Asbestosis is an occupational lung disease. It most often occurs in workers of asbestos mining and processing enterprises, people working with materials containing asbestos, and sometimes it can also occur in relatives of people. The disease refers to pneumoconiosis (damage to the lungs by foreign matter) and silicosis (damage by silicon compounds).
Asbestos is an important construction and finishing material; it easily crumbles under physical impact, forming dust that can remain in the air for a long time and settle on objects and people’s clothing. Therefore, asbestosis can develop not only in people who directly work with asbestos, but also in their relatives due to contact with work clothing.
The cause of asbestosis is the constant inhalation of asbestos dust, and the duration of contact does not matter much. Symptoms of the disease can develop both in people who recently began working with asbestos and in workers several years after retirement. Contribute to the development of pulmonary asbestosis:
- smoking;
- stress;
- poor nutrition;
- the presence of other occupational hazards (especially dust and aerosols), in addition to asbestos;
- chronic diseases.
Symptoms and signs of asbestosis
Symptoms of asbestosis usually develop over several years. They can be divided into general symptoms, symptoms of the respiratory system and signs of respiratory failure.
Symptoms from the respiratory system are a cough, usually without sputum or with a small amount of it. If sputum is produced, it is mucous, white, transparent, and difficult to separate. Shortness of breath during physical activity, which increases over time and may begin to appear even at rest. It is more pronounced during inhalation; as the disease progresses, shortness of breath may occur during exhalation. Increasing signs of pulmonary emphysema are an increase and change in the shape of the chest. When the pleura is involved in the pathological process, chest pain associated with breathing occurs.
General symptoms:
- weakness;
- decreased performance;
- loss of appetite;
- weight loss for no apparent reason.
Symptoms develop due to insufficient oxygen supply to tissues. First of all, the brain suffers from hypoxia, so one of the early symptoms is deterioration of memory and attention, and a decrease in mental performance. A specific sign of asbestosis is the appearance of wart-like growths on the skin, which are called asbestos warts.
Respiratory failure develops with severe and prolonged asbestosis. It manifests itself as cyanosis, the nail phalanges of the fingers thicken, swelling of the legs, and pain in the heart occur. The formation of cor pulmonale is possible - stagnation of blood in the pulmonary veins and expansion of the right chambers of the heart.
These symptoms are not specific; they are characteristic of most lung diseases. Therefore, the description of symptoms is not the main thing in making a diagnosis. It is diagnosed when asbestos particles are detected in the sputum. An occupational pathologist must participate in the examination of a patient with suspected asbestosis.
Pathogenesis and complications of the disease
Asbestosis develops from inhalation of asbestos dust. When it enters the lungs, it causes mechanical irritation of the alveoli, and when it reacts with lung surfactant, it releases silicic acid, which also becomes a damaging factor. Asbestos compounds with surfactant block gas exchange in the alveoli and reduce their ability to stretch during inspiration.
With prolonged exposure to asbestos, pneumofibrosis (pneumosclerosis) develops - the appearance of connective tissue fibers in the lungs. This further reduces the restrictive function of the lungs and excludes even more alveoli from breathing.
The presence of asbestosis increases the risk of developing tuberculosis, pneumonia, malignant tumors of the lungs, pleura, mediastinum and peritoneum.
Diagnosis of asbestosis for treatment
Several methods are used to make an accurate diagnosis. Patient complaints and medical history help establish the fact of occupational contact with asbestos dust and suspect the patient has asbestosis.
X-ray of the lungs in the early stages reveals an increase in the pulmonary pattern, in later stages its deformation in the form of a network in the lower parts of the lungs (a sign of pneumofibrosis) and weakening or complete disappearance in the upper parts (a sign of emphysema). The x-ray also shows an increase and change in the shape of the cardiac shadow, characteristic of cor pulmonale. In controversial cases, a chest CT scan is prescribed for a more accurate diagnosis.
