klimatKrystyna Janukowicz, MD, PhD

"The impact of forest microclimate of Ameryka near Olsztynek on the health condition of children with recurrent allergic disorders and infections of the respiratory system"

The pharmacological treatment of patients with respiratory system diseases is generally similar in every centre, based on the universally accepted standards, consistent with the up-to-date medical knowledge, however the unsuccessful pharmacological treatment, inefficiency of repeated antibiotic therapy, recurrent infections, difficulties in treatment of allergic diseases make us seek other treatment methods, such as the environment change. Treatment in the beneficial microclimate conditions may undoubtedly give more promising results. The tradition of tuberculosis treatment in the Ameryka climate, which dates back to the beginning of the century has indicated that this place possesses a unique microclimate. The hospital is entirely situated in the forest, on the outskirts of large forest complex. The pine and spruce stand with rich undergrowth and fauna is, in the oldest parts of the forest, about 180 years old. It constitutes a tight isolation from the nearest housing complexes and communication routes. In geographical terms, it is a borderland of Warmia and Mazury, area of Olsztyn Lakeland, which has a macroclimate with the characteristics of the continental climate. In the vicinity of Hospital, there is Pasłęk lake through which Pasłęka river flows, whose water is classified as belonging to the first class of purity. In order to prove the presence of specific microclimate in Ameryka, to verify and document the purposefulness of directing to this region children with respiratory system disorders, the scientific study was conducted, whose objective included:
1. Determination of microclimate characteristics and air cleanliness.
2. Comparison of microclimate characteristics with the climate characteristics of the largest pulmonary centre – Rabki and with the climate characteristics of Olsztyn, i.e. city, from which about half of the patients treated in Ameryka comes.  
3. Assessment of the children’s health status and treatment results on the basis of the clinical observations, laboratory tests and questionnaire surveys. 

In order to assess the conditions of centre in Ameryka, the observation and meteorological measurements were conducted every day for five years (from 1977 to 1982). The following parameters were marked: temperature, air humidity, precipitation levels, wind intensity and direction. On the basis of records the following parameters were later on determined and calculated: monthly and yearly average air temperatures, maximum and minimum temperatures, temperature amplitudes, extreme values and threshold temperatures, relative humidity and air saturation deficit, winds and rainfalls were characterized. In order to assess the level of atmospheric air pollution, the following parameters were determined: the amount of free-falling dust, the concentration of fine dust, the non-toxic dust and the concentration of sulphur dioxide. The assessment of treatment results was based on the precise clinical observations, laboratory tests and questionnaire surveys of 154 randomly selected patients. There were mainly children aged 3 to 8. The most frequent reasons of hospitalization included the recurrent pneumonia and bronchitis. The changes in the patients’ health status were assessed on the basis of physical examination and the following laboratory test: ESR, blood morphology, urinalysis, the levels of immunoglobulins G, A and M in blood serum, ratio of spontaneous and stimulated NBT reduction, rosette test. They were conducted upon the admittance to the Hospital and after 2.5-month stay based solely on the climatic treatment.

In order to assess the long-termed effects of the children’s stay in the Hospital, after 6 months from the discharge date, the questionnaires were send to the parents with request to complete the form.

The improvement of the children’s health status was expressed by the decrease in frequency of and attenuation of the course of respiratory tract infection, appetite improvement, increase in body weight, reduction of the enlarged lymph nodes and palatine tonsils. The beneficial changes were statistically confirmed by significant differences in laboratory test results: the increase on average by 0.30 g% in the amount of haemoglobin in erythrocytes, changes in the ratio of spontaneous and stimulated NBT reduction (average reduction by 2.24% and 3.98%), the reduction on average by 419.6 mg% of pathologically high values of IgG in serum. The improvement is also expressed by positive, however not statistically significant, direction of changes in the scope of ESR, the level IgA, IgM and the value of rosette test.

