Speleotherapy improves asthma control and breathing patterns in patients with respiratory conditions

A randomized controlled trial evaluated the efficacy of speleotherapy for patients with asthma, COPD, or Long COVID receiving standard background therapy. The study enrolled 208 participants across nine centers in Germany, Austria, and Italy, administering a three-week course consisting of six sessions lasting two hours per week. The primary objective focused on fractional exhaled nitric oxide (FeNO) in asthma patients, while secondary outcomes assessed lung function, symptom scores, quality of life, and respiratory mechanics. Follow-up assessments occurred at three months to determine sustained effects.

Results regarding asthma control revealed clinically relevant gains in the Asthma Control Test (ACT) with a p-value less than 0.001. Similarly, total Asthma Quality of Life Questionnaire (AQLQ) scores demonstrated statistically significant improvement with a p-value of 0.005. These findings suggest that speleotherapy may offer meaningful benefits for managing asthma symptoms beyond standard pharmacological interventions. However, the primary endpoint of FeNO reduction did not show significant improvement, indicating that the therapy does not necessarily alter airway inflammation markers in the same way it affects patient-reported outcomes.

Lung function analysis showed statistically significant but modest improvements in forced vital capacity (FVC) and peak expiratory flow (PEF) for the overall cohort. In participants under 70 years old, forced expiratory volume in one second (FEV1) also improved significantly. For the COPD subgroup, no improvements in lung function were observed, highlighting a potential difference in response based on underlying disease pathology. These modest changes in spirometry metrics must be interpreted with caution, as they may not translate to dramatic clinical shifts for all patients.

Symptom burden and functional capacity saw notable enhancements. The COPD Assessment Test (CAT) scores improved significantly, reflecting reduced daily symptom interference. Patients reported better ability to climb stairs and perform muscle exertion, with significant gains noted at the two-month mark. Dyspnea scores improved significantly by both two and three months, suggesting a progressive benefit in breathlessness management. Additionally, dysfunctional breathing patterns, measured by the Nijmegen Questionnaire, showed significant improvement, reinforcing the therapy's role in correcting breathing mechanics.

Psychological and physiological markers also responded positively. Anxiety and sleep-related symptoms decreased significantly, which is crucial for overall well-being in chronic respiratory disease. Respiratory muscle strength, measured by maximal inspiratory and expiratory pressures, increased significantly, potentially aiding in cough efficacy and airway clearance. Furthermore, end-tidal carbon dioxide levels rose, indicating improved ventilation efficiency. These physiological shifts support the hypothesis that speleotherapy influences breathing patterns more directly than airway inflammation.

Safety data indicated no adverse events, serious adverse events, or discontinuations related to the intervention, suggesting a favorable tolerability profile. The study limitations include retrospective trial registration and the modest magnitude of lung function changes. Evidence is more consistent for improvements in breathing patterns than for direct airway effects. Clinicians should consider speleotherapy as a complementary therapy, particularly for patients struggling with symptom burden or dysfunctional breathing, while managing expectations regarding spirometric improvements.

Key takeaway: Speleotherapy improves asthma control, breathing patterns, and respiratory muscle strength with a favorable safety profile, though lung function gains remain modest.