Clinical effect and action of spa therapy on bronchial asthma were discussed in relation to the action mechanisms.
1. General spa therapy including swimming training in a hot spring pool, fango therapy and inhalation therapy with iodine salt solution was effective in patients with bronchial asthma.
2. The improvement of ventilatory function, especially in small airways was observed as direct action of spa therapy, accompanied with decrease in resistance of the airways and bronchial hypersensitivity. The function of adrenocortical glands and cardiovascular system was also improved or enhanced by indirect action of spa therapy.
3. Spa therapy was more effective and more valuable in cases with steroid-dependent intractable asthma, cases with Ib. bronchoconstriction+hypersecretion type and II. bronchiolar obstrction type and cases over 41 years of age.
4. Clinical effects of spa therapy on bronchial asthma was also found for longer than one year as distant effect, which was more predominant in cases with maintenance therapy.

In recent years, the number of patients with respiratory disease has been increasing. In this study, pathophysiological characteristics of asthma in the elderly were discussed in relation to the action mechanisms and the clinical efficacy of spa therapy. In the action mechanisms of spa therapy for asthma, improvements of subjective and objective symptoms and ventilatory function, decrease in airway resistance, improvement of hyperinflation of the lung, and suppression of hypersecretion were observed in direct action of the therapy. Furthermore, improvement of depressed function of adrenocortical glands, psychological relaxation, and antioxidant action (increase in SOD activity) were found in indirect action of the therapy.
Characteristics of asthma in the elderly was expressed as weak allergic reaction, decrease in ventilatory function, DLco and bronchial hyperresponsiveness, increase in residual volume accompanied by weak bronchoconstriction, and suppressed function of adrenocortical glands, which are beneficial for clinical efficacy of spa therapy. Thus, spa therapy is more effective in elderly patients than in younger patients.

Spa therapy which has been performed for patients with respiratory disease, particularly for those with asthma and pulmonary emphysema for last 22 years, demonstrates that spa therapy is effective for asthma and pulmonary emphysema. The characteristics of patients with respiratory disease has been changing during last 22 years.
The frequency and number of elderly patients with asthma, and the number of those with pulmonary emphysema has been increasing in recent years. Elderly patients with asthma and COPD including pulmonary emphysema show the narrowing of airways by mucus, and hyperinflation of the lungs as results of aging. At present time any physicians have no medication improving hyperinflation of the lungs. In the present study, evaluation of hyperinflation of the lungs by a band display procedure on HRCT and the effects of spa therapy on the hyperinflation were discussed in patients with asthma and COPD. The results show that spa therapy is important for the treatment of elderly patients with asthma and COPD, because the therapy can improve hyperinflation of the lungs without adverse side effects.

Examinations to some extent were made on yearly transitions of 52 patients with bronchial asthma who were hospitalized in Misasa Medical Branch, Okayama University Medical School and received spa therapy during the five years from 1982 to 1986.
1) In the first two years (1982 to 1983), we had many patients from Okayama Prefecture. The majority of them had suffered from severe asthma attacks. They included a higher rate of cases of dependency on steroid-therapy as compared to those patients in the last three years (1984 to 1986). Some cases exhibited a remarkable airways obstruction in spite of high dosage of steroid hormone.
2) From 1984 to 1986, the patients with bronchial asthma from Tottori Prefecture increased. Their involvements were less severe with a lower dependency on steroid-therapy as compared to those hospitalized during the first two years.
3) Terms of hospitalization were generally reduced in the last two years as compared to the preceding three years. The average term was about two months from 1985 to 1986.
4) No difference in clinical symptoms based on the patient's age, age at onset, or asthma types was found between the first two years and the last three years.