Action mechanisms of complex spa therapy on bronchial asthma. 3. Relationship to airway inflammation

The degree and characteristic of airway inflammation were evaluated by the proportions of bronchoalveolar lavage (BAL) cells. Clinical asthma types such as Ia. simple bronchoconstriction, Ib. bronchoconstriction + hypersecretion, and Ⅱ. bronchiolar obstruction correlate with airway inflammation. The increased proportion BAL　neutrophils is characteristic of type Ⅱ asthma, and increase in BAL eosinophil count is often observed in type Ib asthma. Bronchial hyperresponsiveness also correlates with airway inflammation. Action of spa therapy has been speculated to be related to airway inflammation, since the therapy has no action inhibiting IgE-mediated allergic reaction. In fact, spa therapy is more effective in patients with type Ib and type Ⅱ than in those with type Ia showing slight degree of airway inflammation. Bronchial hyperresponsiveness is also improved by spa therapy. From a point of view, the direct action of spa therapy may be to clean airways and improve damaged mucous membrane of the airways, leading to suppression of airway inflammation.

気道炎症反応の程度や特徴が,気管支肺胞洗浄液(BAL)中の細胞成分によって評価された｡Ia.単純性気管支攣縮型,Ib.気管支攣縮+過分泌型,Ⅱ.細気管支閉塞型などの各臨床病型は気道炎症反応と関連している｡BAL液中好中球増多は,Ⅱ型喘息の特徴的所見であり,また好酸球増多はIb型喘息でしばしば観察される｡気道過敏性もまた気道炎症反応と関連している｡温泉療法の作用機序としては,温泉療法にIgEにmediateされるアレルギー反応(液性因子相)を抑制する作用がないことから,気道炎症反応(細胞性因子相)の抑制が推測されている｡実際,温泉療法は,気道炎症反応が軽度なIa型喘息に比べ,Ib型やⅡ型などの明らかに気道炎症反応をともなう病型に対してより有効である｡気道過敏性もまた温泉療法により改善される｡これらの 結果から,温泉療法は,気道を清浄化し,気道粘膜を正常化することによって,気道炎症反応を抑制していくものと考えられる｡