title: Effects of thermal water inhalation in chronic upper respiratory tract infections in elderly and young patients.
abstract: BACKGROUND
  Chronic upper respiratory tract infections (cURTI) are very frequent illnesses which occur at any age of life. In elderly, cURTI are complicated by immunosenescence, with involvement of lung immune responsiveness.
  
  
  RESULTS
  In the present study, 51 elderly (age range: 66-86) and 51 young (age range 24-58) cURTI patients underwent a single cycle (two weeks) of inhalatory therapy with salt-bromide-iodine thermal water in the thermal station "Margherita di Savoia" (Margherita di Savoia, BAT, Italy). Peripheral blood serum cytokines and clinical assessment were performed before therapy (T0) and after six months (T1) and 12 months (T2) from inhalatory treatment. In both elderly and young patients, at baseline an increased release of T helper (h)1-related cytokines [interleukin (IL)-2 and interferon-γ] and of Th2-related cytokine (IL-4) was documented. Inhalatory treatment reduced the excessive secretion of all the above-cited cytokines. IL-10 values were above normality at all times considered in both groups of patients. In addition, an increase in IL-17 and IL-21 serum levels following therapy was observed in both groups of patients. Pro-inflammatory cytokine (IL-1β, IL-6, IL-8 and tumor necrosis factor-α) baseline values were lower than normal values at T0 in both elderly and young cURTI patients. Their levels increased following inhalatory treatment. Clinically, at T2 a dramatic reduction of frequency of upper respiratory tract infections was recorded in both groups of patients.
  
  
  CONCLUSIONS
  Thermal water inhalation is able to modulate systemic immune response in elderly and young cURTI patients, thus reducing excessive production of Th1 and Th2-related cytokines, on the one hand. On the other hand, increased levels of IL-21 (an inducer of Th17 cells) and of IL-17 may be interpreted as a protective mechanism, which likely leads to neutrophil recruitment in cURTI patients. Also restoration of pro-inflammatory cytokine release following inhalatory therapy may result in microbe eradication. Quite importantly, the maintenance of high levels of IL-10 during the follow-up would suggest a consistent regulatory role of this cytokine in attenuating the pro-inflammatory arm of the immune response.
authors.affiliation: Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Thea
authors.initials: T
authors.lastname: Magrone
authors.affiliation: Thermal Water Station "Margherita di Savoia", Margherita di Savoia, BAT Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Galantino
authors.affiliation: Thermal Water Station "Margherita di Savoia", Margherita di Savoia, BAT Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Di Bitonto
authors.affiliation: Thermal Water Station "Margherita di Savoia", Margherita di Savoia, BAT Italy.
authors.forename: Luisella
authors.initials: L
authors.lastname: Borraccino
authors.affiliation: Thermal Water Station "Margherita di Savoia", Margherita di Savoia, BAT Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Chiaromonte
authors.affiliation: Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Jirillo
keywords: Ageing; Chronic upper respiratory tract infections; Cytokines; Thermal water inhalation