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JOURNAL OF AEROSOL MEDICINE
Volume 8, Number 3, 1995
Mary Ann Licbert, Inc.
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HALOTHERAPY FOR TREATMENT
OF RESPIRATORY DISEASES
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ALINA V. CHERVINSKAYA and NORA A. ZILBER
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Saint-Petersburg Pavlov
National Medical University, Russia
Joint- Stock Company Aero med, Saint-Petersburg, Russia
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This work elucidates the questions upon
the development of a new drug-free method for respiratory diseases
treatment. Halotherapy (HT) - is a mode of treatments in a controlled
air medium which simulates a natural salt cave microclimate. The
main curative factor is the dry sodium chloride aerosol with particles
of 2 to 5 mkm in size. Particles density (0.5-9 mg/m³) varies
with the type of the disease. Other factors are: comfortable temperature,
humidity regime, the hypo bacterial and allergen- free air environment
saturated with the aerosol.
The effect of HT was evaluated in 124 patients (pts) with various
types of respiratory diseases. The control group of 15 pts received
placebo. HT course consisted of 10-20 daily procedures of 1 hour.
HT resulted in improvements of clinical state in the most of the
patients. The positive dynamics of flow-volume loop parameters and
decrease of bronchial resistance measured by bodyplethysmography
were observed. The changes in the control group parameters after
HT were not statistically significant. The specificity of this method
is the low concentration and gradual administration of dry sodium
chloride aerosol. Data on healing mechanisms of a specific air dispersive
environment of sodium chloride while treating the respiratory diseases
are discussed.
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The considerable increase of allergic diseases
and reactions and of other serious complications due to the drug
therapy explains the interest of clinicians to the development of
drug-free methods of treatment. Halotherapy ("halos" in
Greek means salt) is one of such methods. Halotherapy (HT) is a
mode of treatments in a controlled air medium which simulates a
natural salt cave microclimate.
The treatment in the natural salt caves (Speleotherapy) has been
known since long. The efficacy of Speleotherapy is associated with
the unique cave microclimate. The natural dry sodium chloride aerosol
is the major curative factor of the cave microclimate. It is formed
by the convective diffusion from salt walls. Other factors such
as comfortable temperature and humidity regime, the hypo bacterial
and allergen-free air environment saturated with aero ions enhance
the therapeutic effect.
A suggestion that it is the air saturated with saline dust that
causes the main curative effect in the Speleotherapy of patients
with respiratory diseases was first formulated by a Polish physician
F.Bochkowsky in 1843. Salt mines are known to be used for therapeutic
purposes in other countries such as Austria (Solzbad-Salzetnan),
Rumania (Sieged), Poland (Wieliczka), Azerbaijan (Nakhichevan),
Kirgizia (Chon-Tous), Russia (Berezniki, Perm region), the Ukraine
(Solotvino, Carpathians), Artiomovsk, Donietsk region).
Speleotherapy has been recognized as a highly effective drug-free
treatment method. Great experience in the treatment of patients
with various forms of chronic nonspecific pulmonary diseases has
proved Speleotherapy to be very effective under the conditions of
the salt mine microclimate of Solotvino. The therapeutic effect
has been proved by the data of biochemical immunological and microbiological
research (Simyonka 1989, Slivko, 1980, Yefimova et al, 1990, Zadorozhnaya
et al, 1986). It is assumed that during the treatment the organism
adapts to the specific features of the microclimate and alters all
its functional systems.
However, adaptation of the patients who came from different climate
areas, travel and transport problems, and limited number of beds
kept back its wide spreading. So HT has been worked out.
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DESCRIPTION OF HALOTHERAPY
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HT is performed in a special room with salt coated walls -Halochamber.
Dry sodium chloride aerosol (DSCA) containing the dominating amount
of 2 to 5 mkm particles (Table I) is produced by a special nebulizer.
TABLE I
Fractions of dry sodium chloride aerosol in Halochamber (According
to the data of optical devices)
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Size of particles, mkm
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Fractions, %
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1-2
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35.4 ± 2.1
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2-5
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61.8 ± 3.3
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5-10
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2.8 ± 0.4
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>10
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0.003
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TABLE 2
Composition criteria requirements for salt to be used in halotherapy.
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Chemical composition of salt
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% ( mass)
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Chemical composition of salt
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% ( mass)
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Na, not less than
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97.70
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Fe2O3, not more than
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0.01
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Ca-ion, not more than
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0.50
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Na2SO4
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0.50
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Mg-ion, not more than
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0.10
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Water insoluble sediment, not more than
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0.45
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SO4 - ion, not more than
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1.20
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Moisture in rock-salt, not more than
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0.25
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K-ion, not more than
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0.10
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pH of NaCL solution
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6.5-8.0
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The constant level of desirable aerosol mass concentration in the
range of 0.5-9 mg/m³ is maintained automatically. Composition
of the salt used for HT is shown in the Table 2 (The Russian State
Standard is 13830 - 4). The temperature of 18-22 C and
45-55% humidity of the medium are maintained by air conditioning
system and heating devices. The HT process and microclimate parameters
are controlled with the help of computer.
The treatment in Halochamber is conducted daily, the duration of
the procedure is 1.0 hour, and the length of the course is
12-25 days. The duration of each course and parameters of aerosol
medium depend on nosology, clinical features, phase of the disease,
etc and are prescribed by the physician (Table 3). The duration
of the course and the DSCA concentration may be changed during the
period of treatments in accordance with the requirements of the
changing state of the patient.
The patients breathe quietly while reclining in the special armchairs.
Therapy is accompanied by musical psycho suggestive program and
demonstration of slides, HT is carried out either alone or in association
with the base medication and other methods of treatment.
TABLE 3
Concentrations of dry sodium chloride aerosol and duration of halotherapy.
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Disorders
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Specificity
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FEV1 (% Pr.)
