Medicinal clays improve the endurance of loaded inspiratory muscles in COPD: a randomized clinical trial of nonpharmacological treatment

Simonetta Baldi,¹ Gian Domenico Pinna,²
Claudio Bruschi,¹ Fabrizio Caldara,³
Roberto Maestri,² Elena Dacosto,¹
Antonella Rezzani,¹ Ermanno Popovich,¹
Ezio Bellinzona,¹ Paola Crotti,¹
Silvia Montemartini,¹ Claudio Fracchia¹

¹Department of Pneumology, ²Department of Biomedical Engineering, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia), ³Center of Thermal Studies Pietro d’Abano, AbanoTerme, Padua, Italy

Background: Inspiratory resistive breathing (IRB) challenges affect respiratory muscle endurance in healthy individuals, which is considered to be an interleukin 6 (IL-6)–dependent mechanism. Whether nonpharmacological thermal therapies promote the endurance of loaded inspiratory muscles in chronic obstructive pulmonary disease (COPD) is unclear. The objectives of this study were to compare the effects of two thermal interventions on endurance time (ET) and plasma IL-6 concentration following an IRB challenge.
Methods: This study was a randomized, parallel-group, unblinded clinical trial in a single-center setting. Forty-two patients (aged 42–76 years) suffering from mild to severe COPD participated in this study. Both groups completed 12 sessions of the mud bath therapy (MBT) (n=22) or leisure thermal activity (LTA) (n=19) in a thermal spa center in Italy. Pre- and postintervention spirometry, maximum inspiratory pressure, and plasma mediators were obtained and ET and endurance oxygen expenditure (VO_2Endur) were measured following IRB challenge at 40% of maximum inspiratory pressure.
Results: There was no difference in ΔIL-6 between the intervention groups. But, IRB challenge increased cytokine IL-6 plasma levels systematically. The effect size was small. A statistically significant treatment by IRB challenge effect existed in ET, which significantly increased in the MBT group (P=0.003). In analysis of covariance treatment by IRB challenge analysis with LnVO_2Endur as the dependent variable, ΔIL-6 after intervention predicted LnVO_2Endur in the MBT group, but not in the LTA group. Adverse events occurred in two individuals in the MBT group, but they were mainly transient. One patient in the LTA group dropped out.
Conclusion: MBT model improves ET upon a moderate IRB challenge, indicating the occurrence of a training effect. The LnVO_2Endur/ΔIL-6 suggests a physiologic adaptive mechanism in respiratory muscles of COPD patients allocated to treatment. Both thermal interventions are safe.

Keywords: hydrotherapy, cytokine IL-6, inspiratory resistive breathing, balneotherapy, pulmonary rehabilitation