Our previous studies have shown that spa therapy can reduce subjective symptoms and improve ventilatory function in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to measure the effects of spa therapy on walking distance during the six-minute walk test in patients with COPD. Twenty-five COPD patients hospitalized for pulmonary rehabilitation at our hospital were included in this study. Twenty-two patients were male and 3 patients were female. Two patients had stage I, 9 patients had stage II, and 14 patients had stage III COPD, according to the Global Initiative for Chronic Obstructive Lung Disease. We offered complex spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution, and fango therapy) in all patients for 4 weeks. Ventilatory function, six-minute walk distance, oxygen saturation and Borg scale were measured. Vital capacity (VC) was significantly improved by spa therapy at 4 weeks (p<0.05). The values of forced vital capacity (FVC), forced expiratory volume in one second (FEV_1.0), forced expiratory flow after 75% of expired FVC (FEF₇₅), forced expiratory flow after 50% of expired FVC (FEF₅₀), forced expiratory flow after 25% of expired FVC (FEF₂₅), mean expiratory flow during the middle half of the FVC (FEF_25-75), residual volume (RV), functional residual capacity (FRC), peak expiratory flow (PEF) and diffusing capacity for carbon monoxide (DLco) showed a tendency to increase, however the increase in the 10 parameters was not significant. The values of six-minute walk distance before and after spa therapy were 288±106m and 323±114m, respectively (p<0.05). There was a significant decrease in values of maximum Borg Scale values (p<0.05). The values of minimum oxygen saturation and the values of oxygen saturation at rest slightly increased, but not significantly. The change of six-minute walk distance correlated with change of VC (r=0.545; p<0.05), with change of FVC (r=0.628; p<0.05), with change of FEV_1.0 (r=0.559; p<0.05), with change of FEF₅₀ (r=0.480; p<0.05), with change of minimum oxygen saturation (SpO₂) (r=0.554; p<0.05) and with change of SpO₂ at rest (r=0.445; p<0.05). We found that spa therapy induced improvements in ventilatory dysfunction and six-minute walk distance in patients with COPD. The results from this study reveal that spa therapy may improve disease control and exercise tolerance in patients with COPD.

Characteristics of low attenuation area (LAA) of the lungs on HRCT were studied in 132 patients with asthma, and long-term spa therapy on the LAA of the lungs was observed in 5 patients with asthma, whose me an %LAA was more than 30%.
1. The morphology of LAA of the lungs on HRCT observed in asthma was different from that in pulmonary emphysema. 2. The LAA of the lungs in asthma was closely related to residual volume (RV). 3. The mean %LAA value significantly decreased from 33.5% before spa therapy to 24.5% at 24 months after beginning of the therapy. CT number also significantly increased after long-term spa therapy. 4. %FEV1.0 value significantly improved from 52.1% before spa therapy to 72.1% at 24 months after spa therapy. The RV value also decreased by spa therapy, however, the decrease was not significant. These results suggest that LAA of the lungs in asthma is associated with hyperinflation, and the LAA of the lungs decreases after long-term spa therapy.

Clinical effects of spa therapy for patients with pulmonary emphysema (PE) were evaluated by observing changes in %LAA of the lung on HRCT, %RV, %FVC, %FEV 1.0, and %DLco values after the long-term therapy. The subjects in this study 16 patients with PE. The subjects were divided into two groups according to the extent of %LAA<-950 HU of the lung on HRCT: %LAA<50% (N=6) and 50%≤%LAA (N=8). 1. Spa therapy significantly improved %LAA (42.5% at the initial stage to 36.3% 24 months after spa therapy), %RV (202.1% to 156.1%) and %DLco 71.0% to 85.7%), but not %FVC and %FEV 1.0, in patients with PE of %LAA<50%, however, significant. Improvement of these parameters was not observed in patients without spa therapy. 2. Spa therapy did not improve the values of %LAA, %RV, and %DLco, as well as %FVC and %FEV 1.0, in patients with PE of 50%≤%LAA. These parameters tended to decrease in the patients of 50%≤%LAA. These results suggest that spa therapy improves %LAA and parameters related to pulmonary function when they are at early stage of PE, however, the therapy was not remarkably effective for these parameters when they were at advanced stage of PE.

Clinical studies have shown that Aggregatibacter actinomycetemcomitans(A.actinomycetemcomitans)is associated with aggressive periodontitis and can potentially trigger or exacerbate rheumatoid arthritis(RA).However,the mechanism is poorly understood.Here,we show that systemic infection with A.actinomycetemcomitans triggers the progression of arthritis in mice anti-collagen antibody-induced arthritis(CAIA)model following IL-1β secretion and cell infiltration in paws in a manner that is dependent on caspase-11-mediated inflammasome activation in macrophages.The administration of polymyxin B(PMB),chloroquine,and anti-CD11b antibody suppressed inflammasome activation in macrophages and arthritis in mice,suggesting that the recognition of lipopolysaccharide(LPS)in the cytosol after bacterial degradation by lysosomes and invasion via CD11b are needed to trigger arthritis following inflammasome activation in macrophages.These data reveal that the inhibition of caspase-11-mediated inflammasome activation potentiates aggravation of RA induced by infection with A.actinomycetemcomitans.This work highlights how RA can be progressed by inflammasome activation as a result of periodontitis-associated bacterial infection and discusses the mechanism of inflammasome activation in response to infection with A.actinomycetemcomitans.