cm above the wrist joint.
Results: The blood flow increased during the foot bath and decreased after the bath was removed; during in a 10min bath, the flow was 264±135 (%) (p<0.05) of the flow before the feet were placed into the bath. 5min after the bath was removed, the flow was 256±174 (%) of the original pre-bath rate. 15min later it was 146±60 (%), 25min later it was 112±23 (%), and 35min later it was 107±24 (%), as low as the flow before the feet were placed in the bath. The arm blood flow also increased during the foot bath and decreased after the bath was removed. During a 10min bath, the flow was 119±49 (%) of the rate before the feet were placed in the bath. 5min after the bath was removed, the flow was 120±66 (%) of the original pre-bath rate. 15min later it was 113±28 (%), 25min later it was 109±16 (%), and 35min later it was 95±14 (%), essentially the same as the flow before the feet were placed in the bath.
Discussion: Our work demonstrates an increase in blood flow, by 2.6X, by using a foot bath containing artificial CO₂. The increase was maintained for 5min after removed of the foot from the bath. However, the blood flow decreased 15min after the baths were removed. We hope that this simple and effective foot bath will be used both at home and elderly care service stations. Its use could see prevention from refractory leg ulcers or gangrene, particularly as average life span continues to increase in Japan.

The effects of long-term spa therapy were studied in 10 patients with pulmonary emphysema: five patients had long-term spa therapy for 5 years (group A), and another 5 patients had not spa therapy for the same 5 years (group B). There were no significant differences in %FVC, %FEV 1.0, %LAA of the lung on HRCT, %DLco and %RV between the two groups. 1. The LAA of the lung on HRCT slightly, but did not significantly increase in patients with spa therapy for 5 years. In patients without spa therapy, the %LAA of the lung significantly increased after 4-(61.1%) (p<0.01) and 5-year observation (65.5%) (p<0.001) compared with the initial value (52.2%). 2. The %DLco and %RV values slightly decreased in patients with spa therapy, but the decrease in the two parameters was not significant. 3. The %DLco significantly decreased (67.2% to 49.0%), and the %RV also significantly increased (175.4% to 230.6%) after 5-year observation in patients without spa therapy. The results obtained here suggest that spa therapy for pulmonary emphysema should start as early as possible when the diagnosis of the disease is decided, and the therapy should be continued as long as possible.

Effects of spa therapy on % low attenuation area (LAA)<-950 HU of the lungs on HRCT at full inspiration, CT number, a ratio of expiratory LAA to inspiratory LAA (exp LAA/ins LAA), residual volume (RV) and diffusing capacity for carbon monoxide (DLco) in asthma were compared between never-smokers and ex-smokers of asthmatics.
1. The % LAA of the lungs on HRCT in asthma significantly decreased after spa therapy both in never-smokers and ex-smokers of asthmatics. CT number also significantly increased in the two groups. 2. The exp LAA/ins LAA significantly decreased after spa therapy in never-smokers, but not in ex-smokers. 3. The %RV also significantly decreased by spa therapy in never-smokers, but not in ex-smokers. 4. The DLco value did not significantly change by spa therapy both in nevers-mokers and ex-smokers. 5. The values of %FVC and %FEV 1.0 tended to increased in the two groups, but the increase was not significant. The value of FEV 1.0% significantly increased after spa therapy in never-smokers, but not in ex-smokers. The results suggest that hyperinflation and destruction of terminal airspaces are stronger in ex-smokers than in never-smokers, and that spa therapy is more effective in never-smokers than in ex-smokers.

The effects of spa therapy for asthmatics with a long history of cigarette smoking were studied, compared with the effects for those without smoking history. 1. Of 22 patients with smoking history, 15 (68.2%) had definite efficacy of spa therapy (4 had marked efficacy, and 11 had moderate efficacy), and the residual 7 had slight or no efficacy. In contrast, of 36 patients without smoking history, 29 (80.6%) had definite efficacy. The effects of spa therapy for asthmatics were significantly higher in never-smokers than in ex-smokers.
2. A significant increase in the production of IgE antibodies, bronchial hyperresponsiveness and the generation of leukotrienes B₄ (LTB₄) and C₄ (LTC₄) by leucocytes was observed in ex-smokers compared with never-smokers. 3. The frequency of patients with a positive BAST against inhalant allergens was larger in subjects with slight or no efficacy than in those with marked or moderate efficacy in never-smokers, but not in ex-smokers. 4. Bronchial hyperresponsiveness was significantly increased in patients with slight or no efficacy than in those with marked or moderate efficacy both in ex-smokers and never-smoker. 5. The generation of LTB₄ was more increased in subjects with slight or no efficacy than in those with efficacy both in ex-smokers and never-smokers, however, the differences were not significant. 5. The generation of LTC₄ tended to be more increased in subjects with slight or no efficacy than in those with efficacy in never-smokers, but not in ex-smokers, although these were not significant. The results suggest that an increase in the production of IgE antibodies, bronchial hyperresponsiveness, and the generation of LTB₄ and LTC₄, which might be influenced by cigarette smoking, affect the effects of spa therapy for patients with asthma.