For post COVID-19 subjects, a comprehensive rehabilitative approach comprising a multidisciplinary and professional team, offering cardiorespiratory, neuromuscular, and psychological interventions, is recommended (Agostini et al. 2021). Main goals of respiratory rehabilitation in post COVID-19 subjects are: to improve symptoms of dyspnea, to reduce chronic inflammation in the airways, to ameliorate chest wall kinematics, to reduce complications and long-term outcomes, to minimize disability, and to improveQoL (Wang et al. 2020, Liu et al. 2020, Antonelli et al. 2020).
Since recent evidence has shown that in chronic pathologies of the lower and upper respiratory tract, thermal water treatments are effective in improving respiratory function, the use of spa therapy can be hypothesized also in post-COVID patients with persistent respiratory outcomes.
The spa setting, benefiting also from a multidisciplinary staff, can offer specific breathing physio-kinesiotherapy associated with mineral waters inhalation treatments, focused at the enhancement of respiratory outcomes that could affect COVID-19 survivor (Antonelli et al. 2020, Masiero et al. 2020a).
Mineral-rich water inhalations have been demonstrated to be effective in ameliorating the elastic properties of pulmonary interstitium, reducing inflammation and stimulating the muco-ciliary function. One of the current hypothesis explaining the mechanism of action of inhalation treatments is that inhalations can replace or increase glutathione (GSH), reducing oxidative stress associated with inflammation in lung disorders and production of Reactive Oxygen Species (ROS) (Corradi et al. 2012). The heat applied to the whole body during the water immersions could have ulteriorly positive effects on the respiratory system modulating innate and acquired immune defences (Cohen et al. 2020; Masiero et al. 2020b, Maccarone et al. 2021a, Maccarone et al. 2020).
Spa treatments can also offer psychological benefits and enhance mental wellness, improving relaxation and increasing stress resilience and QoL (Antonelli et al. 2020, Masiero et al. 2020a., Cohen et al. 2020).
Moreover, spa setting can represent an appropriate location to take care of comorbidities such as obesity, advanced age, COPD, neurological and musculoskeletal conditions (Masiero et al. 2020a, Masiero 2008, Masiero et al. 2018, Masiero et al. 2019).
Combining all these beneficial effects, in the spa setting customized post-COVID programmes could be drawn, referring, as suggested by Antonelli et al. , to already existing rehabilitative plans, such as those ones prescribed for work-related respiratory diseases.
Finally, we would like to remark that post-COVID-19 subjects accessing spa treatments must not be infectious anymore, which means that they must have no residual symptoms and two consecutive negative RT-PCR results (Antonelli et al. 2020, Masiero et al. 2020a).