Asbestosis is the form of a pneumoconiosis which is developing as a result of a long ingalirovaniye of asbestsoderzhashchy dust and characterized by diffusion fibrosis of pulmonary fabric. The clinic of asbestosis consists of all-somatic violations (an indisposition, fatigue, anorexia), signs of respiratory insufficiency (short wind, cyanosis, deformation of trailer phalanxes of fingers), symptoms of damage of respiratory organs (cough with a mucous phlegm, a pleural syndrome). For diagnosis of asbestosis X-ray, KT of lungs, spirometry, a research of a phlegm and washing waters of bronchial tubes is used. At asbestosis the supporting therapy (respiratory gymnastics, physical therapy, oxygenotherapy) is carried out.
Asbestos pneumoconiosis, or asbestosis – the diffusion interstitsialny pneumosclerosis caused by inhalation of asbestos particles. Along with talkozy treats silikatoza – the damages of lungs caused by impact on pulmonary fabric of compounds of silicon acid. Asbestosis is observed at the persons occupied with production and processing of asbestos, and also working with asbestos materials. The greatest prevalence of an asbestos pneumoconiosis is registered in Canada – the country holding a world championship on asbestos reserves. Frequency of developing of asbestosis increases in proportion to increase in time of contact with this material and averages 25-65% of cases. Danger of asbestosis consists not only in development of diffusion fibrosis of pulmonary fabric, but also the terrible remote consequences – the increased risk of development of an asbestotuberkulez, mesothelioma of a pleura and a peritoneum, an adenocarcinoma of lungs and a stomach.
As immediate cause of this form of a pneumoconiosis serves long inhalation of fibers of asbestos. At the same time asbestosis can develop both at length of service less than 3 years, and 15-20 years later after the termination of professional contact with asbestos dust. Asbestos is the fine-fibered mineral presented by hydrosilicate of magnesium, iron, calcium and sodium. Among various kinds of asbestos serpentine-asbestos (chrysotile and antigorit), and also amfibol-asbestos (amosite, antofillit, crocidolite, tremolit) have the greatest industrial value – the last differ in a bigger fibrogennost and carcinogenicity.
By the nature of the professional activity in close contact with asbestos there are workers occupied in asbestodobyvayushchy and processing industry, the building, mechanical, ship-building, aviation industry. These persons make group of the increased risk on development of asbestosis. Besides, cases of incidence of asbestosis at rather short and not intensive influence of asbestsoderzhashchy dust are known, for example, among the women washing working clothes of husbands, or the painters and electricians working indoors where asbestsoderzhashchy materials are applied. Except professional, the household contact with asbestos when using children's powder or asbotekstilny products in houses is possible. It is known that smoking promotes developing of asbestosis, its bystry progressing and a heavy current.
The mechanism of development of pulmonary fibrosis at asbestosis remains not clear. In pulmonology it is accepted to consider several versions of developing of a disease: mechanical irritation of pulmonary fabric needle fibers of asbestos, damage of alveoluses by the released silicon dioxide, cytotoxic effect of asbestos concerning macrophages, development of immunopathological reactions, etc. Distinguish pulmonary and pleural forms of asbestosis. From the point of view of morphological changes in lungs, asbestosis passes two phases in the development: deskvamativny alveolit and bronkhiolit. Pneumofibrosis (pneumosclerosis) has interstitsialny character, is localized mainly in average and the lower shares whereas in the top departments emphysema is defined. Existence of rough pleural unions, sometimes a pleural exudate is characteristic of asbestosis. In a phlegm, and also a pulmonary parenchyma existence of asbestos little bodies comes to light, however it only confirms the fact of contact with asbestos dust, but is not the basis for establishment of the diagnosis. At a pleural form of asbestosis the isolated damage of a pleura at an intact pulmonary parenchyma is noted.