The studies on the microclimate of Ameryka have indicated, in comparison with Rabka and Olsztyn, considerable mitigation of daily, monthly and yearly thermal fluctuations, reduction of relative humidity fluctuations and air saturation deficit. These characteristics are significantly beneficial regarding the treatment of respiratory track diseases, especially in connection with incomparably little air pollution of the forest complex (concentration of sulphur dioxide in Ameryka -18 mg/m3, in Olsztyn 50 mg/m3, in Rabka 69,9 mg/m3, the average annual dust fall rate – in Ameryka 30 t/km2/year, in Olsztyn 130 t/km2/year, in Rabka 73,2 t/km2/year). In response to the questionnaire, 83% of parents stated that the overall health status of their children has improved considerably after their stay in Ameryka, the respiratory system infections have occurred less frequent and the course of those infections has been more attenuated than previously, the children have had lower drug intake. Among all the meteorological elements, the most negative impact on the condition of respiratory tracks comes from the fluctuations of daily temperatures and of the relative air humidity, especially those of considerable level and those occurring in short time. They predispose to the cold-related diseases and contribute to respiratory tract infections. Humidity and temperature have influence, in a particular way, on the respiratory tract mucous membrane status. Water vapour saturation of air together with temperature determine the direction and the level of exchange water vapour and heat between breathing air and respiratory tract mucous membrane. Since the exhaust air of 37,0° temperature is always in 100% saturated with water vapour, inhaling excessively dry air causes increased excretion of water vapour from the respiratory tract. That leads to the dryness mucous membrane which cease to be an efficient safety barrier against the allergens and bacteria. Low fluctuations of relative humidity and low level of air saturation deficit indicated in Ameryka are by all means beneficial to the respiratory tract, mainly for the mucociliary apparatus. The group of factors that predispose to the respiratory tract infections also includes the air movement of considerable intensity. Sudden fluctuations have particularly negative impact. As it was indicated by the appropriate measurements, quietness and low-speed winds mainly predominate in Ameryka. It is related, among others, with protective and inclosing character of the forest. The large forest complex that surrounds the Centre in Ameryka contributes to the mitigation of daily and seasonal fluctuations of the particular weather and climatic parameters. The forest is not only a great climate-generating factor, but it also performs the biological, sanitary and recreational functions. The biological role, of paramount value, especially for those with the respiratory tract infections, apart from carbon dioxide absorption and oxygen production also involves the production of so-called phytoncides, i.e. essential oil and other aerosol ingredients with the bacteriostatic and antibacterial properties. They have a regenerating and tonic influence on the system, deepen the breath, have low disinfecting properties and have very beneficial impact on the nasal and bronchial mucous membranes. There is a high concentration of them in the coniferous forest during warm season of the year as they are a direct result of evaporation of pine and spruce resins. The presence of phytoncides and essential oils, among others, explains the common opinion on the positive influence of forest on the human organism, especially on the infection-burdened children. The forest air has 2-3 times less microorganisms than the forestless areas. The forest location of the Hospital in Ameryka contributes to the unusually low air pollution which is confirmed by the measurements. At this time it is even lower as heating based only on gas has replaced the previous coal-fuelled boilers that had been in use in the period of conducting the studies. The conducted observations and climatic studies allow to claim that the intensity of microclimatic stimuli of the Hospital in Ameryka is suitable for children. These stimuli are not as powerful as those present in the mountain or maritime climate during the stormy weather – these conditions, very stimulative for the majority of the polish children, cause the exacerbation of the upper respiratory congestion symptoms. On the other hand the climate that lacks any stimuli has no influence on the human organism.

Generally it may be stated that microclimate of Ameryka is sparing, low stimulative, with optimal layout of the particular parameters in relation to the respiratory system needs, especially for such growing organisms like children. The studies conducted in Ameryka have not indicated the presence of factor, that could have a negative impact on the respiratory tract status.

Climatotherapy may be and should be used in the forest climate of Warmia and Mazury as a very efficient, safe and non-burdening element of the children’s treatment, especially those with long-termed treatment, who are very frequently treated with pharmaceuticals. Regarding the allergy-burdened children – treated in their own thus the most allergenic environment, such treatment may become invaluable measure, which allows to reduce the doses or even to discontinue the drug intakes that were very frequently administrated for many months.

The optimal results of the studies both meteorological and clinical allow to claim that in Ameryka there is a significantly beneficial microclimate for the treatment of children with infections, respiratory system allergy.