Antrakoz is the damage of lungs caused by inhalation of particles of coal dust and which is characterized by development of pulmonary fibrosis. Symptoms of an antrakoz (cough, short wind, breast pain, fatigue) have the progressing character. At diagnosis the occupational history, data of a X-ray analysis and computer tomography of lungs, spirometry, the analysis of gas composition of blood is considered. Treatment of an antrakoz, mainly, symptomatic: reception of bronchial spasmolytics, steroid medicines, massage of a thorax, kislorodoterapiya. Antrakozy observation of the pulmonologist and pathologist is shown to patients; in some cases – change of a profession.
Antrakoz (from Greek "anthrax" — coal) – the pneumoconiosis developing at long impact on pulmonary fabric of coal dust. Treat the damages of lungs caused by inhalation to carboniferous dust (karbokonioza) , and a black pneumoconiosis. In their row is the most frequent occupational disease. Develops at the workers occupied in coal mining and having a long production standing. Depending on working conditions and duration of contact with coal dust prevalence of an antrakoz among miners makes from 12 to 50%. Progressing of an antrakoz can lead to severe damages of lungs, development of warm and pulmonary insufficiency, disability that causes its medico-social importance for professional pathology and pulmonology.
Reasons of an antrakoz
Treat the main mechanisms defining risk of development of a coal pneumoconiosis: concentration of coal dust in air, an experience of production harm, and also existence of the contributing factors. Usually strikes miners, employees of the mining and processing works and the coke-chemical plants which worked in coal branch not less than 15-20 years. More often and earlier kliniko-radiological changes develop at the faces tied with extraction of anthracite is more rare - the breeds having smaller extent of carbonification (stone, brown coal). Along with antrakozy other pneumoconiosis, first of all, or since dust of coal mines often has silicon dioxide impurity can occur at workers of the coal industry. As the additional factors increasing risk of development of an antrakoz serve the accompanying smoking, non-compliance with requirements of labor protection, violation of technological process of coal mining, chronic respiratory diseases, etc.
The smallest particles of coal dust get into an organism in the inhalation way. A certain part of them settles on mucous nasopharynxes, a trachea and bronchial tubes and by means of movements of eyelashes of a vibrating epithelium and the formed slime leaves outside. At high concentration and an intensive exposition dust particles get into the lower airways where are found in a gleam of alveoluses, macrophages and cages of an alveolar epithelium. With current of a lymph of a particle of coal also other lymphatic glands can be transferred in regionarny (bronchial, trakhealny, bifurcation). At an antrakoza the surface of a lung takes a characteristic spotty form and gray-black color. The constant irritation of bronchial tubes coal dust causes development of chronic catarrhal bronchitis, and adjournment of coal masses in interweft fabric - deskvamativny interstitsialny pneumonia with the subsequent outcome in cirrhosis of lungs.
On the basis of patomorfologichesky and kliniko-radiological changes in pulmonary fabric distinguish 2 forms of a coal pneumoconiosis: spotty (benign antrakozny fibrosis) and the progressing massive fibrosis of lungs. The current of a spotty antrakoz which is slowly progressing and rather favorable. In lungs there are single local centers of coal pigmentation in the form of "anthracitic spots". Fibrosis of pulmonary fabric is expressed poorly; nevertheless, owing to an ektaziya of terminal bronchioles local tsentrilobulyarny emphysema develops. Serves as a kind of this form knotty spotty at which radiological in pulmonary fabric small knots up to 1 cm in size are defined.
The progressing massive fibrosis of lungs usually develops at patients with interkurentny complications (for example, tuberculosis of lungs). In an etiology of this form of an antrakoz the role of the immunocomplex mechanism of damage of pulmonary fabric is not excluded - as the proof of it serves the frequent combination of the coal pneumoconiosis and rheumatoid arthritis which received the name of a syndrome of Kaplan and Colin. The progressing massive fibrosis has an adverse current; in the final of this form of an antrakoz there is a change of structure of tissue of lungs as "bee honeycombs" (a so-called "cellular lung"), pulmonary heart is formed. Warm and pulmonary insufficiency becomes a cause of death of patients, as a rule.
