Vincenzo Condemi, U. Solimene, Angelico Brugnoli

Centre for Research in Medical Bioclimatology, Biotechnologies, and Natural Medicines — State University of Milan, Italy

Marginal diseases that aroused growing clinical interest in the past few years include Cystic Fibrosis. This is also especially interesting for the prevalence of a special pathological form, related to CF, known as allergic bronchopulmonary aspergillosis associated with cystic fibrosis, caused by certain fungine species, mostly Aspergillo fumigatus, and observed in 10% of CF patients. Cystic fibrosis, which is at its origin, is confirmed in turn as the most widespread genetic disease affecting white populations. It is transmitted by the parents through a mutated gene, the CFTR gene, of which 4-5% of the population are healthy carriers. The chronic pulmonary disease, that sooner or later affects most CF patients, is generally caused by certain bacteria, particularly Pseudomonas aeruginosa and Staphylococcus aureus, and can be complicated by atelectasy (air depletion in certain pulmonary districts), bronchiectasy (bronchial dilation), sometimes pneumothorax (air penetration into the pleural hollow), or haemoctysis (bronchial vessel bleeding). A chronic sinusitis is usually associated, sometimes with development of nasal polyps.

Aspergillosis, a complication observed in CF patients, is generally treated with the long-term (weeks or sometimes months) administration of cortisone-derived drugs; the term of the treatment usually depends on the clinical response and on the trend of E-immunoglobulin levels, whose regular dosage in blood is required to monitor the effectiveness of the treatment. The therapy is based on antifungine antibiotics, particularly itraconazole, as well as voriconazole, although this has not been widely tested.

In-depth studies carried out by the Centre of Research on Medical Bioclimatology at a national and international level demonstrated that no specialized research exists aimed at identifying any climatic/environmental contexts (outdoor environments) that are capable to mitigate or exacerbate the symptoms of aspergillosis in its various forms and in particular, for the purpose of this paper, associated with some forms of asthma or cystic fibrosis.

An assumption for this work is therefore the need to carry out a comparative study and analysis of the bioclimatic environments that can turn out favourable for the purpose.

The aim of this paper is to present a preliminary bioclimatic map (bioclimatic basins), limited to a number of sites in Northern Italy selected for the purpose and aimed at identifying criteria and indicators for bioclimatic healthiness as factors capable to mitigate the onset of the disease. The causes for the proliferation of fungine species in a given environment, both indoor and outdoor, are by now well known; the development and production of mycotoxins basically depend on specific thermo-hygrometric conditions. As to temperature, moulds, and Aspergillo fumigatus in particular, can easily proliferate within a temperature range from 0° to 40°C, with ideal values between 20° and 30°C. The ability of moulds to develop in a given coating material is, in turn, related to a parameter of the activity of the water contained in the substrate, defined as aw, an Index that results from the ratio of the pressure of the superficial water vapour to the pressure of vapour on a water film under the same temperature and atmospheric pressure conditions.

Expressed as a percent rate, it is identified as the equivalent relative humidity index. Hence the importance of expanding the study to include outdoor environments in careful climatological analyses.

As to bioclimatic aspects, temperature, relative humidity, wind — here analyzed in its different characteristics — and rainfalls have been considered; in various respects these parameters, appropriately integrated with the analysis of certain climatic Indexes (dryness index, evapotranspiration index, Angot’s index, etc.) have a varying incidence on the mean relative humidity rates, outlining habitats — not necessarily ideal — that can provide positive or negative factors (climatotherapic indications and contraindications) for the colonization and proliferation of different species of aspergilli.

The practical applications, that need to be first compared and supported by a strong epidemiological and clinical basis, which is now still poorly significant, are aimed at reducing the pharmacological dependence of the affected individuals, with benefits that can be extended to drug-addiction and to the relevant side effects that are tied to the drug therapy.

Another application, to be assessed in later studies, refers to a careful consideration of the psychological profiles of patients and relates to the concept of «climatic and/or environmental preference» as an anything but secondary factor for climatotherapic prescriptions. In accordance with psychosomatic medicine, classical climatotherapic schemes need to be carefully reviewed, in that they still do not expressly mention the psychological factor. A patient should be addressed towards an indicated as well as preferred climate, if no absolute contraindications are in place, such as, for example, heart diseases, that pose an absolute contraindication for medium-high mountain climates. The psychological factor, in an integrated mind-body vision, should not be underestimated when choosing a bioclimatic (and environmental in its widest sense) context, not too far from the environmental residence humus and from the environmental preference expressed by the patients.