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Concentration (mg/m³)
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HT duration (days)
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Bronchial asthma
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Allergic
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-
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0.5-1
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12-14
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Infection
dependent
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<60
>60
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0.5-1
1-2
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18-21
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Chronic obstructive bronchitis
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-
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<60
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0.5-1
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18-21
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Chronic nonobstructive bronchitis
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-
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-
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3-5
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18-21
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Bronchiectasis
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-
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<60
>60
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1-2
7-9
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21-25
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Cystic fibrosis
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-
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3-5
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21-25
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MATERIAL AND METHODS
HT was administrated in a group of 124 patients
(54 males and 70 females) aged from 16 to 62 years (mean age 34.3
+ 2.5 years) with various types of chronic nonspecific pulmonary
diseases (Table 4). In all of the patients (pts), the disease was
in the stage of a prolonged exacerbation. Before the treatments
95% of the pts of the main group had been coughing, half of them
(47%) had severe attacks of coughing with scanty viscous sputum.
Most of the pts (81%) suffered from attacks of asthma so that one
third of them used combined medication to control it. Auscultation
revealed harsh and weakened breathing, and dry rales in 58% of the
patients.
60% of the pts received a base therapy (beta-agonists, theophyllines,
chromoglycate natrii, corticosteroids, etc.), the effect of which
was insufficient and did not allow to achieve a complete remission.
The pts had not taken any antibacterial medicine.
The control group was represented by 15 pts (7 females and 8 males)
aged from 18 to 56 years (mean age 38.4+1.5 years). Placebo course
consisted only of 10 procedures of musical psychosuggestive program
with slides demonstration in an ordinary room.
The pts' condition was assessed by daily medical supervision, with
functional and laboratory tests made before and after HT, as well
as every 7th day during the treatments. Series of examinations in
the control group consisted of the tests similar to those for the
main group of pts.
TABLE 4
The patients studied
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Disease
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Number of patients
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Bronchial asthma
Mild
Moderate
Severe
Chronic bronchitis
Nonobstructive
Obstructive
Bronchiectasis
Cystic fibrosis
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87
32
34
21
26
12
14
6
5
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Total
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124
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Standard method of flow-volume loop was registered by "Pneumoscreen"
("Jager", Germany).The following parameters were assessed:
vital capacity (VC), forced VC (FVC), forced expiratory volume of
the 1st sec FEV1), peak expiratory flow (PEF), forced expiratory
flow at 5O% FVC (FEF50). The character and the extent of bronchial
patency impairment were estimated according to predicted values
and limits of norm and its deviation (Klement et al, 1986).
Dynamics of the indices were assessed from differences in their
absolute meaning before and after therapy and were expressed in
% or the initial value. Individual assessment of the results was
achieved by comparing changes in the parameters and their variability.
Inhalation bronchospasmolytic test with 0.4 mg of Berotec was carried
out in 56 patients before and after therapy (Melnikowa & Zilber,
1990). When the test was positive, the obstructions was considered
to be reversible i.e., bronchospastic component was significant
in the genesis of obstruction. Airway resistance (Raw) and intrathoracic
gas volume (ITGV) were measured by "Bodyscreen" ("Jager",
Germany). Total lung capacity (TLC), residual volume (RV) and their
ratio (RV/TLC) were calculated on the base of spirography and bodyplethysmography
data. Raw analysis was carried out in absolute values, whereas other
parameters were given in predicted values ( Kristufec et al, 1979).
Diffusion capacity of the lungs by steady state method (DLss) was
measured by "Transfersacen" in absolute values and as
% of predicted values (Pivotean & Dechouret et al, 1968).
Standard methods of variation statistics were used for group analysis
of the material, students' test being used for significant differences
in independent and correlated samples.
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Clinical studies
After 3-5 sessions of HT 70-80% of the pts (according to nosology)
presented some improvements: expectoration of good amount of sputum-
it was less tenacious and easier to discharge, better auscultator
pattern of the lungs, less frequent occurrence of cough attacks
or respiratory discomfort. Some pts with severe and moderate bronchial
asthma (BA) (35 patients - 27% of the total number) experienced
difficulty in brining up the phlegm and worsening of cough during
3-4 days after 3-4 sessions. These manifestations seem to be due
to the temporal bad bronchial drainage resulting from hyper secretion
of mucus and discharge of old clots of secretion from bronchi of
smaller diameter. Expiratory dyspnea appeared or became more pronounced
in 18 patients (15% or cases) at different periods of HT. Those
were mainly the patients with exercise-induced asthma and aspirin-induced
asthma. None of the pts complained of bad condition during the HT
procedures.
By the end of the course of HT all the pts felt better they slept
well, had no fatigue or weakness, and their nervous system stabilized.
Clinical symptoms analysis demonstrated that the number of asthma
attacks and respiratory discomfort cases decreased significantly
as compared to the initial ones (81% and 52%, respectively, p<0.001).
The number of asthma attacks controlled by combined medication also
decreased (32% and 2%, respectively, p<0.001).
The cases of cough occurred more rarely (95% and 70%, respectively,
p<0.001), cough became easier and more productive, the amount
of sputum reduced, it became mucousal. The number of the patients
with signs of vasomotor rhinitis decreased (61% and 24%, respectively
p<0.001).
Corticosteroids were discontinued in 50 % (11 pts) of the pts with
corticosteroid therapy (22 pts). Those were the cases when inhaled
corticosteroids were prescribed as anti-inflammatory agents. In
7 pts it was possible to reduce the dose, 41 pts (60% of pts who
inhaled beta- agonists) were able to discontinue beta-agonists or
reduce the dose. Reduction (or cancellation) in bronchodilator and
inhaled corticosteroid consumption was an indicator of clinical
benefit.
The clinical state of 85% of the pts with mild and moderate BA,
75 % with severe BA, 98%- with chronic bronchitis, bronchiectasis
and cystic fibrosis improved after HT. The pts were examined 6 and
12 months after the first HT course. No aggravations of the disease
were seen from the 3d to the12th month. The average duration of
the remission was 7.6-0.9 m. Most of the pts (60%) used no medication
and sought no medical advice.