To assess the state of respiratory function, spirometric tests are performed. In the early stages, they detect breathing disorders that are still invisible to the patient and are compensated for most loads due to reserves. Such tests allow timely treatment of the disease to begin. At later stages, they make it possible to quantify the degree of damage to the external respiratory function and the severity of asbestosis. Changes in functional indicators - a progressive decrease in tidal volume and vital capacity of the lungs. Unlike another, no less common lung disease - COPD, restrictive disorders (decreased ability of the lungs to stretch during inhalation) prevail over obstructive disorders (decreased bronchial conductivity during exhalation).
The final diagnosis is made after microscopic analysis of sputum. Diagnostics reveals the presence of asbestos fibers in it. If they are absent, it is necessary to be examined for other diseases with similar symptoms.
Treatment and prevention
Asbestosis is chronic, its development can be stopped if contact with asbestos is stopped, but the reverse development of pathological processes in the lungs does not occur. That is why treatment of asbestosis is aimed at improving the patient’s quality of life. Always, even with mild forms of asbestosis, the patient is recommended to change his occupation: transfer from work in industrial premises to office work, and, if necessary, retraining. It is necessary to quit smoking, vaccinate against seasonal infections, treat chronic diseases and prevent their exacerbations.
For mild forms, breathing exercises that preserve the restrictive ability of the lungs, spa treatment, and oxygen cocktails are recommended. In more severe cases, oxygen therapy in a hospital setting may be required.
Prevention of asbestosis involves following safety precautions in the workplace.
Work with asbestos should be carried out in well-ventilated areas with low humidity levels. Workers must be provided with a change of work clothes and respirators. Work clothes should only be taken off and put on in the locker room and washed in a specially equipped laundry room. You should not bring work clothes home or enter work areas in street clothes. Regular health checks for workers are also required.
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Asbestosis- a lung disease that occurs as a result of the effect of asbestos on the body (when a person inhales its fibers). The term “asbestosis” includes the formation of benign focal lesions of the pleura, and lung cancer, and thickening of the pleura, and malignant pleural mesothelioma, and benign pleural effusions. Asbestosis and mesothelioma cause shortness of breath that develops over time.
To make a diagnosis, you need to take a medical history and perform a chest X-ray or computed tomography scan. If malignant tumors are detected, a tissue biopsy is needed. Treatment of asbestosis gives a good effect if there is no malignant process, when there is a need for surgical removal of the formation or chemotherapy.
Causes
Asbestos is a silicate that occurs naturally, has structural and heat-resistant properties, and is therefore valuable for the shipbuilding and construction industries. It is also used in some textile industries and for the production of automobile brakes. Chrysotile (snake fiber), chrocidotile and amosite (amphibole, or straight fibers) are the 3 main types of asbestos fibers that are the cause of the disease in question. Asbestos can affect the lungs and/or pleura.
Asbestosis is a form of interstitial pulmonary fibrosis. Malignant diseases are recorded less frequently. The following groups have an increased risk of disease:
- builders
- shipbuilders
- workers of textile factories and enterprises
- workers dealing with the repair and reconstruction of homes
- miners and workers who deal with asbestos fibers, etc.
Secondary damage is also likely. At risk in such cases are family members of sick people and people living close to the mines.
Pathophysiology
The pathophysiology is very similar to that of others. Alveolar macrophages absorb asbestos fibers that are inhaled by humans. Next, they produce growth factors and cytokines, which causes an inflammatory process to develop and collagen to be deposited. The result is fibrosis. Also note that the asbestos fibers themselves can be directly toxic to lung tissue. The risk of disease correlates with the duration and intensity of exposure and the type, length and thickness of inhaled fibers.
