History
Halotherapy (Greek halos = salt) involves the use of aerosols with salt microparticles (sodium chloride) and some versions and other minerals in the treatment of respiratory diseases. It appeared as a variant of speleotherapy (Greek. Speleos = cave), the therapeutic method applied in Eastern Europe, in salines, from the beginning of the 19th century. (5)
In the 1980’s, “halo-chambers” were projected and used in the Soviet Union to reproduce the microclimate in salines, a method that later spread to Europe and North America, especially in the treatment of bronchial asthma. (5)
Subsequently, the specialists focused on imagining “portable” devices that can be used both before the hospital (ambulances) and in hospital and at home. Thus, in Hungary a “ceramic pipe” was projected which contained saline microparticles and through which inhalation occurred, the expiration being done through the nose.
In Romania, the company TehnoBionic projected a filter cartridge with saline microparticles that are forcedly nebulized under air or oxygen pressure (not humidified!) by connecting to a common oxygen face mask. (4)
THE PRINCIPLE OF THE METHOD
Fine micronized sodium chloride (1-5 µm) is easily aspirated into the upper and lower airways. At this level it dissolves in the soil phase of the mucus film lining the respiratory epithelium. From here, by local osmotic effect, water from the interstitial tissue is attracted by the lumen of the airways.
In this way, the inflammatory oedema decreases and the amount of mucus increases.
It becomes more fluid and is easily mobilized by the vibrating cilia of the respiratory epithelial cells, improving a number of symptoms found in acute respiratory diseases. (1), (2), (3)
Thus, the nebulization of saline microparticles in the airways is a therapeutic method to be used in respiratory diseases such as: asthma, chronic obstructive pulmonary disease, pneumonia, etc.
The mechanism of action in infectious lung diseases appears to be decreased microbial contamination of the upper respiratory tract (especially with staphylococci) in children with respiratory allergies. The bactericidal capacity would be explained by the complex immunomodulatory effects induced by the procedure: increase in the number and activation of T lymphocytes, normalization of the number of B lymphocytes, increase in IgA levels. (4)
Indications
- Bronchial asthma;
- Bronchitis;
- Chronic obstructive pulmonary disease;
- Sinusitis;
- Respiratory allergies;
- Chronic diseases of the upper airways;
- Pneumonia.
Although there are studies on the effects of halotherapy in other types of lung pathologies: cystic fibrosis, ARDS, ALI, etc. The effect is not fully demonstrated, although it appears to be favourable.
Material and method
The filter cartridge (SaltMed) has been used in patients with respiratory failure due to bronchopulmonary asthma (asthma and exacerbated COPD), in a range of approx. 11 months, for patients presented in the UPU-SMURD Department of the Bucharest Emergency Clinical Hospital as well as on the means of on the field intervention (first aid crews – EPA = B2 ambulances and mobile intensive care units – UTIM = C1 ambulances).
Until 01.03.2009, 224 patients benefited from this treatment, simultaneously with the classic medication: betamimetics inhaler, corticotherapy, methylxanthines, etc.
A second group of 196 patients (especially pre-hospital) benefited from classic drug treatment and non-invasive facial mask oxygen therapy.
The clinical monitoring parameters were followed: ventricular rate (AV), respiratory rate (FR), EKG and SpO2 (at presentation, every 20 minutes in the first hour, then every hour until leaving the ICU). For those presented in the ICU, the parameters of acid-base balance (EAB) were also determined at presentation and at after one hour.
The results are being processed, especially since there are more patients to be included in the study.
Cases transported to other hospitals were not included in the evaluation because subsequent monitoring is extremely difficult, so only the results of the first hour of monitoring were presented as preliminary data.
Stage results:
- The „SaltMed” Group:
The 204 patients remained under evaluation and the rest could not be monitored because they were either transported by the EPA to hospitals or by UTIMs who arrived at hospitals before the first 20 minutes of monitoring were completed.
| FR | Presentation | 20 min. | 40 min. | 60 min. |
| 18-24 | 125 | 61 | 12 | 3 |
| 25-30 | 56 | 48 | 19 | 11 |
| >30 | 23 | 21 | 16 | 3 |
| SpO2 | Presentation | 20 min. | 40 min. | 60 min. |
| >92% | 47 | 98 | 154 | 190 |
| 86-92% | 128 | 82 | 31 | 10 |
| <86% | 29 | 24 | 19 | 4 |
Thus, it is observed that after 20 min. respiratory distress begins to be reduced by almost half (evidenced by high FR and low SpO2), and after 60 min. practically only 6.86% of patients still had respiratory failure.
- The „Oxygen therapy” Group:
It counted 196 of which 189 patients received non-invasive facial mask oxygen therapy and 7 patients required orotracheal intubation (IOT) for ventilatory assistance and were not included in this assessment:
| FR | Presentation | 20 min. | 40 min. | 60 min. |
| 18-24 | 122 | 116 | 102 | 79 |
| 25-30 | 47 | 46 | 38 | 31 |
| >30 | 20 | 20 | 16 | 11 |
| SpO2 | Presentation | 20 min. | 40 min. | 60 min. |
| >92% | 116 | 121 | 127 | 147 |
| 86-92% | 51 | 46 | 44 | 31 |
| <86% | 22 | 22 | 18 | 11 |
The data show that after the first 20 min. there was no significant improvement in respiratory distress and at one time 22.22% still had severe respiratory failure.
Conclusions
- As adjunctive therapy, patients who received treatment with the saline filter cartridge had a significant improvement in respiratory distress after the first 20 min. of administration, noting that however, cases of severe respiratory failure have significantly improved after one hour.
- The group that received halotherapy did not require IOT to facilitate mechanical ventilation during the first hour after treatment, so it may be an option in the non-invasive management of these patients.
- The filter cartridge can be reused by the same patient several times, if it is kept in the original packaging (silica gel removes moisture from the cartridge) and the treatment can be repeated in the ward; can be an adjuvant at home in the early treatment of asthma attacks.
- In the pre-hospital, although we do not have enough data, we believe that it can be of real use in the treatment of asthma attacks by crews who do not have the competence to practice IOT for mechanical ventilation, thus being able to transport the patient to the hospital.
Bibliography:
- ANDERSON SD. , SPRING J., MOORE B. et al., The effect of inhaling a dry powder of sodium chloride on the airways of asthmatic subjects, eur. Respir. J. 1997 Nov; 10 (11): 2465-73
- LAUBE BL., SWIFT DL., WAGNER HN. JR. et al.., the effect of bronchial obstruction on central airway deposition of a saline aerosol în patients with asthma, Am. Rev. Respir. Dis. 1986 May, 133 (5): 740-3.
- PHIPPS PR., GONDA I., ANDERSON SD. and colab., Regional deposition of saline aerosols of different tonicities in normal and asthmatic subjects, Eur. Respir. J. 1994, Aug.; 7(8): 1474-82;
- TUDORACHE, SF. MIHĂICUŢĂ, RODICA POTRE, ANCA KIGYOSI; Aeroionizarea forţată a aerului din încăpere ca şi terapie adjuvantă în terapia astmului şi bronşitei cronice (www.saltmed.blogspot.com; 03.03.2009)
- HALOTHERAPY – adjuvant therapy în the treatment of respiratory disorders; www. Scientiapress.com; 31.03.2009
