Prof. dr Svetozar Dluholucky

Pediatric Clinic
F. D. Roosevelt Hospital Banska Bystrica, Slovak Republic

Disorders of the respiratory organs are the most common diseases in childhood in all parts of the world. Whereas acute respiratory infections are the main killer of children in the developing countries, asthma and allergy-related diseases comprise the main health problem in the developed world. Asthma is one of the most common chronic and potentially disabling disease in childhood and young adulthood. It is the most common cause of pediatric hospital admission in the US- US children with asthma missed 10.1 million more days of school, were hospitalized 200,000 times more often and had 12.1 million more physician visits in 1988 than children without the disease. Asthma prevalence increased 29% from 1979 to 1987 in USA and affects 4% of the population. Total cost of asthma represented 6.2 billions USD in 1991. These alarming data have attempted to assess of all questions about the pathogenesis, and thus prevention and treatment of asthma. These efforts have elucidated a lot of questions. Currently, there are no doubts that conditions occurred in the early life of individual (even intrauterine) are substantial for development of asthma. Asthma today is defined as: “chronic inflammatory disease of the airways in which the inflammation is due to allergic cells and mediators.” This inflammation causes recurrent episodes of wheezing, breathlessness and cough, usually associated with airflow limitation. The lack of appropriate terminology complicates not only epidemiological studies, but treatment too.

In childhood, the disease is often classified as “wheezy bronchitis, cough, recurrent respiratory infections, asthmatic bronchitis,” etc. Roughly, three main factors are responsible for development of not only asthma, but atopic disease as well.

The genetic predisposition is a substantial factor for developing atopic disease. The occurrence of atopic history in one or both parents increases the risk of asthma from 10% to 20%-60%, respectively. On this susceptible person, the environmental specific and nonspecific factors influence the development of allergic disease. Primarily, nonspecific factors are more important than specific allergens

Detailed analysis exceeds the frame of this review, but there is the need to stress the importance even intrauterine exposure to maternal smoking and aggressive allergens as excessive drinking of cow milk in atopic mother. Early lung disease particularly viral infection is the promoting factor for sensitization. Many controversies have been found during the research of the environmental impact to sensitization. There is no doubt about the importance of environmental outdoor pollution. Exhaust fumes as nitrogen dioxide and sulphur dioxide and hydrocarbons-derived ozone all increase the bronchial hyperresponsiveness in asthmatics, and increase the number of wheezing attacks. But there is an “asthmatic paradox”- while asthma incidence is sharply increased over the past two decades, many atmospheric pollutants were diminished in industrial countries. Moreover, studies from Sweden have reported a higher prevalence in northern, less polluted part, than in the southern, industrialized parts of the country. The most exciting is the finding of a significantly lower incidence of childhood asthma in countries of Central Europe (reforming countries), previously referred as very highly polluted. Recently, the importance of indoors pollutant factors overweigh the outdoors ones. Early postnatal exposure to parent’s smoking, exposure to house dust mite, animal dander, other environmental irritants are expected to influence the early development of asthma. Again, precise studies have not found any correlation to animal exposure, and the fume was responsible mainly for development of the chronic bronchitis. It seems to be probable that the early respiratory infections on genetically predisposed organism and the exposure to nonspecific irritants and allergens all together are responsible for the development of bronchial mucosal damage and subsequently chronic inflammation with bronchial hyperreactivity- hallmarks of asthma

Taking into account the increased morbidity and mortality of asthma, the need of any effective treatment is obvious. The breakthrough in asthma treatment is anti-inflammatory approach. The use of this mode of treatment diminished the hospitalization rate of asthma in Swedish children. Nevertheless, the incidence of asthma was still increased. Recently, the “nonconventional” or “alternative” treatments such as acupuncture, homeopathy, etc. have been evaluated with constrained ending procedures. Despite long-term presented positive experiences, speleotherapy has not been mentioned as a mode of therapy in those reviews

History of the speleotherapy (ST) reached to Roman era when the beneficial effect of the cave environment to “wheezy attack” was described. This same discovery had been frequently reported in the first mid-twenty century in Europe. After the second World War, the research was oriented to analysis of cave aerosol and its treatment effect to respiratory disorders. In the 50-th, the first base of speleotherapy had started its activity in Germany and shortly afterward, ST was started in Hungary, Poland and Czechoslovakia (Gombasek-1962). The Section of Speleotherapy was established as a branch of Union Internationale de Speleoterapie in Europe (UIS). Many papers, both oriented to the environment of caves and to treatment effects, have been reported in UIS annual symposia. Unfortunately, in the beginning, only scant reports were published in official medical journals, and few reports fulfill the strict scientific criteria of research. In the 1980, the first interrelationships between composition of the cave aerosol and its influence on the respiratory and allergic disease were clearly defined, but a lot of questions remains unresolve.

One of the recent important step in speleotherapeutic research was project PHARE EC/HEA 10, introduced and technically equipped in former Czechoslovakia in 1993-1996. Until this time, the ST activities were provided without the possibility to monitor the cave environment continuously during the course of treatment

The evaluation of medical parameters was possible but only seldomly and nonsystematically. Medical equipments extended by PHARE were used to monitor the basic functional respiratory parameters, for detection of sudden worsening of the clinical status of patients, and for prospective research.

Since 1972 to 1994, 1787 children with repeated and allergic respiratory diseases had been treated with a mean of 80 children/year.During 1995 and 1996, 192 resp. 447 children were treated, 137 of them as outpatients in summer-camp course. Total number of treated children since the start of speleotherapy in Banska Bystrica is 2,426.

Research during this time clearly confirms the treating effect of speleotherapy to repeated and allergic respiratory disorders in children. Study from 1975-79 confirmed that this effect was directly attributable to the cave environment, not to the clima of Low Tatras, using control group. Effectiveness was in the immediate lowering of the frequency of respiratory attacks one year after ST. Repeated evaluation of the ST patients after 10 years confirmed the long-term effect of this treatment. Only 23% of the patients remained in regular allergologic care, in comparison to 50-65% patients, reported in recent reviews (Grol, M. H. et al. Allergy 1996). “Outgrow from asthma” was clearly facilitated by ST. Studies from PHARE study clearly confirmed the diminishing of inflammatory activities, the expression of atopic predisposition (IgE levels) and thus healing the respiratory mucosal barrier. Parents confirmed the increased physical and psychical activity in their children one year after ST. They classified ST as “excellent.” Monitoring of the cave environment not only confirmed its excellent self-cleansing capability, but also contributed to the elucidation of its treating mechanism. The mutual parameter for all kinds of ST (salt, mine, etc) is the alpha-radon ionization of cave aerosol and its sequent electronegativity. This negative charge of aerosol has substantial healing effect to cilial border of the respiratory mucosa thus improving the clearance capacity and “closing the gate of infection and sensitization.”

Asthma is recently the most common disease, disabling both children and adults mainly in the developed countries. Despite a lot of new discoveries, the incidence of this disease is sharply increasing. This statement is fully true namely in the USA and Western European countries. To contrast with this, in Slovakia, the slope of increasing asthma in childhood is not sharp and the hospitalization rate has diminished during 20 years. If speleotherapy contributes to this effect, it remains to be established in the future.