Symptoms
At the beginning of development, asbestosis occurs without pronounced symptoms, that is, in a latent form. But there may be progressive shortness of breath, cough without expectoration, and poor health (malaise). After cessation of contact with the provoking factor, the disease can develop (get worse) in 10 cases out of 100. If the disease progresses and is not treated, the patient’s terminal phalanges of the fingers thicken, and dry basilar rales appear. In severe cases, symptoms and manifestations of right ventricular failure, that is, cor pulmonale, are noted.
A sign of asbestos damage is damage to the pleura. This includes the formation of:
- calcification
- pleural overlays
- adhesions
- thickening
- effusion
With pleural lesions, there is effusion and malignant development, but few symptoms. Diagnosis is carried out using X-ray or high-resolution CT. But the computed tomography method is considered more sensitive in terms of detecting pleural lesions. Treatment is rarely required except in cases of malignant mesothelioma.
Discrete deposits are recorded in 60% of workers who deal with asbestos. They often affect the parietal pleura on both sides at the level between the 5th and 9th ribs, adjacent to the diaphragm. Calcification of the macules is often noted, which may lead to a misdiagnosis of severe lung disease if radiographically superimposed on the lung fields. HRCT can distinguish between pleural and parenchymal lesions in such cases.
Diffuse thickening can occur in both the visceral and parietal pleura. This can be either a nonspecific reaction to pleural effusion or the spread of pulmonary fibrosis from the parenchyma to the pleura. Pleural thickening (with or without calcification) can lead to restrictive disorders. Round atelectasis is a manifestation of pleural thickening, in which invagination of the pleura into the parenchyma can trap lung tissue, causing atelectasis. On chest x-rays and computed tomography, it is usually visible as a scar mass with an uneven contour, often localized in the lower parts of the lung. On radiography, it can be confused with a pulmonary malignancy.
Pleural effusion also occurs, but is less common than the other pleural lesions that it accompanies. The effusion is an exudate, often hemorrhagic, and in most cases disappears spontaneously (without special treatment).
Diagnosis of asbestosis
For diagnosis, correct history taking is important, revealing the patient’s contact with asbestos. X-ray or CT scan is also performed, as already noted. Using the radiographic method, reticular or focal infiltrates that reflect fibrosis can be identified. They are found mainly in the peripheral parts of the lower lobes. They are often accompanied by damage to the pleura. In the “advanced” course of the disease, a “honeycomb lung” is detected; in such cases, the middle lung fields may be involved in the pathological process.
The severity of the disease is determined according to the scale of the International Labor Organization (as with) according to the size, shape, location and severity of infiltrates. Asbestosis causes reticular changes mainly in the lower lobes of the lungs, which distinguishes the disease from silicosis. If adenopathy of the mediastinum and roots is detected, this indicates a diagnosis other than asbestosis.
The HRCT method is informative in cases of suspected asbestosis. High-resolution CT is useful in determining which pleural lesions are present. Pulmonary function tests, which can detect a decrease in lung volume, are not used to make a diagnosis. But these studies can characterize changes in lung function long after the diagnosis is made.
Bronchoalveolar lavage or lung biopsy as diagnostic methods are used only if it is impossible to make a diagnosis using atraumatic methods. If asbestos fibers are found, this indicates asbestosis in people with pulmonary fibrosis. But in some cases, such fibers are found in the lungs of people who do not have the disease, but asbestos affected their body.
Treatment and prevention
No specific treatment has been developed. If hypoxemia and right ventricular failure are detected early, supplemental oxygen is used and heart failure is treated. If asbestosis worsens, your doctor may prescribe pulmonary rehabilitation. Preventive measures include eliminating contact with the pathogen, stopping smoking, and reducing the asbestos content in non-working areas. Also, for preventive purposes, vaccinations against influenza and pneumococcus are carried out. It is also necessary to quit smoking to prevent multifactorial risk in people working with asbestos.
Forecast
The prognosis for this disease depends on the characteristics of each specific case. Some patients live without anxiety, when symptoms do not appear or appear only slightly. And some patients complain of increasingly worsening shortness of breath. In a few cases, the development of respiratory failure, malignant neoplasms and right ventricular failure is recorded.
