Khaltaev Nikolai, Solimene Umberto, Vitale Federico, Zanasi Alessandro
Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland.
World Federation of Hydrotherapy and Climatotherapy, Milan, Italy.
J Thorac Dis. 2020 Aug;12(8):4459-4468. doi: 10.21037/jtd-gard-2019-009.
Chronic respiratory diseases (CRD) belong to major noncommunicable diseases (NCD) targeted by World Health Organization (WHO) NCD Action Plan and United Nations (UN) Sustainable Development Goal (STG) 3.4 to achieve 30% decline of mortality by the year 2030. Strong evidence is now available in the literature for therapeutic aquatic exercise interventions in improving health status of chronic obstructive pulmonary diseases (COPD) patients. However, gym-based exercises can be difficult for patients with COPD who are mainly elderly and often have co-morbidities-such as severe arthritis and obesity-which may impair their ability to exercise at an adequate intensity. Besides improving respiratory function and health status in COPD, exercise in water helps overcoming patient's fears and promote socialization, contrasting the risk of depression, which is a major condition often associated with long term COPD condition. Susceptibility to respiratory infections plays a role in exacerbations of COPD. Sulphur-rich water inhalations improve muco-ciliary clearance, reduce inflammatory cytokines production and inflammatory mucosal infiltration, reduce elastase secretion by neutrophils, preserving elastic properties of pulmonary interstitium and thus facilitating expectoration. Repeated cold water stimulations in COPD also reduce frequency of infections. Finally, sauna bathing reduces the risk of pneumonia. On the other side, hydrotherapy/balneotherapy also help obesity control, which is one of the most difficult NCD risk factors to modify and consequently is an important component of the WHO preventive strategy to achieve STG 3.4. Along with high prevalence and mortality, CRD cause increasing pharmaceutical and hospital costs. In this perspective, Health Resort Medicine should not be ignored as a resource in the WHO NCD strategy and Universal Health Coverage, providing a multi-stakeholder platform (including the network of health resorts and their facilities) able to give a real help to the achievement of UN goal STG 3.4 by the year 2030.
慢性呼吸道疾病（CRD）属于世界卫生组织（WHO）非传染性疾病行动计划和联合国（UN）可持续发展目标（STG）3.4所针对的主要非传染性疾病，目标是到2030年将死亡率降低30%。目前文献中有充分证据表明，治疗性水上运动干预可改善慢性阻塞性肺疾病（COPD）患者的健康状况。然而，对于主要为老年人且常伴有合并症（如严重关节炎和肥胖症）的COPD患者来说，在健身房锻炼可能会有困难，这些合并症可能会削弱他们以适当强度锻炼的能力。除了改善COPD患者的呼吸功能和健康状况外，水中运动有助于克服患者的恐惧并促进社交，降低抑郁症风险，而抑郁症是与长期COPD病情常相关的主要病症。易患呼吸道感染在COPD急性加重中起作用。吸入富含硫的水可改善黏液纤毛清除功能，减少炎性细胞因子的产生和炎性黏膜浸润，减少中性粒细胞分泌弹性蛋白酶，保持肺间质的弹性特性，从而促进痰液排出。对COPD患者反复进行冷水刺激也可降低感染频率。最后，桑拿浴可降低肺炎风险。另一方面，水疗/浴疗法也有助于控制肥胖，肥胖是最难改变的非传染性疾病风险因素之一，因此是WHO实现STG 3.4预防战略的重要组成部分。随着CRD的高患病率和高死亡率，其导致的药物和住院费用不断增加。从这个角度来看，健康度假村医学作为WHO非传染性疾病战略和全民健康覆盖中的一种资源不应被忽视，它提供了一个多利益相关方平台（包括健康度假村及其设施网络），能够切实帮助实现到2030年的联合国目标STG 3.4。
