Pneumoconiosis

Description:

The term "pneumoconiosis" combines "the chronic occupational diseases of lungs which are developing from inhalation of dust and followed by permanent diffusion connective tissue reaction of the pulmonary fabric, preferential fibrous type which radiological is expressed in the disseminated pulmonary process of nodular or intersticial type".

Harmful effect of dust on a human body was noticed still in the ancient time. It was known that work in the conditions of an intensive zapyleniye leads to the diseases which are followed by cough with department of a phlegm and quite often coming to an end with death ("a black tuberculosis", "a tuberculosis of coal miners"). Hippocrates, Paracelsus, Ramazzini wrote about it. In domestic literature of mentioning of the diseases connected with dust influence are available in A. N. Nikitin (1847) works, V. Por - a tugalova (1870), F. F. Erismana (1877), etc.

For designation of professional dust pathology of lungs in 1866 F. Zenker offered the term "pneumoconiosis" (from Greek pneumon - a lung and conia - dust). Then And. Visconti called the pneumoconiosis connected with quartz dust inhalation, a silicosis, and further as was considered that all types of dust are capable to cause a pneumoconiosis, tens of new terms - "asbestosis", "anthracosis", "siderosis", "sucrose" etc. appeared. In process of accumulation of clinical, radiological and morphological data the special place of a silicosis as heaviest pneumoconiosis was defined. In due time it found an otyorazheniye in categorical formulations: "there is no pneumoconiosis, except a silicosis" and even "a pneumoconiosis and a silicosis - synonyms". In modern professional pathology it is conventional that though the silicosis remains to the most serious of a pneumoconiosis, the last can be called by influence not only quartz, but also other types of dust.

Pneumoconiosis belongs to the most widespread occupational diseases, and in industrialized countries of the world there are hundreds of thousands of patients piyevmoko-niozam. In our country thanks to continuous improvement of working conditions and effective carrying out in the state scale of other preventive actions their frequency steadily decreases, and far come forms meet rather seldom. At the same time total number of patients still remains considerable, and in structure of professional incidence a pneumoconiosis continues to be high on the list.

Pneumoconiosis symptoms:

According to domestic classification [Kaliteevsky T. N., etc., 1976], by the etiological principle distinguish: 1) silicosis; 2) silikatoza (asbestosis, talcosis, cement pneumoconiosis, etc.); 3) metalconioses (berylliosis, siderosis, aluminosis, baritosis, etc.); 4) karbokonioza (anthracosis, gra-phytosis, black pneumoconiosis, etc.); 5) a pneumoconiosis from the mixed dust: a) containing free Si02 (ant-ракосиликоз, a siderosilicosis, силикосиликатоз); b) not containing free Si02 or with its insignificant contents (a pneumoconiosis of shlifovalshchik, electric welders, etc.); 6) a pneumoconiosis from organic dust (cotton, grain, pith, reed, etc.).

In the clinicoradiological characteristic are considered type of shadings (nodular, iiterstitsialny, nodal), their prevalence occupied by them the space, and also a process stage (I, II, III). On a current distinguish quickly and slowly progressing, regressing and late options (at the last the pneumoconiosis develops after the termination of contact with пылыо). The nalny characteristic of ppevmokonioz is provided in classification kliniko-funktsio-and their complications are listed (tuberculosis, spontaneous pheumothorax, pneumonia, a pseudorheumatism, etc.).

Scarcity of clinical manifestations of a silicosis in comparison with its X-ray pattern of an obshchepriznap. Nevertheless most of patients complain of stethalgias, short wind and cough. In the beginning the pains pricking, non-constant, amplify at deep breath, cough, cooling, are localized preferential in interscapular and infrascapular areas. Gradually pains become more constant, pressing or pulling together. Direct dependence of their intensity on expressiveness of a silicosis does not manage to note. However, it belongs also to other complaints. An asthma arises only at a considerable physical tension in the beginning, then - at small loading and even at rest. Development and progressing of respiratory insufficiency are defined not so much by a silicosis stage, how many its complications and their expressiveness. Cough usually dry or with a scanty viscous phlegm. Further, at accession of infectious process, cough can become more expressed, and the phlegm - more plentiful and gains purulent character. Other complaints (weakness, perspiration, subfebrile condition and so forth) seldom meet at a neoslozhpenny silicosis.

The objective symptomatology is also quite poor. The general condition of patients long remains satisfactory. Body weight usually does not decrease. Cyanosis of lips, extremities develops at far come process or the expressed complications. At a part of patients it is possible to state deformation of trailer phalanxes of fingers of hands and a zakruglennost of nails like "drum sticks" and "hour glasses".

The main objective symptoms come to light in system of breath. On bigger speaking rapidly they are obliged by the origin not to actually fibrous process, and the developing emphysema and bronchitis, is more rare - to a bronchiolitis. And the nogda already in an initial stage is possible to reveal unsharp protrusion of nizhpelateralyiy departments of a thorax, further it becomes more expressed. Respiratory excursions and mobility of the bottom pulmonary edges long do not change, but further almost always decrease. The percussion sound gets a bandbox shade, is also preferential in lower parts, breath becomes weakened here. Bronchitis is shown by rigid breath, sometimes dry rattles. Sometimes already in an initial stage are listened unstable small - bubbly rattles over the bottom pulmonary edge; on a measure about - a silicosis gressirovaiiya the frequency of detection of wet rattles increases. Formation of fibrous fields is shown by change of stetoakustichesky symptomatology: sites of a bandbox percussion sound alternate with sites of its shortening, over the massive centers of fibrosis breath gets a bronchial shade, rigid breath adjoins with weakened ("mosaicity" of a physical picture). Sometimes it is possible to note clear retraction over - and subclavial poles. The pleural rub, mainly in infrascapular areas is quite often listened.