Non-small cell lung cancer occurs in people with asbestosis 8-10 times more often than in people without such a diagnosis. It occurs especially often in workers whose bodies are affected by amphibole fibers. It is worth considering that all forms of inhaled asbestos are nevertheless associated with an increased risk of cancer. Asbestos and smoking have a synergistic effect on the risk of lung cancer. That is, smoking workers who deal with asbestos have many times greater chances of developing lung cancer, which has a poor prognosis and requires complex and difficult treatment.
ASBESTOSIS honey.
Asbestosis -. diffuse interstitial pulmonary fibrosis resulting from inhalation of asbestos fibers; a variant of pneumoconiosis that develops 15-20 years or more after cessation of contact with asbestos. With asbestosis, there is an increased risk of developing tuberculosis, mesothelioma, and lung cancer. Characterized by a chronic progressive course.
Etiology
Occupational exposure to asbestos dust or asbestos fibersSecondary contact in workers' families
Powders containing asbestos. Risk factor is smoking.
Pathogenesis
Restrictive ventilation disorders and decreased diffusion capacity of the lungs.Pathomorphology
Thickening of the parietal pleuraCalcification of the parietal pleura
Interstitial inflammation
Interstitial fibrosis
Fibrosis of the alveolar septa
Extensive pulmonary fibrosis
Destruction of the alveoli.
Clinical picture
Fast fatiguabilityChest pain when breathing
Dyspnea
Nonproductive cough
Wheezing in the lower parts of the lungs
Cyanosis
Drumstick finger deformity
Pleural effusion
Secondary pulmonary hypertension.
Diagnostics
Bronchoalveolar lavage - macrophages and asbestos fibersPulmonary function test:
Decrease in vital capacity of the lungs
Decreased tidal volume and diffusion capacity of the lungs
Tiffno index is within normal limits
Radioisotope scanning of the lungs:
Dysfunction of alveolar capillaries
Narrowing of the small airways
Chest X-ray:
Reduced lung capacity
Calcifications
Linear mesh deformation of the pattern, infiltrates
Bilateral pleural effusion
Interstitial fibrosis
Cell lung
The lower lobes of the lungs are most affected.
Differential diagnosis
SiderosisStannoz
Baritosis
Anthracosis
Silicosis
Talkoz
Disease of those in contact with wood dust.
Treatment
Once asbestosis develops, there is no effective treatmentObservation to exclude the development of malignant neoplasms
To give up smoking
Avoid continued contact with asbestos
Physiotherapy
Oxygen therapy
Treatment
pulmonary heartBronchodilator drugs - for the development of broncho-obstructive syndrome
Antibiotics
when a secondary infection occurs.
Complications
Lung cancerPleural mesothelioma
Peritoneal mesothelioma
Diffuse interstitial pulmonary fibrosis
Adenocarcinoma of the colon
Acute respiratory failure
Non-tumor lesions of the pleura - effusion pleurisy, pleural moorings.
Course and prognosis
The severity of the disease depends on the duration and intensity of contact with asbestos; changes in the lungs are irreversible.Synonyms
Asbestos pneumoconiosisSee also, Pneumoconiosis
ICD
J61 Pneumoconiosis due to asbestos and other mineral substancesLiterature
129: 22-24Directory of diseases. 2012 .
