In this particular type of inhalation treatment, the particles of thermal water are larger than those of a traditional aerosol and are pushed directly into the nostrils under pressure. This abundant flow of particles of thermal water causes an immediate fluidification of the secretions in the nasal fossa and in the nasopharyngeal district.

To allow the cleaning of secretions also from the sinuses and from the middle ear, it is necessary to close the contralateral nostril with a finger and swallow frequently. The thermal water and secretions are made to flow through the mouth. The operation is repeated alternately through the two nostrils. This is an excellent treatment of sinusopathies and a gentle physiotherapy of the Eustachian tuba, useful to improve its elasticity and functionality. It is a type of treatment generally well tolerated by children, even younger ones, and very useful in middle ear pathologies in paediatric age.

• Duration

The duration gradually increases, from 6 minutes of the first day to 12 minutes.

It is performed once a day for a minimum cycle of 12 days.

Particularly indicated in all chronic catarrhal diseases of the nose and throat: rhinitis, rhinosinusitis, rhinopharyngitis. Useful in secretive otitis media (or medium with effusion) of the child and in chronic otosalpingitis of the adult.

The previous inhalations are often and usefully associated with a therapeutic bath in the thermal pool. Such therapeutic association appears useful in modifying the soil on which chronic diseases of the respiratory tree are established. The bath, through local and general mechanisms of action (transcutaneous absorption, vasomotor stimulus, vagal, adrenal), seems able to increase the body’s defence systems, enhancing the action of inhalational crenotherapy and extending its therapeutic effects over time.

• Indications

The extraordinary epidemiological increase in respiratory diseases and their distribution in extreme age groups brings the influence of exogenous factors in the air we breathe to be considered fundamental. Among chronic and obstructive respiratory diseases, there are the Chronic Obstructive Pulmonary Disease (COPD) and asthmatiform bronchitis which are the most disabling.

Worldwide, an estimated 328 million people are affected by COPD, a disease that is one of the leading causes of death. According to ISTAT data, the incidence of COPD in Italy appears to be on the rise. The main reasons for this are probably the growing ageing of the population and the increasing prevalence of external risk factors such as smoking and pollution.

As for asthma, the WHO reports that between 100 and 150 million people worldwide suffer from this condition. In Italy, about 3 million people (5% of the population) are affected by bronchial asthma.

Among the diseases considered social, both for the extent of their spread and for the ways in which they affect human activities, the pathologies of allergic and hyperallergic nature are becoming increasingly important.

The profound environmental changes, strongly altered both in the urban climate and in the environmental microclimate, and food, favor conditions of abnormal reactivity of the organism.

It is now established, in fact, that the action of the microclimate on asthmatic people and on the ones with bronchial hyperresponsiveness, is so important that it overcomes the genetic imprint in the development of the disease and its clinical evolution.

There are now many factors contributing to the development of these conditions: modern industrial activities have led to conditions of high air pollution; modern architectural technologies have greatly altered the residential microclimate in the parameters of temperature, humidity, micro-particles in the air (air conditioners, insulation materials, plywood, acrylic paints, etc.).

In general, man breathes 10 - 20 thousand liters of air every day. The lung and nose act as filters to prevent all substances to enter. If bronchial hyperreactivity (B.I.) is one of the salient features, together with phlogistic edema and bronchospasm, of asthmatic syndrome, nasal hyperreactivity (I.N.) is the dominant pathogenic moment of nonspecific rhinitis syndrome, more properly understood as non-specific vasomotor rhinopathy.

The triggers of hyperreactivity are predominantly exogenous (chemical, physical, allergenic and inhalant) and may be a precursor to disease. This may be located in the nose or bronchi, after an inflammatory injury of the respiratory mucosa has been determined.

Such mucosal damage may be temporary and resolve after the acute episode, or evolve into chronicity.

This results in a symptomatology that depends only on the effector organ: while rhinitis is manifested by increased secretion and nasal obstruction resulting from the alteration of the micro vascularization that dominates the anatomical structure, in asthma the spasm of the smooth bronchial muscle is determined and acts as an effector organ. The primus movens is represented by the epithelial response to the environment and inhalants that in the normal subject is devoid of reaction, whereas in hyperreactivity it leads to an enhancement of the effector organ. This unambiguous interpretation gives reason to the similar results obtained in the research on the themes of vasomotor rhinopathy and allergic asthma, where the pathogenic mechanisms coincide until the time when the participation of the effector body takes place. The mechanisms then diverge because different structures are involved.

In common language, a hyperreactive subject is defined as one who reacts in an exaggerated or abnormal way to a stimulus of not excessive magnitude or severity. We can define hyperreactivity as that clinical condition in which the organ reacts abnormally or overtly to external stimuli otherwise harmless or well controlled. These stimuli may be of a physical nature (wet or cold air, wind, etc.), chemical (chemical vapours, irritant gases, etc.), allergenic (pollen) or even physiological or psychic.

Many of these airway pathologies are affected favourably by inhalation treatment with thermal waters.

The success that can be achieved with inhalation crenotherapy is closely linked to both the correct identification of the forms of disease to be treated and its pathological expression, together with the precise indication of the thermal water to be used.

The water used in the Bibione Thermal Spa is a hyperthermal alkaline bicarbonate-sodium fluorinated mineral water.

• Mechanism of action

Considering the biocinetic activities of mineral waters and the clinical effects on the respiratory system, the activities of interest that concern bicarbonated waters are:

1. Anticholinergic action, decongestant action, for closing the pre-capillary sphincters and opening of the artero-shuntsvenous, favouring the emptying of cavernous erectile tissue that characterizes the type of vascularization of the nasal mucosa
2. Inhibition of mastocyte degranulation and stimulation of ciliary mobility
3. Myorelaxant and sedative activity for direct action on nerve endings of the respiratory mucosa
4. The antispastic action leads to an improvement in lung ventilation with increased intracellular oxidation and peripheral vasodilation
5. The anion bicarbonate (HCO₃) is responsible for changes in the acidic environment of tissues in a logistic state, acting as a buffer system in equilibrium with carbonic acid (H₂CO₃), thus facilitating the resolution of the inflammatory process.
6. In addition to anti-inflammatory and decongestant activity, these waters possess mucolytic and fluidizing properties of secretions and bacteriostatic activity and promote the regeneration of damaged mucous epithelium

These characteristics underline the particular efficacy and indication of hyperthermal alkaline bicarbonate, sodium fluoride, thermal water of the Bibione Thermae in espiratory system pathologies of an allergic and hyperergic nature such as: allergic and non-allergic vasomotor rhinitis, chronic rhinitis, chronic rhinosinusitis, chronic catarrhal otitis, chronic catarrhal otosaplingitis, chronic pharyngitis, pharyngolaryngitis, chronic laryngitis, chronic rhinosinusitical syndrome, allergic and non-allergic bronchial asthma, chronic bronchopneumopathy accompanied by obstructive component and chronic bronchopneumopathy not accompanied by obstructive component, bronchicotic disease, pulmonary emphysema.

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