Lung function studies
Before HT bronchial obstruction was found in 83 pts (67% of all
cases), 1/3 of them (25 pts) had marked impairment. By the end of
the therapy bronchial obstruction was found in 50% of the pts but
the numbers of cases with marked impairment were diminished (16
pts) (Fig.1).
Direct effect of a HT procedure on bronchial potency was studied
in 12 pts. The difference between the average flow-volume loop parameters
in the group after 1 procedure was insignificant (p>0.05) when
compared to the initial values.
Individual analysis showed that 5 pts had a significant increase
of the parameters, a decrease was seen in 4 pts and in 3 cases there
were no changes. On the basis of these data it is impossible to
estimate the real action of DSCA on bronchial patency.
The patients showed significant increase of FVC, FEV1, PEF, FEF50
by the 7th day, of FVC and FEF50 by the 14th day and of FVC, VC
and PEF by the end of HT (Table 5). There was no difference in the
extent of the parameter changes after the 7th day and by the end
of the treatment.
FIGURE I. Bronchial obstruction
before and after the halotherapy (number of patients - 124)
TABLE 5
Change of flow-volume loop parameters at various
terms of halotherapy (Mean ± SE)
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Parameter, % baseline
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Treatment
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7 days
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14 days
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End of course
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Number of cases
VC
FVC
FEV1
PEF
FEF 50
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115
0 ± 0.9
2 ± 0.9*
3 ± 1.2*
4 ± 1.4*
7 ± 1.5*
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98
2 ± 1.3
3 ±1.3*
3 ± 1.6
3 ± 1.9
7 ± 2.9*
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124
2 ± 0.9*
2 ± 1.0*
2 ± 1.3
3 ± 1.2*
2 ± 2.0
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*significant (p< 0.05, here and further)
changes vs initial values (paired t-test)
Findings of bodyplethysmography and diffusion capacity of the
lungs are given in Table 6. After the HT there was a significant
decrease in Raw and RV/TLC, other parameters changes were insignificant.
To know whether the initial extent of obstruction had any effect
on the dynamics of bronchial patency during HT all pts were divided
into four groups according to the extent of obstruction (Table7).
Group I included patients with normal indices of forced expiration
(FEF 50>62%Pr.); group II - with mild impairment of bronchial
patency (FEF50 <51%Pr.); group III - with moderate (FEF50<31%Pr.),
and group IV - with severe obstruction (FEF50<22%Pr.)
TABLE 6
Bodyplethysmography and diffusion capacity of lung before and
after halotherapy (M ± SE), number of patients-85.
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Parameter, (% baseline)
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Treatment
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before
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after
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VC
ITGV
RV
TLC
RV/TLC
Raw*
DLss
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99 ± 3
141 ± 4
156 ± 6
111 ± 2
142 ± 5
0.37 ± 0.04
83 ± 7
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102 ± 3
133 ± 5
139 ± 7
109 ± 3
126 ± 6*
0.28 ± 0.02*
79 ± 4
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x in kPa/l/s
* significant differences as compared to "before"
TABLE 7
Dynamics of bronchial obstruction indices at the
end of halotherapy as compared
to the initial extent of obstruction (M ± SE).
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Parameter,
(% baseline)
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Groups
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I
FEF 50 > 62%
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II
FEF 50 < 51%
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III
FEF 50 < 31%
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IV
FEF 50 < 22%
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Number of cases
VC
FVC
FEV1
PEF
FEF 50
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41
-1 ± 1.1
-1 ± 1.2
-3 ± 1.3
1 ± 1.6
-3 ± 2.9
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31
1 ± 1.3
0 ± 1.4
0 ± 1.9
-1 ± 1.9
-1 ± 3.7
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27
8 ± 2.5*
5 ± 2.9
7 ± 4.2 °
4 ± 4.2
22 ± 9.0*°
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25
14 ± 4.9 *° x
14 ± 4.9* °
25 ± 8.1* °
37 ± 10.2* °
33 ± 11.9* ° x
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* Significant changes as compared to the initial values
° significant difference from groups I and II
x significant difference from groups III.
At the end of HT the indices in groups I and II did nor differ
from the initial ones. In group III values of FEF 50 became significantly
higher and in group IV all indices significantly increased. The
extent of changes of group IV indices was significantly greater
than of groups I and II. Similar findings were obtained on the 7th
and 14th day of HT. Irrespectively of the therapy duration the greatest
dynamics in bronchial patency were found in group IV (severe obstruction),
not so marked one was in group III (moderate obstruction), and no
dynamics were seen in groups I and II (slight or no obstruction).
Relationship between the character of obstruction disorders and
the changes in indices during the course of therapy were studied.
According to the findings of broncholytic tests the pts were divided
into two groups: those with reversible and irreversible obstruction.
By the end of HT no significant differences as compared to the initial
parameters were found (p>0.05). Both in the presence of bronchospasm
and its absence the efficacy of HT on bronchial patency was the
same.
Control group
One-two days after beginning of the therapy many placebo pts (80%)
felt better and slept normally which seemed to be associated with
psychotherapeutic effects. However, no objective improvement in
their lung auscultation picture was noted. There were no significant
changes of flow-volume loop parameters as compared to initial values
after the course of placebo (VC- -3 ±5.0; FVC- -3 ±4.3;
FEV1- -3 ±3.4; PEF- -6 ±2.6;FEF 50 -2 ±3.8).
At the same time, 20% of pts with prevailing allergic mechanism
of the disease had positive dynamics of function values which was
probably associated with no exposure to allergens.
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DISCUSSION
The course of HT resulted in improvements
of clinical state in the most pts. In the overwhelming majority
of cases, the number and intensity of asthma attacks and respiratory
discomfort decreased or disappeared, which allowed, in a number
of cases, to cancel or reduce the dosage of beta-agonists. The most
pts showed positive dynamics of symptoms indicative of a better
drain function of their airways: sputum secretion alleviates, it
becomes less viscous, coughing relieves, and the auscultative picture
of the lungs alters. The difficulty in brining up the phlegm and
worsening of cough during 3-4 days seemed to be due to the temporal
bad bronchial drainage resulting from hypersecretion of mucus and
discharge of old clots of secretion from bronchi of smaller diameter.