Synonyms:See what "ASBESTOSIS" is in other dictionaries:
Asbestosis- (a. asbestosis; n. Asbestose; f. asbestose; i. asbestosis) chronic. prof. respiratory disease that develops over long periods of time. inhalation of Asbestos dust. A. belongs to the group of Pneumoconiosis, called. silicates. Patients A. complain of cough,... ... Geological encyclopedia
asbestosis- noun, number of synonyms: 2 disease (995) pneumoconiosis (10) ASIS Dictionary of Synonyms. V.N. Trishin. 2013… Synonym dictionary
asbestosis- — EN asbestosis A non malignant progressive, irreversible, lung disease, characterized by diffuse fibrosis, resulting from the inhalation of asbestos fibers. (Source: CONFER)… … Technical Translator's Guide
asbestosis- rus asbestosis (m) eng asbestosis fra asbestose (f), amiantose (f) deu Asbestose (f), Asbeststaublungenerkrankung (f) spa asbestosis (f), amiantosis (f) ... Occupational safety and health. Translation into English, French, German, Spanish
asbestosis- (asbestosis) professional pneumoconiosis, developing as a result of systematic inhalation of asbestos dust... Large medical dictionary
– a form of pneumoconiosis that develops as a result of prolonged inhalation of asbestos-containing dust and is characterized by diffuse fibrosis of the lung tissue. The clinical picture of asbestosis consists of general somatic disorders (malaise, fatigue, anorexia), signs of respiratory failure (shortness of breath, cyanosis, deformation of the terminal phalanges of the fingers), symptoms of respiratory damage (cough with mucous sputum, pleural syndrome). To diagnose asbestosis, X-rays, CT scans of the lungs, spirometry, and examination of sputum and bronchial lavage are used. For asbestosis, supportive therapy is carried out (breathing exercises, physiotherapy, oxygen therapy).
Asbestosis (asbestos pneumoconiosis) is a diffuse interstitial pneumosclerosis caused by inhalation of asbestos particles. Along with talcosis, it belongs to silicosis - lung lesions caused by exposure to silicic acid compounds on the lung tissue. Asbestosis is observed in persons engaged in the extraction and processing of asbestos, as well as those working with asbestos-containing materials. The highest prevalence of asbestos pneumoconiosis is recorded in Canada, a country that holds the world championship in asbestos reserves. The incidence of asbestosis increases in proportion to the increase in time of contact with this material and averages 25-65% of cases. The danger of asbestosis lies not only in the development of diffuse fibrosis of the lung tissue, but also in dire long-term consequences - an increased risk of developing asbestos tuberculosis, mesothelioma of the pleura and peritoneum, adenocarcinoma of the lungs and stomach.
Causes of asbestosis
The immediate cause of this form of pneumoconiosis is prolonged inhalation of asbestos fibers. At the same time, asbestosis can develop both with work experience of less than 3 years, and 15-20 years after the cessation of professional contact with asbestos dust.
Asbestos is a fine-fiber mineral represented by hydrosilicate of magnesium, iron, calcium and sodium. Among the various types of asbestos, serpentine asbestos (chrysotile and antigorite) and amphibole asbestos (amosite, anthophyllite, crocidolite, tremolite) are of greatest industrial importance - the latter are more fibrogenic and carcinogenic.
Due to the nature of their professional activities, workers employed in the asbestos mining and processing industries, construction, engineering, shipbuilding, and aviation industries are in close contact with asbestos. These individuals constitute a high-risk group for the development of asbestosis. In addition, there are known cases of asbestosis with relatively short and low-intensity exposure to asbestos-containing dust, for example, among women washing their husbands' work clothes, or among painters and electricians working in premises where asbestos-containing materials are used. In addition to professional contact, household contact with asbestos is possible when using baby powder or asbestos textile products in residential buildings. It is known that smoking contributes to the occurrence of asbestosis, its rapid progression and severe course.
The mechanism of development of pulmonary fibrosis in asbestosis remains unclear. In pulmonology, it is customary to consider several versions of the occurrence of the disease: mechanical irritation of the lung tissue by needle-shaped asbestos fibers, damage to the alveoli by released silicon dioxide, the cytotoxic effect of asbestos on macrophages, the development of immunopathological reactions, etc.