Expressiveness of symptoms of asbestosis depends on duration of influence of asbestos particles and their concentration in air. It is considered that at an experience of professional harm 3-4 years develop an easy form of asbestosis, 8 years – medium-weight, 10 and more years – a severe form. As well as the current of other pneumoconiosis, clinic of asbestosis is characterized by chronic bronchitis and symptoms of emphysema of lungs. All complaints and objective manifestations keep within three groups of symptoms: all-somatic, signs of damage of respiratory organs and respiratory insufficiency. Nonspecific symptoms are presented by an indisposition, fatigue, pallor, weakness, anorexia and loss of weight. Quite often on hands and legs there are warty outgrowths – so-called "asbestos warts".
On involvement in pathological process of airways and a pleura specifies emergence of cough unproductive or with a poor mucous phlegm and severe pains in a thorax. In hard cases short wind is expressed, cyanosis develops, the thickening of nail phalanxes of fingers of hands is defined. Development of the ekssudativny pleurisy having serous or hemorrhagic character is possible.
The course of asbestosis quite often is complicated by the pneumonia, a bronkhoektatichesky disease, bronchial asthma, pulmonary heart which are making heavier the forecast of a pneumoconiosis. Most often death of patients occurs from respiratory and warm and pulmonary insufficiency. Correlation of asbestosis with rheumatoid arthritis is noted. Against the background of asbestosis at patients the risk of development of tuberculosis of lungs (mainly, its focal form), cancer of a lung, malignant mesothelioma of a peritoneum and a pleura, cancer of a gullet, a stomach and a thick gut several times increases.
Examination of patients with suspicion on a pneumoconiosis is conducted by the pulmonologist with the assistance of the pathologist. In establishment of the diagnosis of asbestosis the crucial role belongs to studying of a professional route and existence of the data indicating influence of asbestos dust. At an auskultation rattles, noise of friction of a pleura are listened damp melkopuzyrchaty (sometimes dry). Over the top departments of lungs the box sound is perkutorno defined. In blood tests acceleration of SOE, a gipergammaglobulinemiya, the Russian Federation, anti-nuclear antibodies, decrease in level of oxygen in arterial blood can come to light.
Are radiological signs of asbestosis linearly - mesh deformation of the pulmonary drawing, radical fibrosis, pleural changes (plaques, unions, an exudate), in late stages – "a cellular lung". At doubtful results of a X-ray analysis of lungs I resort to carrying out KT of lungs of high resolution allowing to consider authentically subpleural linear, focal or irregular shape of a shadow.
The research of function of external breath at asbestosis indicates prevalence of restrictive violations over obstructive (reduction of ZhYoL and respiratory volume, etc.). In view of similarity of a kliniko-radiological picture of asbestosis with other pneumoconiosis, the differential diagnosis is carried out with antrakozy, gemosiderozy lungs, stannozy, talkozy, a fibroziruyushchy alveolit, etc. diseases. The microscopic analysis of a phlegm, a research of washing waters of bronchial tubes, a bioptata of pulmonary fabric in which find asbestos little bodies and fibers is for this purpose conducted.
Treatment of asbestosis
As changes in lungs at asbestosis are irreversible, the disease is treated symptomatic. First of all, it is necessary to stop completely contact with asbestos, to get rid of nicotine addiction, to exclude considerable physical activities. In order to avoid accession of the infections which are making heavier respiratory insufficiency vaccination against flu and a pnevmokokkovy infection is recommended. The supporting therapy is directed to relief of symptoms; it includes a posturalny drainage, massage of a thorax, medicinal inhalations, respiratory gymnastics, physical therapy, if necessary – a kislorodoterapiya. Drug treatment assumes use of inhalation bronkhodilyatator, reception of vitamins.
Forecast and prevention
At development of complications forecast for working capacity and satisfactory quality of life not encouraging: the probability of an invalidization, development of serious associated diseases and death of patients is high. Prevention of asbestosis consists of measures of production and medical character. The first of them assume providing the required sanitary and hygienic conditions and individual protection of workers, observance of safety measures. All workers who are in contact with asbestos or asbestsoderzhashchy materials have to have periodic medical examinations according to the established scheduled plan. Considering the increased risk of development of tuberculosis and malignant tumors against the background of asbestosis, observation at the phthisiatrician and the oncologist is recommended to patients with the established diagnosis.