The similar clinical results were obtained in other investigations.
Efficacy of this method has been noted in pts with various pathogenic
variants of BA, chronic bronchitis, acute bronchitis, bronchiectasis,
upper airways diseases, etc. (Alexandrov & Chervinskaya et al,
1994, Chervinskaya et al, 1993, 1994, Norvaishas et al, 1992, Pokhaznikova
et al, 1992, Telyatnikova et al, 1992, Tikhomirova et al, 1993).
In our investigation the improvement in the clinical state of pts
was accompanied by positive dynamics of the functional measurements.
HT gave significant improvement in bronchial patency which started
on the 7th day and persisted to the end of the course. There was
no direct bronchospasmolytic effect. The dynamics of bronchial patency
depended upon the initial extent of obstruction: the more marked
was the bronchial obstruction, the better were the results of HT.
The effect depended not upon the character of obstruction (reversible
or irreversible).
Thus, clinical functional results suggest, that HT has gradual positive
influence on bronchial obstruction. With this mode of therapy which
is based on cumulative action, there should be series of procedures.
It seems to be associated with improvement of mucociliary clearance
and decrease of bronchial inflammation. The conception of antiinflammatory
influence is confirmed by the data of cytobacteriologic examinations
(Chervinskaya et al, 1994).
The evaluation of brush samples from nosopharynx mucosa in HT showed
that the average amount of neutrophils, macrophages and lymphocytes
have been diminished. The index of epitheliocyte infection with
pneumococci and that of adhesion the average number of pneumococci
per one affected epithelicyte decreased. These indices are indicative
of elimination in pathogenic microorganisms and of decrease in inflammatory
reaction of the mucosa. Other investigations demonstrated decrease
of the amount of neutrophils and pathogenic microorganisms and increase
of the amount of alveolar macrophages in bronchial secretion of
pts with BA, chronic obstructive bronchitis and cystic fibrosis
after HT (Voronina at al, 1994). Research testified of positive
effects of HT on the state of humoral and cellular immunity in patients
with BA (Spesivykh et al, 1990, Torokhtin et al, 1987); decrease
of IgE level was observed (Dityatkovskaya et al, 1993). Certainly,
the arguments of mucociliary clearance change of pts in HT are necessary.
HT is a type of aerosol therapy, which takes from Speleotherapy
the main acting factor. Curative effect of HT is caused by aerodispersed
environment saturated with dry sodium chloride aerosol with predominance
amount of particles of 2 to 5 mkm in size. Such particles can penetrate
deep into the smallest airways.
In our view, the positive effect of HT can be accounted for the
following. One of the pathogenetic mechanisms of obstructive pulmonary
diseases is mucociliary clearance impairment. Normal function of
mucociliary clearance depends on the amount and viscoelastic properties
of the airway surface liquid, together with the number and function
of the cilia. Aerosol of sodium chloride initiates the fluid release
into the bronchial lumen, and influences the viscoelastic properties
of the bronchial secretion by changing the conformation of protein
molecules and releasing water into the outer layers of the clots
which promotes evacuation of bronchial sputum (Clarke et al, 1979,
Pavia et al, 1978, Wurtemberger et al, 1987). In addition, sodium
chloride is the main component of the airway surface liquid, the
mucus layer and the periciliary fluid, it is needed for normal functioning
of bronchial ciliary epithelium (Wetch M.J., 1987). According to
the evidence of certain authors, the amount of sodium chloride in
bronchial secretions in patients with chronic pulmonary pathology
is lower (Brogan et al, 1971). It is possible, that inhalation of
this chemical compound compensates for its deficit in the lungs
and improves the ciliary epithelium drainage function.
Sodium chloride aerosol causes bactericidal and bacteriostatic effects
on the respiratory airways microflora and prevents the development
of inflammatory processes (Simyonka, 1989, Rein & Mandell, 1973).
The intensity of this action depends on the concentration of the
aerosol that causes dehydration of microbial cells and the impairment
of the albuminous structure of the cells killing the microorganisms.
Another mechanism is possible which causes adhesion of small particles
of salt to microbial bodies. As their mass grows, they precipitate
rapidly.
The experiments show that low doses of DSCA have a beneficial effect
on phagocytic activity of alveolar macrophages (Konovalov et al,
1992) and hence on bronchial clearance and elimination of foreign
agents.
Thus, sodium chloride aerosol improves rheological properties of
the bronchial contents, decreases edema of bronchial mucosa and
contributes to functioning of cilia epithelium, it has a bactericidal
action, enhances functioning of alveolar macrophages.
The study of aerodisperse environments of halochamber allowed to
establish that the negative volumetric charge of dry aerosol particles
was considerable (6-I0 nK/m3) (Konovalov et at, 1990). Higher negative
charge of particles is of therapeutic significance as well (Afanasyev,
1990).
However, it is known, that sodium chloride aerosol is an osmolar
stimulus, and it can result in the airways hyperactivity (Schoeffel
et al, 1981). The specificity of HT is the low concentration and
gradual administration of DSCA. Salt consumption during the procedure
depends upon the regime chosen and is about 1-9 mg. In comparison:
sodium chloride aerosol inhalation challenge is used for diagnosing
hyperactivity of the airways. Hypotonic (less than 0.9%) or hypertonic
(2-5%) solutions of sodium chloride are usually employed. When the
inhalator production is 1 ml per minute, 20 mg of sodium chloride
(measured as a dry substance) gets into the airways during 1st min
of the challenge test with 2% solution and the amount reaches 50
mg in case of 5% solution. Compare: during a minute session of HT
0.05- 0.10 mg of dry sodium chloride penetrates into the patient's
airways when the concentration in the Halochamber is 5 mg/m3. Sodium
chloride aerosol in low concentration does not affect the airway
mucosa thus preventing any side effects. Besides, using of dry aerosol
permits to achieve the suitable humidity of environment and to avoid
the adverse reactions of airways, associated with humidification
(Linker, 1982)
In summary, theoretical prerequisites and the data of clinical functional
studies obtained allow to suggest that the efficacy of HT results
from the combination of the curative properties of sodium chloride
aerosol and the way of its administration. At the same time HT mechanisms
of influence are not yet studied well enough, and this fact requires
continuation of the research.