There are pulmonary and pleural forms of asbestosis. From the point of view of morphological changes in the lungs, asbestosis in its development goes through two phases: desquamative alveolitis and bronchiolitis. Pneumofibrosis (pneumosclerosis) is interstitial in nature, localized mainly in the middle and lower lobes, while emphysema is detected in the upper parts. Asbestosis is characterized by the presence of rough pleural adhesions and sometimes pleural effusion. The presence of asbestos bodies is detected in the sputum, as well as in the pulmonary parenchyma, but this only confirms the fact of contact with asbestos dust, but is not the basis for making a diagnosis. In the pleural form of asbestosis, isolated damage to the pleura with intact pulmonary parenchyma is noted.
Symptoms of asbestosis
The severity of asbestosis symptoms depends on the duration of exposure to asbestos particles and their concentration in the air. It is believed that with an occupational exposure of 3-4 years, a mild form of asbestosis develops, 8 years - a moderate form, 10 or more years - a severe form.
Like the course of other pneumoconiosis, the clinical picture of asbestosis is characterized by chronic bronchitis and signs of pulmonary emphysema. All complaints and objective manifestations fit into three groups of symptoms: general somatic, signs of damage to the respiratory system and respiratory failure. Nonspecific symptoms include malaise, fatigue, pallor, weakness, anorexia and weight loss. Often warty growths appear on the arms and legs - the so-called “asbestos warts”.
Involvement of the respiratory tract and pleura in the pathological process is indicated by the appearance of a cough that is unproductive or with scanty mucous sputum and severe pain in the chest. In severe cases, shortness of breath is expressed, cyanosis develops, and thickening of the nail phalanges of the fingers is determined. It is possible to develop exudative pleurisy, which is serous or hemorrhagic in nature. Most often, the death of patients occurs from respiratory and cardiopulmonary failure.
The course of asbestosis is often complicated by pneumonia, bronchiectasis, bronchial asthma, and cor pulmonale, which worsen the prognosis of pneumoconiosis. A correlation has been noted between asbestosis and rheumatoid arthritis. Against the background of asbestosis, patients have a several-fold increased risk of developing pulmonary tuberculosis (mainly its focal form), lung cancer, malignant mesothelioma of the peritoneum and pleura, cancer of the esophagus, stomach and colon.
Diagnosis of asbestosis
An examination of patients with suspected pneumoconiosis is carried out by a pulmonologist with the participation of an occupational pathologist. In establishing the diagnosis of asbestosis, a decisive role belongs to the study of the professional route and the availability of data indicating exposure to asbestos dust. During auscultation, moist, fine-bubbling (sometimes dry) rales and pleural friction noise are heard. A box sound is detected by percussion over the upper parts of the lungs. Blood tests may reveal accelerated ESR, hypergammaglobulinemia, RF, antinuclear antibodies, and a decrease in oxygen levels in arterial blood.
Radiological signs of asbestosis include linear reticular deformation of the pulmonary pattern, hilar fibrosis, pleural changes (plaques, adhesions, effusion), and in the later stages - “honeycomb lung”. If the results of X-ray of the lungs are questionable, I resort to high-resolution CT of the lungs, which allows us to reliably examine subpleural linear, focal or irregularly shaped shadows.
A study of the function of external respiration in asbestosis indicates a predominance of restrictive disorders over obstructive ones (decrease in VC and tidal volume, etc.). Due to the similarity of the clinical and radiological picture of asbestosis with other pneumoconiosis, the differential diagnosis is made with anthracosis, pulmonary hemosiderosis, stannosis, talcosis, fibrosing alveolitis and other diseases. For this purpose, microscopic analysis of sputum, examination of bronchial lavage water, and biopsy of lung tissue are carried out, in which asbestos bodies and fibers are found.
Treatment and prevention of asbestosis
Since changes in the lungs with asbestosis are irreversible, the disease is treated symptomatically. First of all, it is necessary to completely stop contact with asbestos, get rid of nicotine addiction, and eliminate significant physical activity. To avoid infections that aggravate respiratory failure, vaccination against influenza and pneumococcal infection is recommended.
