Background. Inhalation of thermal water has been used empirically in the treatment of chronic diseases of upper and lower respiratory tract. This study investigates biomarkers of effect in exhaled breath (nitric oxide (NO)) and in exhaled breath condensate (EBC) (hydrogen peroxide ( H 2 O 2 ), anions, toxic heavy metals of tobacco smoke) for patients with lung diseases inhaling salt-bromide-iodine thermal water. Methods. This study enrolled two groups of patients, twenty with alveolar pulmonary diseases—pneumoconiosis—twenty-two with bronchial diseases. Patients received 12 days inhalation treatment with thermal water in Terme of Monticelli (Parma), Italy. Results. No statistically significant differences were found for NO at different flow rates in both groups of patients before and after thermal water inhalation. Also in EBC no statistically significant differences were present for H 2 O 2 concentrations, toxic heavy metals concentrations, and anion concentrations before and after treatment. Nitrates in EBC were found to be significantly higher in patients before inhalation than in controls as well as in patients after inhalation versus controls. Conclusions. This study contributes to better quantify functional and biochemical changes in airways before and after thermal water treatment. 1. Introduction The treatment of diseases with thermal water belongs to the oldest medical therapies. Waters and their components were used as therapeutic agents from the nineteenth century to the present day especially for lung diseases. The most frequently used therapies based on mineral waters were drinking, bath, and inhalation cures. The positive influence of these cures on the recovery of the patients was attributed to the physicochemical properties of the water. Particulary, some studies show that sulphurous thermal water inhalation has mucolitic, antioxidant, and antielastase activity [1] that may help to control airway inflammation at the upper alveolar or lower bronchial level [2, 3]. The possible benefit of thermal sulphurous water inhalation could be attributed to the presence of hydrogen sulphide (H2S). In the past, hydrogen sulphide was considered only a toxic gas. Recent studies indicate that it is also produced at significant amounts (50？μM) in most tissues and exerts many physiological effects suggesting its potential role as a regulatory mediator such as monoxide oxide (CO) or nitric oxide (NO) [4]. Moreover, inhaling treatments can be done with salt-bromide-iodine thermal waters of natural springs. Many scientists think that particular composition of
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