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Subterranean Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

  • Magdalena KostrzonEmail author
  • Agnieszka Sliwka
  • Tomasz Wloch
  • Małgorzata Szpunar
  • Dorota Ankowska
  • Roman Nowobilski
Part of the Advances in Experimental Medicine and Biology book series


Pulmonary rehabilitation (PR) has been recommended as an integral part of treatment for patients with chronic obstructive pulmonary disease (COPD). Climate therapy in salt mine chambers has been found of benefit in chronic respiratory diseases. The study compares long-term effects of underground PR in the Wieliczka Salt Mine with that conducted on the surface. There were 42 COPD patients enrolled in the study, with FEV1/FVC <0.7 predicted and post-bronchodilator reversibility <12%, randomized into pulmonary rehabilitation in the mine (Group I, n = 23) and PR on the surface (Group II, n = 19). The outcomes consisted of lung function variables, exercise performance (6-min walk test – 6MWT), dyspnea (mMRC), and compliance with the disease and quality of life (COPD Assessment Test – CAT) and BODE index, compared at baseline (P0), end (P1), and 6 months after pulmonary rehabilitation (P2). The findings were that subterranean pulmonary rehabilitation significantly reduced CAT score (p < 0.001), BODE index (p = 0.004), and dyspnea (mMRC) (p = 0.001) and increased distance in 6MWT (p < 0.001), compared with its equivalent conducted on the surface. Further, beneficial effect of subterranean treatment was sustained during the following half a year as opposed to the effect noticed on patients treated on the surface. We conclude that subterranean pulmonary rehabilitative treatment reduces symptoms and improves exercise tolerance to a greater and sustained extent, compared to a similar treatment on the surface, in patients suffering from COPD.


COPD Pulmonary rehabilitation Speleotherapy Subterranean therapy 


Conflicts of Interest

MK, MS, and DA are employees of the Wieliczka Salt Mine. The other authors declare no conflicts of interest related to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Regional Medical Chamber in Cracow, Poland (No. 38/KBL/OIL/2015 dated 15th of April 2015).

Informed Consent

Informed written consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Magdalena Kostrzon
    • 1
    Email author
  • Agnieszka Sliwka
    • 2
  • Tomasz Wloch
    • 3
  • Małgorzata Szpunar
    • 1
  • Dorota Ankowska
    • 1
  • Roman Nowobilski
    • 2
  1. 1.Wieliczka Salt Mine Health ResortWieliczkaPoland
  2. 2.Institute of Physiotherapy, Faculty of Health SciencesJagiellonian University Medical CollegeCracowPoland
  3. 3.Faculty of Motor RehabilitationUniversity of Physical EducationCracowPoland

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