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LINKER E.S. (1982). Asthma is a disease. A new theory of pathogenesis.
Chest 82 (3), 263-264.
MELNIKOWA E.A, ZILBER N.A. (1990). Criteria for the assessment the
inhalation broncholytic test with Berotec. In New medical technologies
of' preventing and ireating the respiratory diseases. Leningrad,
p.l33-139 (Russ).
NORVAISHAS A., NORVAISHAS G., DUBINSKAYA A., KONOVALOV S.I., LOZINSKY
I. (1992). Halotherapy in endogenous bronchial asthma. In The 3rd
National Congress of Respiratory Diseases. St.-Petersburg, abstr.
818.(Russ).
PAVIA D., THOMSON M, L., CLARKE S.W.(1978). Enhanced clearance of
secretion from the human lung after the administration of hypertonic
saline aerosol. Am.Rev.Resp.Dis. 117(2), 199-204.
POKHAZNlKOVA M.A., RORISENKO L.V., DUBINSKAYA A.V., STEPANOVA N.G.
(1992). Halotherapy in rehabilitation of patients with acute bronchitis
of lingering and relapsing type. In The 3rd National Congress on
Respiratory Diseases. St .Petersburg. abstr. 8l9 (Russ)
REIN M.F., MANDELL G.Z. (1973).Bacterial killing by bacteriostatic
saline solutions:
Potential for diagnostic error. New Eng.J.Med. 289(15), 794-795
SCHOEFFEL R.E., ANDERSON S.D., ALTOUNYAN R.E. (1981).
Bronchial hyperactivity in response to inhalation of ultrasonically
nebulised solutions of distilled water and saline. Br.Med.J. 283(14),
1285-1287.
SIMYONKA Y-M. (1989).
Some particular features of infections and inflammatory processes,
and immune status in patients with infection-dependent bronchial
asthma during speleotherapy in salt-mine microclimate. In Bronchial
asthma. Leningrad, p.136-140.(Russ).
SLIVKO R.Y. (1980). Dynamics or blood serum histaminopexy levels
in patients with bronchial asthma after treatment in salt mines.
Immunology and allergology. 14, 22-25.
(Russ).
SPESIVYKH I.A., MALTSEVA O.B., KAZANKEVICH V.P., TOROKHTIN A.M.
(1990).
Particularities in the treatment of old age group patients with
bronchial asthma in "Ionotron" artificial microclimate.
In Geriatric aspects of clinical pulmonology.
Leningrad, p. 141-14i (Russ)
TELYATNIKOVA G.V., GULEVA L.I. IVANOVA S.A., SlDORENKO T.G.
ALABUZHEVA M.L. (1992). Efficacy of halotherapy in practical public
health. In Clinical- epidemiologlcal problems and prevention of
nonspecific pulmonary diseases. St-
Petersburg, p. 121-l25(Russ).
TIHOMIROVA K.S., ALIYEVA I.Z., TCHALAYA E.N.. (1993). Halotherapy
as a component of spa treatment of children with bronchial asthma.
Problems of spa
treatment, physiotherapy and exercise therapy 4, 10-I 2. (Russ.).
TOROKHTIN M.D. MALLTSEVA O.B., SPESIVYKH I.A (1987). Alterations
of cellular indices of immunity in patient with bronchial asthma
exposed to chamber artificial
microclimate. In Immunology and allergology, issue 21. Kiev, p.
5-7.(Russ).
VORONINA L.M., CHERNIAEV A.L., SAMSONOVA M.V., DOUBINSKAYA A.V.
(1994). Cytobacteriologic estimation of bronchial secretion in halotherapy.
In The 4th. National Congress on Respiratory Diseases. Moscow, abstr.
166. (Russ).
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Vestn Otorinolaringol. 2003;(4):42-4.
[Halotherapy in combined non-puncture therapy
of patients with acute purulent maxillary sinusitis]
[Article in Russian]
Grigor'eva NV.
Halotherapy was applied for non-puncture treatment
of 45 patients with acute purulent maxillary sinusitis. The response
was evaluated by changes in clinico-immunological, cytological,
x-ray and bacteriological parameters. Halotherapy was found effective
in the treatment of acute purulent maxillary sinusitis without
puncture.
PMID: 13677023 [PubMed - indexed for MEDLINE]
Vopr Kurortol Fizioter Lech Fiz Kult. 2001 Jan-Feb;(1):26-7.
[Efficacy of therapeutic use of ultrasound and
sinusoidal modulated currents combed with halotherapy in patient
with occupational toxic-dust bronchitis]
[Article in Russian]
Roslaia NA, Likhacheva EI, Shchekoldin PI.
Immunological and cardiorespiratory characteristics
were studied in 88 alloy industry workers with occupational toxic-dust
bronchitis who received the following therapy: sinusoidal modulated
currents (SMC), ultrasound (US) on the chest, halotherapy (HT)
(52 patients, group 1); SMC + HT (10 patients, group 2); US +
HT (15 patients, group 3); HT (11 patients, group 4). The patients
did also therapeutic exercise and were massaged (chest). It was
found that device physiotherapy (SMC, US) in combination with
HT raise the treatment efficacy to 86.5%. This combined treatment
is recommended both for treatment and prevention of obstructive
syndrome in toxic-dust bronchitis.
PMID: 11530404 [PubMed - indexed for MEDLINE]
Klin Med (Mosk). 2000;78(12):37-40.
[Effects of halotherapy on free radical oxidation
in patients with chronic bronchitis]
[Article in Russian]
Farkhutdinov UR, Abdrakhmanova LM, Farkhutdinov
RR.