Changes from cardiovascular system are available already in initial stages of a silicosis, but are found only at an in-depth study and do not leave an essential mark on a clinical picture. Only in late stages when forming a pulmonary heart the corresponding subjective and objective clinical symptoms poyavyolyatsya. Changes from other bodies and systems have no natural character.

Pneumoconiosis reasons:

Etiological factor of ppevmokonioz, as appears from its definition, - dust.

The greatest value has chemical composition of dust. It is reflected also by classification of ppevmokonioz which basis the etiological group by types of production dust is. Dust with the high content of free silicon dioxide - BYug is especially aggressive. The silicosis caused by it is eurysynusic and differs in an adverse current. It is observed at miners (drillers, drifters, coalminers), workers of metal-working industry (obrubshchik, core makers, formers), productions of fire-resistant materials, the farforofayansovy industry.

Dust of other silicates (asbestos, talc) is also capable to cause a pneumoconiosis - silikatoza. Asbestosis on the speed of development, expressiveness of a clinical picture concedes to a silicosis a little, on other silikatoza have more high-quality character. The same can be told about karbokonioza - a pneumoconiosis from carbon-containing dust - and metalloko-nioza though at contact with some metals, first of all beryllium, major importance is got neikhfibro-by gene activity, and the sensibilizing or direct toxic action. Properties pyly the mixed structure are defined by a combination of properties of their fractions; the leading role belongs free 5! Ог at which high content the pneumoconiosis substantially reminds a silicosis.

Dust of an organic origin (cotton, flax, wool, a sugarcane, plastics, etc.) on biological effect significantly differs from all others. At contact with it the diseases sometimes reminding bronchial asthma regarding cases - an allergic alveolitis develop, but the diffusion pneumofibrosis is noted not always. Therefore the pathology caused by inhalation of organic dust can be carried to a pneumoconiosis only conditionally.

Some types ached are known in the crystal and amorphous modifications having unequal aggression. So, the crystal modifications of B the South (quartz, крпстобалпт, трндимнт, кохалонг) having various fibrogenny activity, more pathogens than amorphous (disgraces, bergmeal, the SI - лпкагель). Other characteristics of dust (dispersion, a way of formation of an aerosol - disintegration or condensation, etc.) can also influence their pathogenicity.

Dispersion of dust considerably determines depth of its penetration into a respiratory organs and intensity of elimination. The fraction with a particle size about 1-2 microns is most active. More coarse particles are late and quicker are removed by means of the mukotsiliarny device; smaller eliminirutsya partially with expired air, without managing to settle on mucous, partially on lymphatic ways.

The particle shape on which the possibility of mechanical traumatization of fabrics depends plays rather modest role.

Treatment of the Pneumoconiosis:

Drastic remedies by means of which it would be possible to achieve treatment of a pneumoconiosis to these holes are not created. Certain hopes are pinned on drugs of group of polyvinylpyridine-m-oxide, obladayoyushchy ability to slow down fibrous process recently, but deprived of its expressed side effect.

However told should not mean refusal of an active position of the doctor in questions of treatment [Rashevskaya A. M., etc., 1970]. It is carried out in the following directions: prevention or delay of progressing; the prevention and le - chsny the complications which considerably are making heavier a condition of patients; recovery of the broken functions. For normalization of exchange processes food, protein-rich and vitamins is appointed (the high doses of ascorbic acid applied in the recent past are not recommended now).

Treatment by hormonal drugs (a cortisone, AKTG, etc.) on which antiinflammatory properties and ability to brake a kollagenoobrazovaniye were laid great hopes, was not widely adopted. The indication to use of hormones are considered bystry to progress a silicosis and its combination to bronchial asthma.

Hormonal drugs, for obvious reasons, are appointed under tuberculostatic cover.

Well proved fermental drugs about - tsolitichesky action (trypsin, chymotrypsin, химонсин), the promoting evacuations of a phlegm, to improvement of a drainage, suppression of inflammatory process and reducing thereby expressiveness of bronchial obstruction; the enzymes of group of hyaluronidase (a lndaz, a ronidaz) increasing permeability of fabrics and increasing efficiency of the applied medicines, in particular antibacterial drugs. As the fibrogenesis at use of enzymes is braked, their action on fabric outgrows a framework of so-called symptomatic therapy and can be considered as pathogenetic treatment.

Regarding cases are shown an ant of IS an ist and mine means, and also drugs from group of bronchial spasmolytics. The most important method of treatment is the oxygenotherapy, especially in a combination with bronchial spasmolytics.

It is necessary to use physiotherapeutic procedures (ultrasound, an electrophoresis with novocaine and calcium п other), respiratory gymnastics.

Sanatorium treatment in a local zone, and also in Kazakhstan, a pas Southern берс is shown to most of patients! at the Crimea, etc.

Treatment a complication of pnevmokoppoz Is carried out by the standard methods.

Forecast. Regressing of pulmonary process meets seldom and only at separate types of a pneumoconiosis. In most cases changes in lungs have irreversible character and progress even after the termination of contact with dust.

At far come pneumoconiosis, development of complications working capacity quite often is completely lost. At a pneumoconiosis the increased size of disability pensions is established.