PNEUMOCONIOUSES

PNEUMOCONIOUSES - occupational lung diseases caused by prolonged inhalation of mineral dust and characterized by the development of diffuse interstitial fibrosis. They can be found in mining, coal, asbestos, engineering and some other industries. The development of pneumoconiosis depends on the physico-chemical characteristics of the inhaled dust.

The clinical picture of pneumoconiosis has a number of similar features: a slow, chronic course with a tendency to progress, often leading to disability; Persistent sclerotic changes in the lungs. The characteristic signs of pneumoconiosis are bronchitis, bronchiolitis, emphysema, respiratory failure, development of pulmonary heart. Common are the principles of prevention of pneumoconiosis, especially the implementation of technical and sanitary-hygienic measures aimed at the maximum reduction of dustiness in the air of work premises, the conduct of preliminary (upon admission to work) and periodic medical examinations. So, contraindications for employment related to exposure to siliceous dust are pulmonary tuberculosis, a number of diseases of the upper respiratory tract and bronchi, chronic diseases of the eyes, skin, allergic diseases. It is mandatory to conduct periodic medical examinations 2 times a year or 1 time in 2 years, depending on the potential danger of production. Biological methods of prevention are aimed at increasing the reactivity of the body and accelerating the removal of dust from it. Recommended general ultraviolet irradiation, the use of alkaline inhalation, general and respiratory gymnastics; Special nutrition is organized, aimed at normalizing protein metabolism and inhibiting the konyotic process.

Distinguish the following main types of pneumoconiosis: silicosis and silicatoses, metalloconiosis, karboconioses, pneumoconiosis from mixed dust (anthracosilicosis, siderosilicosis, etc.), pneumoconiosis from organic dust.

Silicosis - the most common and heavily leaking form of pneumoconiosis, develops as a result of prolonged inhalation of dust containing free silica. Often found in miners of various mines (drillers, slaughterers, sawmills, etc.), workers of foundries (sandblasters, stumpers, trimmers, etc.), workers in the production of refractory materials and ceramic products. It is a chronic disease, the severity and rate of development of which can be different and are directly dependent on both the aggressiveness of the inhaled dust (dust concentration, the amount of free silica in it, the dispersity, etc.), and the duration of the dust factor and Individual characteristics of the body.

Silicosis is prone to progression even after stopping work under conditions of exposure to dust containing silicon dioxide. If an unfavorable combination of a number of factors (high dispersion and concentration, high content of free silica in the dust, severe working conditions, etc.), silicosis can develop after several months of work ("early silicosis"), which is extremely rare.

Clinical picture . The disease develops gradually, as a rule, with a long work experience under the influence of dust. Initial clinical symptoms are meager: shortness of breath with physical exertion, chest pain of uncertain character, rare dry cough . But even in the initial stages it is possible to determine the early symptoms of emphysema, which develops mainly in the lower lateral sections of the chest, a boxed hue of percussion sound, a decrease in the mobility of the pulmonary margins and chest excursions, and a weakening of breathing. Attachment of changes in bronchi is manifested by hard breathing, sometimes with dry rales. In severe forms of the disease, dyspnea worries even at rest, chest pain increases, a feeling of pressure in the chest appears, cough becomes more permanent and is accompanied by sputum, increased severity of percussion and auscultatory changes, signs of tightening of pulmonary tissue and pulmonary hypertension.

Complications : pulmonary heart, pulmonary heart failure, pneumonia , obstructive bronchitis, bronchial asthma , less often bronchiectasis . Silicosis is often complicated by tuberculosis, which leads to a mixed form of the disease-silicotuberculosis.

The diagnosis . The main in the diagnosis of silicosis is an x-ray study. In the initial stage, the x-ray patterns show an increase and deformation of the pulmonary pattern, the appearance of cellularity and reticularity, the emergence of single shades of silicic nodes, the consolidation of the interlobar pleura; The changes are usually symmetrical, sometimes more pronounced in the right lung with predominant localization in the middle and lower divisions. Further, the deformation of the bronchial pattern is increasing, numerous numerous small-spotted irregular shapes of the shadow appear with round-shaped silicotic nodules located between them, having clear contours (the picture of a "snow storm" or a "shot" lung is the second stage of the disease). When the process goes to stage III, the shadows merge into large tumor-like conglomerates with the formation of cavities in some cases, more often when combined with tuberculosis; Signs of emphysema are expressed. Important in the diagnosis of silicosis "dust" work experience and sanitary and hygienic characteristics of working conditions of the worker.