Registration of luminol-dependent chemoluminescence
of blood cells and iron-induced chemoluminescence of the serum
was used to study generation of active oxygen forms and lipid
peroxidation in patients with chronic bronchitis (CB). 49 patients
with lingering CB showed inhibition of blood cell function and
enhancement of lipid peroxidation. The addition of halotherapy
to combined treatment of these patients promoted correction of
the disorders and improvement of CB course.
Publication Types:
" Clinical Trial
PMID: 11210350 [PubMed - indexed for MEDLINE]
Vopr Kurortol Fizioter Lech Fiz Kult. 2000 Nov-Dec;(6):21-4.
[Effectiveness of halotherapy of chronic bronchitis patients]
[Article in Russian]
Abdrakhmanova LM, Farkhutdinov UR, Farkhutdinov
RR.
The chemoluminescence test in 49 patients with lingering
inflammatory chronic bronchitis has revealed inhibition of generation
of active oxygen forms in the whole blood, intensification of
lipid peroxidation in the serum, depression of local immunity.
Administration of halotherapy to the above patients results in
correction of disturbances of free-radical oxidation, improves
local immunity and clinical course of the disease.
PMID: 11197648 [PubMed - indexed for MEDLINE]
Vopr Kurortol Fizioter Lech Fiz Kult. 2000 Jan-Feb;(1):21-4.
[The scientific validation and outlook for the practical use
of halo-aerosol therapy]
[Article in Russian]
Chervinskaia AV.
The paper describes a new medical technique--halo-aerosol
therapy, the main acting factor of which is dry highly dispersed
aerosol of sodium chloride in natural concentration. Halo-aerosol
therapy represents a new trend in aerosol medicine. It includes
two methods: halotherapy and halo-inhalation. Biophysical and
pathophysiological foundations of the new method, how it can be
realized are outlined. Clinical reasons are provided for application
of halo-aerosol therapy for prevention, treatment and rehabilitation
of patients with respiratory diseases. Characteristics and differences
of the two halo-aerosol therapy variants are analysed.
Publication Types:
" Review
PMID: 11094875 [PubMed - indexed for MEDLINE]
Voen Med Zh. 1999 Jun;320(6):34-7, 96.
[Halotherapy in the combined treatment of chronic bronchitis
patients]
[Article in Russian]
Maev EZ, Vinogradov NV.
Halotherapy proved to be a highly effective method
in a complex sanatorium treatment of patients with chronic bronchitis.
Its use promotes more rapid liquidation of clinical manifestations
of disease, improves indices of vent function of lungs, especially
those values that characterize bronchial conduction (volume of
forced exhalations per second, index Tiffno), increases tolerance
to physical load, normalizes indices of reduced immunity and leads
to increasing the effectiveness of patient treatment in sanatorium.
PMID: 10439712 [PubMed - indexed for MEDLINE]
Vopr Kurortol Fizioter Lech Fiz Kult. 1997 Jul-Aug;(4):19-21.
[The use of an artificial microclimate chamber in the treatment
of patients with chronic obstructive lung diseases]
[Article in Russian]
Chernenkov RA, Chernenkova EA, Zhukov GV.
Halotherapy was used for sanatorium rehabilitation
in 29 patients with chronic obstructive pulmonary diseases (chronic
bronchitis and asthma). Significant positive effects of this method
resulted in the improvement of the flow-volume parameters curve
of lung function and in hypotensive effects on blood pressure.
Halotherapy is recommended for use in patients suffering from
chronic obstructive pulmonary diseases with hypertension or coronary
heart disease.
PMID: 9424823 [PubMed - indexed for MEDLINE]
J Aerosol Med. 1995 Fall;8(3):221-32.
Halotherapy for treatment of respiratory diseases.
Chervinskaya AV, Zilber NA.
Saint-Petersburg Pavlov National Medical University,
Russia.
This work elucidates the questions upon the development
of a new drug-free method of a respiratory diseases treatment.
Halotherapy (HT)--is mode of treatment in a controlled air medium
which simulates a natural salt cave microclimate. The main curative
factor is dry sodium chloride aerosol with particles of 2 to 5
mkm in size. Particles density (0.5-9 mg/m3) varies with the type
of the disease. Other factors are comfortable temperature- humidity
regime, the hypobacterial and allergen-free air environment saturated
with aeroions. The effect of HT was evaluated in 124 patients
(pts) with various types of respiratory diseases. The control
group of 15 pts received placebo. HT course consisted of 10-20
daily procedures of 1 hour. HT resulted in improvements of clinical
state in the most of patients. The positive dynamics of flow-volume
loop parameters and decrease of bronchial resistance measured
by bodyplethysmography were observed. The changes in control group
parameters after HT were not statistically significant. The specificity
of this method is the low concentration and gradual administration
of dry sodium chloride aerosol. Data on healing mechanisms of
a specific airdispersive environment of sodium chloride while
while treatment the respiratory diseases are discussed.
PMID: 10161255 [PubMed - indexed for MEDLINE]
Ter Arkh. 1996;68(8):24-8.
[Bronchial hyperreactivity to the inhalation of hypo- and hyperosmolar
aerosols and its correction by halotherapy]
[Article in Russian]
Gorbenko PP, Adamova IV, Sinitsyna TM.
18 bronchial asthma (BA) patients (12 with mild
and 6 with moderate disease) were examined before and after halotherapy
(HT) for airways reactivity using provocative tests with ultrasonic
inhalations of purified water (UIPW) and hypertonic salt solution
(HSS). Bronchial hyperreactivity (BHR) to UIPW and HSS before
treatment occurred in 13 and 11 patients (72 and 69%, respectively).
HT reduced BHR in 2/3 and 1/2 of the patients, respectively. In
the rest patients BHR was unchanged or increased, being so to
UIPW only in patients with atopic asthma in attenuating exacerbation.
Clinical efficacy of HT and initial BHR to UIPW correlated (r
= 0.56; p < 0.05). No correlation was found between HT efficacy
and initial BHR to HSS.
