Speleotherapy, halotherapy, haloaerosoltherapy: definitions, mechanisms of influence, perspectives of usage (part II)

Treatment of patients with chronic pathologies, including pulmonary pathology, involves both treatment in the acute phase and certain medical procedures beyond the acute period aimed primarily at maximizing remission, prevention of further exacerbations and complete functional recovery of patients, which is the basis for improving the quality of life [51, 63, 74]. This led to the introduction of the concept of pulmonary rehabilitation and the approval of the provision (recommendations) for its implementation, especially in patients with COPD, which include physical training, educational program, correction of nutritional status, consultation of a psychologist, which is undoubtedly of great importance [47]. However, the issue of other non-pharmacological therapies (physiotherapy or spa treatment) traditionally used in Eastern and Central Europe has been given less attention. The situation changed with the revision of the Regulation on pulmonary rehabilitation (common to ATS and ERS) in 2013. The updated definition clearly stated that pulmonary rehabilitation is a set of methods that include, but are not limited to, the above therapies in patients with chronic respiratory diseases in general [56]. The document also emphasizes the need for scientific research of the mechanisms of the effect of rehabilitation technologies. In this regard, the question arises about conducting a pragmatic analysis of existing developments in the field of pulmonary rehabilitation, confirmation of the validity and appropriateness of their use, definition and concretization of indications and contraindications for their application. One of the possible methods for pulmonary rehabilitation is the use of speleotherapy, halotherapy and haloaerosoltherapy; however, there is no clear conception of these methods among the majority of the medical community, which results in incorrect assessment and lack of understanding of the difference between medical treatment and spa procedures. The aim of the study is to give an analysis of available developments in the field of speleotherapy, halotherapy and haloaerosolterapy, and the validity of the indications for their application, to distinguish between medical and spa use of certain methods and to determine the prospects for their further use. One comment in the Appendix to the Order of the Ministry of Health of Ukraine No. 555, June 27, 2013 «Chronic Obstructive Pulmonary Disease. Adapted Clinical Evidence based Instruction» [9] categorically states that spa treatment is not included in the list of health services provided by the healthcare system in the EU and the USA. Therefore, there is no scientific assessment or studies in these countries regarding the impact of non-pharmacological and spa-related factors on human health. However, the situation is not so straightforward. Firstly, there are a number of publications on this issue in the European Respiratory Journal (including those published in the last 5 years), the International Journal of Respiratory and Pulmonary Medicine, Balneologia Polska, Balneo Research Journal (Romania), Journal оf Cystic Fibrosis (Germany), Alergie (Czech Republic), etc. Secondly, in some EU countries, particularly in Hungary and the Czech Republic, some types of rehabilitation and spa treatment for certain groups of patients are partly provided by the healthcare system. Therefore, accounting the existing potential of medical natural resources, an assessment of the situation regarding this issue is current in Ukraine.