Symptoms of an antrakoz
Features of a clinical current of an antrakoz are defined by expressiveness of bronchitis, emphysema and fibrosis of lungs. On the basis of a kliniko-radiological picture in development of a pneumoconiosis of coal miners allocate three stages.
Symptoms can be absent or be presented by bystry fatigue, cough, short wind at physical efforts to the I stages and thorax pains. According to a X-ray analysis in average departments of lungs melkoochagovy shadows with a diameter from 1 to 3-5 mm are defined; roots of lungs are expanded; the pulmonary drawing is deformed.
Short wind at rest, increase of the general weakness, preservation of cough and a torakalgiya is typical for the II stage of an antrakoz. Radiological changes include increase in number and the sizes of melkoochagovy shadows, the expressed emphysema, a pleura thickening.
The III stage of an antrakoz proceeds with the expressed signs of respiratory insufficiency. At the progressing massive fibrosis it can be observed – the expectoration of a phlegm of black color caused by break of fibrous cavities in airways. Serve as heavy complications of the progressing form of an antrakoz pulmonary hypertensia with right ventricular insufficiency. On roentgenograms of lungs separate massive blackouts up to 5-10 cm in size against the background of multiple melkoochagovy educations and a phenomenon of "honey honeycombs" are defined. Sometimes in the center of large shadows antrakotichesky cavities are visible.
Patients with antrakozy and other karbokonioza are in risk group on development of tuberculosis of respiratory organs. Pulmonary it can be combined with antrakozy skin – adjournment of particles of coal in a term.
Careful collecting the occupational history is necessary for the correct definition of a form of a pneumoconiosis. In favor of an antrakoz the instruction on long contact with coal dust testifies. Fizikalny inspection reveals a barrel-shaped shape of a thorax, weakening of breath, obtusion of a perkutorny sound. Primary stage of tool diagnostics includes a thorax X-ray analysis, however for specification of genesis of focal shadows, additional carrying out KT of lungs is required.
The spirometry allows to judge extent of malfunction of external breath, and a research of gas composition of blood – expressiveness of respiratory insufficiency. Quite often the exception of other pathology of lungs requires carrying out a bronkhoskopiya with a transbronchial biopsy of pulmonary fabric.
Treatment of an antrakoz
At establishment of the diagnosis of an antrakoz, first of all, it is necessary to exclude contact of the patient with the harmful agent – coal dust. The issue of the translation of the patient and less dusty site of work (is resolved at the I stage), change of professional activity or assignment of disability (at II and III stages). Besides, patients are recommended to avoid contact with any dust, to be careful of viral infections, to limit physical activities, to refuse smoking. Specific treatment of an antrakoz it is not developed, therapy has symptomatic character. Depending on a stage of an antrakoz and expressiveness of clinical manifestations, bronchial spasmolytics, steroid medicines, vitamin therapy are appointed. From physiotherapeutic techniques inhalation therapy, perkutorny massage of a thorax is effective. At the expressed signs of respiratory insufficiency the kislorodoterapiya is shown.
Forecast and prevention
Antrakoz – slowly progressing disease, however is later than it identification or accession of complications predetermine a failure. Spotty has more favorable current in comparison with the progressing massive fibrosis. At the I stage of an antrakoz patients keep working capacity; at II and III stages the forecast concerning working capacity is doubtful. Patients with antrakozy have to be under careful observation of the pulmonologist and pathologist; if necessary to consult the phthisiatrician. Prevention of a coal pneumoconiosis consists of holding the technical actions directed to reduction of release of dust during the driving works, minimization of contact of workers with coal dust, use of individual protection equipment (respirators). The persons subjecting to influence of carboniferous dust have to have periodic medical examinations.