PMID: 9019826 [PubMed - indexed for MEDLINE]
Vopr Kurortol Fizioter Lech Fiz Kult. 1995 Jan-Feb;(1):11-5.
[The use of halotherapy for the rehabilitation of patients
with acute bronchitis and a protracted and recurrent course]
[Article in Russian]
Borisenko LV, Chervinskaia AV, Stepanova NG, Luk'ian
VS, Goncharova VA, Pokhodzei IV, Krivitskaia VZ, Vishniakova LA,
Pokhaznikova MA, Faustova ME, et al.
Halotherapy was used for rehabilitation in 25 patients
with acute bronchitis of long-standing and recurrent types. The
main therapeutic action was ensured by aerodispersed medium saturated
with dry highly dispersed sodium chloride aerosol, the required
mass concentration being maintained in the range of 1 to 5 mg/m3.
Therapy efficacy was controlled through assessment of clinical,
functional, immunological and microbiological findings. Metabolic
activity values were taken into consideration as well. Positive
dynamics of the function indices in the clinical picture resulted
from elimination of pathogenic agents, control of slowly running
inflammatory lesions and stimulation of some immune system factors.
Favourable changes in metabolic activity were present: normalization
of serotonin excretion, marked decrease of unbalance in lipid
peroxidation-antioxidant system.
PMID: 7785211 [PubMed - indexed for MEDLINE]
13: Vopr Kurortol Fizioter Lech Fiz Kult 1994 Jul-Aug;(4):34-5
[The efficacy of speleotherapy in atopic dermatitis
in children]
[Article in Russian]
Puryshev EA.
After proper clinical and immunological examinations
112 children with atopic dermatitis underwent immunocorrective
speleotherapy in a chamber with artificial microclimate created
with the use of natrium chloride spraying. During the treatment
positive trends were observed in the patients' dermatological
status and immune homeostasis. A complete 6-24-month response
was reported in 58%, partial in 20%, no response in 6.9% of patients.
The method is recommended for treatment of atopic dermatitis.
PMID: 7846884 [PubMed - indexed for MEDLINE]
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Inhalation
of hypertonic saline aerosol enhances mucociliary clearance in asthmatic
and healthy subjects
E. Daviskas, S.D. Anderson, I. Gonda,
S. Eberl, S. Meikle, J.P. Seale, and G. Bautovich
Eur Respir J 1996; 9: 725-732
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Nebulised hypertonic saline
for cystic fibrosis
(Cochrane Review)
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Wark PAB, McDonald V
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ABSTRACT
_____________
A substantive amendment to this systematic review
was last made on 01 February 2000. Cochrane reviews are regularly
checked and updated if necessary.
Background: The lung disease
in cystic fibrosis is characterized by impaired mucociliary clearance,
recurrent bronchial infection and airway inflammation. Hypertonic
saline has been shown to enhance mucociliary clearance in-vitro
and this may act to lessen the destructive inflammatory process
in the airways.
Objectives: To determine if
nebulised hypertonic saline treatment improved lung function, exercise
tolerance, quality of life and decreased the incidence of exacerbations
of respiratory infections in patients with cystic fibrosis.
Search strategy: Studies were
identified from the Cochrane Cystic Fibrosis and Genetic Disorders
Group trials register. Titles and abstracts were reviewed to identify
all controlled trials. Reviewed articles and bibliographies identified
from this process were surveyed for additional citations & RCTs.
Identification of unpublished work was obtained from abstract books
from the three major Cystic Fibrosis conferences (International
Cystic Fibrosis Conference, The European Cystic Fibrosis Conference
and the North American Cystic Fibrosis Conference). Trial authors
were contacted for additional information when only abstracts were
available to review.
Date of the most recent search of
the Group's specialized register: February 2000.
Selection criteria: All controlled
trials that assessed the effect of hypertonic saline compared to
placebo or other mucolytic therapy, for any duration or dose regimen
in subjects with cystic fibrosis of any age or severity were reviewed.
Studies in languages other than English were included.
Data collection and analysis:
All identified trials were independently reviewed by both reviewers
& all data collected. Trial quality was scored by the Cochrane
assessment of allocation concealment & the Jadad scale of methodological
quality.
Main results: Twelve controlled
trials of hypertonic saline were identified. Seven trials met the
inclusion criteria; these involved 143 subjects with an age range
of 6 to 46 years. Of these, six were published studies and one in
abstract form. The durations of the trials were limited to immediate
effects on mucociliary clearance to a maximum of three weeks.
In two studies, involving thirty
five subjects, a score for the feeling of cleared chest was made
using visual analogue scales. This analysis showed a weighted mean
difference of -0.98 (95% Confidence Interval -1.6, -0.34), favouring
hypertonic saline over isotonic saline.
In two trials with 22 subjects hypertonic
saline improved mucociliary clearance as measured by isotope clearance
from the lungs in 90 minutes demonstrating a weighted mean difference
of -11.3 (95% CI -18.6, -4.0), and as area under the clearance time
curve; weighted mean difference of -212 (95%CI -272, -152), also
favouring hypertonic saline over isotonic saline.
Lung function as measured by improvement
in FEV1 was observed in one study of 27 subjects. The percentage
increase in FEV1 at two weeks increased by a mean 15.0% with hypertonic
saline and 2.8% with isotonic saline (p=0.004).
Adverse events were adequately described
in only one trial and none were serious.
Reviewers' conclusions: Nebulised hypertonic
saline improves mucociliary clearance immediately after administration
which may have a longer term beneficial effect in cystic fibrosis.
The maximum time data were recorded for was only three weeks. Most
of the patients had mild to moderate lung disease and the effect
on severe lung disease remains unclear.
Further studies of hypertonic saline should be carried out to determine
the effect on pulmonary function tests, quality of life, frequency
of exacerbations of respiratory disease and efficacy comparisons
with nebulised deoxyribonuclease, with larger numbers and for longer
duration.
At this stage there is insufficient evidence to support the use
of hypertonic saline in routine treatment for patients with cystic
fibrosis.