The treatment is aimed at the normalization of metabolism, primarily protein, with the help of rational nutrition, saturation of the body with vitamins C, P and PP. Showing preparations of expectorant action, oxygen therapy, respiratory gymnastics; With shortness of breath, bronchodilators (theofedrine, euphyllin, aerosols of atropine, ephedrine, euspyran); With decompensation of the pulmonary heart - diuretics. In the initial stages, spa treatment is indicated.

Silicates are caused by the inhalation of dust silicates - minerals containing silica bound to other elements (magnesium, calcium, iron, aluminum, etc.). This group of pneumoconiosis includes asbestosis, talcosis, cementosis, pneumoconiosis from dust mica, etc. Silicates are widely distributed in nature and are used in many industries. Silicatosis can develop during work related to both the extraction and production of silicates, and with their processing and application. With silicates, a predominantly interstitial form of fibrosis is observed.

Asbestosis is the most common form of silicosis caused by the inhalation of asbestos dust. In the development of asbestosis, not only the chemical action of dust plays a role, but also the mechanical damage to the lung tissue with asbestos fibers. It occurs in workers in the construction, aircraft, machine and shipbuilding industries, as well as in slate, plywood, pipes, asbestos packings, brake bands, etc. It develops in persons with work experience under the influence of asbestos dust from 5 to 10 years. It manifests itself as a symptomatic complex of chronic bronchitis, emphysema of the lungs and pneumosclerosis. The sclerotic process develops mainly in the lower parts of the lungs around the bronchi, vessels, in the alveolar septa.

Patients are usually concerned about shortness of breath and cough . In sputum, "asbestos bodies" are sometimes found. When examined, the so-called asbestos warts on the skin of the limbs are identified.

X-ray in the early stages of the disease is determined by the intensification of the pulmonary pattern, the expansion of the gates of the lungs and increased transparency of their basal sections; As progression - the appearance of rough tyazhistosti. Of complications, pneumonia is most common. Often there is respiratory failure. Possible development of neoplasms of Pleura, bronchi, lungs.

Talcosis is a relatively benign silicosis caused by the inhalation of talc dust used in the textile, paper, rubber, perfume industry. Less often than asbestosis, accompanied by bronchitis syndrome, less pronounced propensity to progress. Heavy itches talcosis, caused by cosmetic powder.

Metalloconiosis is caused by the inhalation of dust from certain metals: beryllium - dust of beryllium, sideroz - dust of iron, aluminosis - dust of aluminum, barite - dust of barium, etc. Metalloconiosis, characterized by accumulation of X - ray contrast dust (iron, tin, Barium) with a moderate fibrotic reaction. These pneumoconiosis do not progress if exposure to dust from these metals is excluded; It is also possible to regress the process due to self-cleaning of the lungs from radiopaque dust. Aluminosis is characterized by the presence of diffuse, mainly interstitial fibrosis. With some metalloconiosis, the toxic and allergic action of dust with a secondary fibrotic reaction (beryllium, cobalt, etc.), sometimes with a severe progressive course, predominates. Berylliosis can manifest itself in various clinical forms: acute pneumonitis, diffuse bronchiolitis, lung granulomatosis, diffuse progressive pneumosclerosis.

Carboconiosis is caused by the influence of carbon-containing dust (coal, graphite, soot) and is characterized by the development of moderately expressed small-focal and interstitial lung fibrosis.

Anthracosis is a carcanconiasis caused by inhalation of coal dust. It develops gradually among workers with a long work experience (15-20 years) under the influence of coal dust, coal miners, workers of concentrating factories and some other industries. The course is more favorable than with silicosis, the fibrous process in the lungs proceeds according to the type of diffuse sclerosis. The inhalation of mixed dust of coal and rock containing silicon dioxide causes anthracosilicosis, a heavier form of pneumoconiosis, characterized by progressive development of fibrosis.

Pneumoconiosis from organic dust can be attributed to pneumoconiosis conditionally, since they are not always accompanied by a diffuse process with the outcome of pneumofibrosis. Bronchitis with bronchial obstruction syndrome is more common, which is typical, for example, of an abscissosis arising from the inhalation of vegetable fiber dust (cotton). When exposed to the dust of flour, grain, sugar cane, plastics, diffuse pulmonary changes of an inflammatory or allergic nature with a moderate fibrotic reaction are possible. This group also includes the so-called "farmer's lung" - the result of exposure to various agricultural dusts with fungi impurities. Characterized by shortness of breath , chills, cough with separation of scant sputum, fever , signs of emphysema, X-ray signs of pneumofibrosis.