Maintenance therapy aims to relieve symptoms; it includes postural drainage, chest massage, medicinal inhalations, breathing exercises, physiotherapy, and, if necessary, oxygen therapy. Drug treatment involves the use of inhaled bronchodilators and taking vitamins.
Prevention of asbestosis consists of industrial and medical measures. The first of them involve ensuring the required sanitary and hygienic conditions and individual protection of workers, and compliance with safety regulations. All workers who are in contact with asbestos or asbestos-containing materials must undergo periodic medical examinations according to an established schedule. Considering the increased risk of developing tuberculosis and malignant tumors against the background of asbestosis, patients with an established diagnosis are recommended to be monitored by a phthisiatrician and oncologist.
And we also have
Some insulating materials (glass fiber, mineral wool), mica, etc. With silicosis, the fibrotic process in the lungs progresses relatively slowly, and tuberculosis is associated less often than with silicosis.
Pathogenesis
Silicate dust enters the alveoli of the lungs, where it is captured by phagocytes, it damages mitochondrial membranes, the oxidation process moves from aerobic to anaerobic, lactic acid begins to accumulate, which activates the enzyme ketoglutorate, which triggers the process of collagen formation, which leads to the replacement of normal alveolar tissue with scar tissue , reducing the respiratory surface of the lungs.
Classification of silicates
Depending on the composition of silicate dust, the following types of silicates are found:
- Asbestosis– caused by inhalation of asbestos-containing dust (magnesium, calcium, iron, sodium silicate). It usually affects workers in asbestos mining and asbestos processing industries.
- Talkoz– develops as a result of inhalation of talc dust, which is a magnesium silicate. It occurs among workers involved in the production of ceramic, rubber, paint and varnish, and perfumery products.
- Kaolinosis– occurs when inhaling clay dust containing kaolinite. It can occur in potters, porcelain makers, and workers in brick and ceramic production.
- Nephelinosis– caused by exposure to nepheline dust - potassium and sodium aluminosilicate. Nepheline pneumoconiosis affects workers in glass, ceramics, leather, and aluminum production.
- Olivinosis– associated with inhalation of olivine dust, which is based on magnesium and iron orthosilicate. It occurs mainly among workers in the ceramic industry and foundries.
- Cementosis– occurs when the respiratory tract and lungs are exposed to cement dust. Affects persons associated with the cement production process and builders.
- Mica pneumoconiosis– caused by inhalation of mica dust upon contact with muscovite, phlogonite, biotite; is rare.
Symptoms of silicates
Among other silicates, asbestosis has the most severe course and rapid progression. Early signs of asbestos pneumoconiosis are catarrhal symptoms (stingling, cough), accompanied by chest pain and shortness of breath. Subsequently, obstructive bronchitis or bronchiolitis, cor pulmonale, is formed. The appearance of asbestos warts on the skin of the extremities is typical. As asbestosis progresses, anorexia and weight loss increase. Serous or hemorrhagic pleurisy may develop. Pneumonia, bronchial asthma, and bronchiectasis often occur against the background of this type of silicatosis. Asbestosis is a favorable background for the occurrence of tuberculosis (asbestos tuberculosis), lung cancer and pleural mesothelioma. Talcosis is characterized by late and slow development of clinical and radiological changes. Symptoms include shortness of breath during physical exertion, periodic chest pain, dry cough, and weight loss. Fibrous changes can be focal or diffuse. Silicatosis caused by inhalation of cosmetic powder has a more severe course: in this case, cardiopulmonary failure quickly increases. In the case of pulmonary tuberculosis, talcotuberculosis occurs with a chronic course. The clinical picture of kaolinosis consists of the phenomena of subatrophic rhinitis and pharyngitis, obstructive bronchitis. The X-ray morphological picture corresponds to emphysema and interstitial focal pneumofibrosis. In some cases, it may be