Citation: Wark PAB, McDonald V. Nebulised hypertonic saline
for cystic fibrosis (Cochrane Review). In: The Cochrane Library,
1, 2001. Oxford: Update Software.
MeSH: Administration, Inhalation; Cystic Fibrosis/*drug
therapy; Human; Nebulizers and Vaporizers; Saline Solution, Hypertonic/administration
& dosage/*therapeutic
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This is an abstract of a regularly updated, systematic review prepared
and maintained by the Cochrane Collaboration. The full text of the
review is available in The Cochrane Library (ISSN 1464-780X).
File Reference: ab001506-20011
Inhalation Aerosols
Reprinted from Respiratory Care (Respir Care 1993;38:1196-1200)
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Efficacy of daily
hypertonic saline nasal irrigation among patients with sinusitis:
a randomized controlled trial.
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Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R.
Department of Family Medicine, University of Wisconsin, Madison,
53715, USA.
drabago@fammed.wisc.edu
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Objectives: To test whether daily hypertonic saline nasal
irrigation improves sinus symptoms and quality of life and decreases
medication use in adult subjects with a history of sinusitis.
Study design: Randomized controlled trial. Experimental
subjects used nasal irrigation daily for 6 months.
Population: Seventy-six subjects from primary care (n=70)
and otolaryngology (n=6) clinics with histories of frequent sinusitis
were randomized to experimental (n=52) and control (n=24) groups.
Outcomes measured: Primary outcome measures included the
Medical Outcomes Survey Short Form (SF-12), the Rhinosinusitis Disability
Index (RSDI), and a Single-Item Sinus-Symptom Severity Assessment
(SIA); all 3 were completed at baseline, 1.5, 3, and 6 months. Secondary
outcomes included daily assessment of compliance and biweekly assessment
of symptoms and medication use. At 6 months, subjects reported on
side effects, satisfaction with nasal irrigation, and the percentage
of change in their sinus-related quality of life.
Results: No significant baseline differences existed between
the 2 groups. Sixty-nine subjects (90.8%) completed the study. Compliance
averaged 87%. Experimental group RSDI scores improved from 58.4
-/+ 2.0 to 72.8 -/+ 2.2 (P < or =.05) compared with those of
the control group (from 59.6 -/+ 3.0 to 60.4 -/+ 1.1); experimental
group SIA scores improved from 3.9 -/+ 0.1 to 2.4 -/+ 0.1 (P <
or =.05) compared with those of the control group (from 4.08 -/+
0.15 to 4.07 -/+ 0.27). The number needed to treat to achieve 10%
improvement on RSDI at 6 months was 2.0. Experimental subjects reported
fewer 2-week periods with sinus-related symptoms (P <.05), used
less antibiotics (P <.05), and used less nasal spray (P =.06).
On the exit questionnaire 93% of experimental subjects reported
overall improvement of sinus-related quality of life, and none reported
worsening (P <.001); on average, experimental subjects reported
57 -/+ 4.5% improvement. Side effects were minor and infrequent.
Satisfaction was high. We found no statistically significant improvement
on the SF-12.
Conclusions: Daily hypertonic saline nasal irrigation
improves sinus-related quality of life, decreases symptoms, and
decreases medication use in patients with frequent sinusitis. Primary
care physicians can feel comfortable recommending this therapy.
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Publication Types:
• Clinical Trial
• Randomized Controlled Trial
PMID: 12540331 [PubMed - indexed for MEDLINE]
The information taken from National Library of Medicine (NLM)
Department of Family Medicine, University of Wisconsin, Madison,
53715, USA.
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A
Controlled Trial of Long-Term Inhaled Hypertonic Saline in Patients
with Cystic Fibrosis
Elkins M. R., Robinson M.,
Rose B. R., Harbour C., Moriarty C. P., Marks G. B., Belousova E.
G., Xuan W., Bye P. T.P., the National Hypertonic Saline in Cystic
Fibrosis (NHSCF) Study Group
N Engl J Med 2006; 354:229-240, Jan 19, 2006.
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Pediatric Allergy
and Immunology
Volume 14 Page 140 - April 2003
doi:10.1034/j.1399-3038.2003.00021.x
Volume 14 Issue 2
Hypersaline
nasal irrigation in children with symptomatic seasonal allergic
rhinitis: A randomized study
ABSTRACT
_____________
Recent evidence suggests that nasal irrigation with hypertonic saline
may be useful as an adjunctive treatment modality in the management
of many sinonasal diseases. However, no previous studies have investigated
the efficacy of this regimen in the prevention of seasonal allergic
rhinitis-related symptoms in the pediatric patient. Twenty children
with seasonal allergic rhinitis to Parietaria were enrolled in the
study. Ten children were randomized to receive three-time daily
nasal irrigation with hypertonic saline for the entire pollen season,
which had lasted 6 weeks. Ten patients were allocated to receive
no nasal irrigation and were used as controls. A mean daily rhinitis
score based on the presence of nasal itching, rhinorrea, nasal obstruction
and sneezing was calculated for each week of the pollen season.
Moreover, patients were allowed to use oral antihistamines when
required and the mean number of drug assumption per week was also
calculated. In patients allocated to nasal irrigation, the mean
daily rhinitis score was reduced during 5 weeks of the study period.
This reduction was statistically significantly different in the
3th, 4th and 5th week of therapy. Moreover, a decreased consumption
of oral antihistamines was observed in these patients. This effect
became evident after the second week of treatment and resulted in
statistically significant differences during the 3th, 4th and 6th
week. This study supports the use of nasal
irrigation with hypertonic saline in the pediatric patient with
seasonal allergic rhinitis during the pollen season. This treatment
was tolerable, inexpensive and effective.
Garavello W, Romagnoli M, Sordo L, Gaini
RM, Di Berardino C, Angrisano A. Hypersaline nasal irrigation in
children with symptomatic seasonal allergic rhinitis: A randomized
study.
Pediatr Allergy Immunol 2003: 14: 140–143. © 2003 Blackwell
Munksgaard
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