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. 2023 Jun 23;33(2):11460.
doi: 10.4081/ejtm.2023.11460.

Mineral water inhalations for bronchial asthma: a meta-analysis

Anatoliy D Fesyun  1 , Umberto Solimene  2 , Irina A Grishechkina  3 , Andrey A Lobanov  4 , Sergei V Andronov  5 , Andrei I Popov  6 , Maxim Yu Yakovlev  7 , Elena Ivanova  8 , Natalia P Sanina  9 , Igor V Reverchuk  10 , Maria Chiara Maccarone  11 , Stefano Masiero  12
Affiliations

Mineral water inhalations for bronchial asthma: a meta-analysis

Anatoliy D Fesyun et al. Eur J Transl Myol. .

Abstract

Bronchial asthma (BA) is a common disease that contributes significantly to the incidence rate and death rate worldwide. A widespread treatment method is the use of inhalations of mineral waters, with conflicting information about their effectiveness. Purpose of the study was to assess the generalized effect power of the course of inhalations of mineral waters on the disease progress in patients with BA. A search of randomized clinical studies in data bases Pubmed, EMBASE, ELibrary, MedPilot amd CyberLeninka, according to PRISMA strategy, published between 1986 and July 2021. Standardized difference of mean values and their 95% of CI were employed for calculation using the random effects model. The meta-analysis drawing on 1266 sources included 14 studies, with 2 of them being randomized controlled clinical studies, including the results of the treatment of 525 patients. All 14 articles contain a conclusion that the inhalation of mineral water has a positive effect on the course of the disease in patients with BA. The analysis demonstrated that the group of patients after mineral water inhalations, compared with the control group, showed improvement of forced expiratory volume (FEV1), expressed both in % of the norm and in liters. The standardized difference of mean values FEV1 (%) (Hedge's g) was 8.2 (95% CI: 5.87 - 10.59; 100%), FEV1 values (liter.) (Hedge's g) was 0.69 (95% CI: -0.33-1.05). A significant heterogeneity of the results of individual studies was found (Q=124.96; tau2 = 14.55, I2 = 69.13%, p<0.0001 and Q=2.35; tau2 = 0, I2 = 0%, p<0.0001). Patients with mild, moderate, and hormone-dependent BA with a controlled and partially controlled disease course, after mineral water inhalations, compared with the control group, demonstrated a statistically significant decrease in the frequency and intensity of the cardinal symptoms of BA and improvement of FEV1.

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Conflict of interest statement

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

As defined by the Global Strategy for Asthma Management and Prevention (GINA) 2019, “bronchial asthma” (BA) is a heterogeneous disease characterized by chronic airway inflammation, the presence of respiratory symptoms, such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation”. BA is one of the most common human diseases in all age groups. In Russia, according to epidemiological studies, the frequency of the current signs of BA (wheezing and rough breathing over the last 12 months) in the population of schoolchildren 13-14 years old averaged 9.7%, varying in different regions by more than 2 times., The prevalence rates of asthma symptoms also vary in different countries: the highest rates between 11 and 14% prevail in the UK, Australia, and New Zealand, while the lowest ones – 2-3% are in Albania, Turkey, the Czech Republic and Romania. The proportion of patients with bronchial asthma exacerbation in admission and emergency departments of hospitals in developed countries accounts for up to 12% of all admissions, while around 25% of them need hospitalization in specialized departments and about 5% in intensive therapy units. Up to now, the death and morbidity rates with BA have remained high in some regions., The concept of a "switch" therapy for the treatment of BA has been developed recently and it includes the prescription of various dosages of mono- and foxed combination medicinal products, used mainly in the form of metered-dose aerosols. Inhalation therapy for BA is considered to be the best method of drug delivery due to the fact that it ensures the maximal penetration of active substances into the respiratory tract and has minimal systemic absorption. Alongside studies of medical substances, scientific efforts were made to assess the treatment efficacy of inhalations of natural curative mineral-rich waters for patients with BA. Most of these studies made an assumption about a positive effect on the disease course of the direct action of the inhaled substance on the respiratory tract, due to the normalization of the structure and the purification of the mucous membrane, as well as the anti-inflammatory and antiallergenic effects in the resorptive action of mineral water components. However, a clear analysis of the results of these works is somewhat difficult due to a small number of patients participating in the studies or due to the publication of uncertain and, sometimes, conflicting results in some typescripts. Based on the aforesaid, after a preliminary analysis of the publications we decided to conduct a systematic analysis of the results of studies on the effectiveness of a program of inhalations (7-10 procedures) of mineral waters on BA evolution, evaluating the characteristics of the clinical course of the disease (the rate of exacerbations, the number of symptoms, the degree of the disease) and the changes of the main indicators of the respiratory function [FEV1, forced vital capacity (FVC), peak expiratory flow PEV) before and after the treatment and in comparison with the control groups.

The purpose of this study was to assess the generalized effect power of the course of inhalations of mineral waters on the course of the disease in patients with BA.

Figures

Fig 1.
Fig 1.
PRISMA Block diagram.,
Fig 2.
Fig 2.
Meta-analysis of studies of effect on FEV1 value, (%) after use of mineral water for BA (Forest plot),,23,26, 28,29,42,
Fig 3.
Fig 3.
Funnel plot (FEV1 values, (%).
Fig 4.
Fig 4.
Meta-analysis of studies of effect on FEV1 value, (liter) after the use of mineral water for BA (Forest plot) ,,,
Fig 5.
Fig 5.
Funnel plot (FEV1 values, (%).
See this image and copyright information in PMC

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