complicated by tuberculosis. The pathomorphological basis of nephelinosis is chronic obstructive bronchitis, pulmonary emphysema and pneumofibrosis. Patients are concerned about shortness of breath on exertion, chest pain, cough with viscous sputum, palpitations, fatigue and weakness. The course of this form of silicosis is relatively benign. Olivinosis, or silicatosis, caused by exposure to olivine dust, is manifested by shortness of breath, cough, and chest pain. Accompanied by a symptom complex of nasopharyngitis, chronic bronchitis, and impaired external respiration function. X-ray of the lungs reveals diffuse reticular fibrosis and basal emphysema. Clinical signs of silicosis often appear before radiographic changes. The course is compensated; when contact with olivine dust is stopped, X-ray morphological changes can regress. When inhaling cement dust, the upper respiratory tract is primarily affected. A sore throat, dry nasopharynx appears, and easily bleeding crusts form on the mucous membranes, causing pain. Pulmonary manifestations of cementosis include cough, asthma attacks, and chest pain caused by interstitial fibrosis. The skin becomes dry and hard-to-heal cracks appear on it. Damage to the organ of vision is characterized by conjunctival hyperemia, lacrimation, and visual impairment may develop over time.
Diagnosis and treatment of silicates
The criteria for diagnosing silicatosis are confirmed occupational hazards, typical radiological changes and clinical picture, and disturbances in respiratory function. Patients are referred for consultation to a pulmonologist and occupational pathologist, and, if necessary, to a phthisiatrician.
When making a diagnosis and determining the type of silicatosis, the length of service in conditions of increased dust formation and working conditions are taken into account. During auscultation, harsh or weakened breathing, dry rales, and sometimes, in some areas, wet rales are heard. X-ray examination in most cases reveals reticular fibrosis and thickening of the interlobar pleura. Spirometry and blood gas analysis can provide certain information about the severity of respiratory failure. In certain forms of silicosis, “asbestos bodies”, “mica bodies”, “talcium bodies” can be detected in the sputum, which allows confirming the etiological diagnosis.
Treatment of silicosis is carried out using conservative methods. A diet enhanced with proteins and vitamins is recommended. To inhibit fibrotic processes, polyvinyl lyridine-M-oxide and hormonal drugs are used. To reduce bronchial obstruction, bronchodilators, inhalations with proteolytic enzymes, breathing exercises, and chest massage are prescribed. Physiotherapeutic procedures (ultrasound, electrophoresis with lidase, calcium and novocaine, etc.) and oxygen therapy are widely used.
If complications occur (bronchitis, bronchial asthma, EBD, emphysema, pneumonia, tuberculosis), their appropriate treatment is indicated. Outside of exacerbation of silicosis, treatment is recommended in dispensaries and sanatoriums in the local area and on the southern coast of Crimea.
Forecast and prevention of silicosis
Regression of pulmonary changes is possible only with certain forms of silicosis. In most cases, the disease is progressive. In severe forms of pneumoconiosis, the ability to work is completely lost, and in certain types, death from cardiopulmonary failure and cancer can occur.
In order to prevent silicates, it is necessary to ensure the sealing of production processes, automation of technological processes and remote control, the use of effective ventilation and air showers, etc. Individual protective measures include wearing protective clothing, gloves, respirators, and safety glasses. Workers exposed to silicate dust should undergo regular medical examinations and be removed from work if the first signs of silicate are detected.
A study of occupational morbidity among workers in various industries in the USSR and the Russian Federation showed that, given the way in which RPEs are now selected and used (in the Russian Federation), it is extremely rare to achieve effective prevention of occupational diseases using this “last resort of defense.”
Notes
- Artamonova V.G. , Likhachev Yu.P. Silicates // Great Medical Encyclopedia: 30 volumes / chapter. ed.