Byssinosis is the chronic occupational disease of a respiratory path resulting from contact with dust of spinning raw materials. On a clinical current reminds bronchial asthma: it is shown by short wind, cough, passing obstruction of airways. For the purpose of diagnostics function of external breath is investigated, beam methods are used (a X-ray analysis, thorax KT), immunoassays are carried out. Depending on a disease stage the positive effect is reached by an exception of action of harmful factors, purpose of bronchial spasmolytics, corticosteroids, metilksantin, oxygenotherapy.
Byssinosis - rare professional pathology of the people occupied with processing of vegetable raw materials (cotton, flax, jute, hemp, and other spinning plants). Treats group of a pneumoconiosis. The name comes from the Greek word "byssos" meaning "cotton". Synonyms – factory cotton fever, hempen fever. In English-speaking sources is called as "a disease of a brown lung". The pneumoconiosis is widespread on all continents, mainly in regions of a lnovodstvo and cotton breeding. Comes to light at 6-50% of workers of textile productions. It is closely connected with working conditions. Men and women are subject to development of byssinosis equally.
The major etiologichesky factors of emergence of a syndrome of a bronkhoobstruktion are the microparticles of fibers of cotton, jute, flax, hemp getting into airways. Organic compounds, a small share of minerals are their part, surely there are microorganisms and mushrooms. The highest incidence is observed at the persons occupied with preprocessing of low-grade raw materials with length of service of 4 years and more. Intensive tobacco smoking serves as the additional factor promoting emergence of a pneumoconiosis. The accompanying chronic bronchitis, bronchial asthma, other pulmonary pathology accelerate development and aggravate weight of a course of disease. Aggravations are provoked by pollution of atmospheric air, hot, damp weather, fog.
The pathogenesis is insufficiently studied. Experts in the field of professional pathology and pulmonology adhere allergologichesky and, to a lesser extent, to the immunopathological theory of development of byssinosis. The bronchospasm is connected with hypersensitivity of the I type, as at bronchial asthma. Reactions with formation of immune complexes and clinical manifestations as an alveolit are less characteristic. The specific changes inherent only in byssinosis, at a patomorfologichesky research are not defined. At autopsy of the dead from the started form of a disease reveal emphysema, a diffusion pneumosclerosis, the changes characteristic of chronic bronchitis, signs of pulmonary heart. Often find local and widespread bronkhoektaza.
The current of a pneumoconiosis depends on duration of contact with harmful substance. At continuous influence of a harmful factor byssinosis slowly progresses. The disease proceeds step by step. At each subsequent step symptoms amplify, disturb the patient during longer temporary period. Being guided by the frequency, intensity and duration of clinical manifestations, byssinosis is divided into the following stages:
- Stage 0. There is a contact with vegetable dust, but complaints are absent.
- Stage 0-I. Signs of a bronchospasm appear incidentally, usually after a long absence in a workplace. Quickly pass independently.
- Stage of I. The weekly aggravations arising after every weekend and the proceeding no more days are observed.
- Stage of II. Symptoms remain for several days or all working week.
- Stage of III. The continuous manifestations characteristic of chronic pulmonary pathology are observed.
For the first time occupational disease has an effect in 4-10 years from the beginning of work. Attacks of the complicated breath, feeling of constraint in a breast appear in 1-2 hours from the beginning of work, arise after the holiday, the days off. This feature received the name "syndrome of Monday". Patients note irritation in a throat, difficulty of a breath and exhalation, weight and pressure in a breast. At an auskultation rigid breath is listened, there are no rattles usually. At the initial stage signs are independently stopped after the end of labor change.
If not to stop harmful effects, byssinosis gradually progresses. At first attacks of suffocation last several days, then full working week. Cough with a small amount of the hardly separated light mucous phlegm is added to short wind. The dry whistling rattles are defined by Auskultativno. Breath frequency increases. Violation of bronchial passability promotes accession of the infection aggravating a course of disease.
At a final step of pathological process cough with short wind become invariable companions of the patient. Symptoms gradually lose touch with professional activity, disturb the patient in time off. The phlegm is produced in bigger quantity, at accession of an infection gets yellow or green coloring. Short wind at first arises at physical activity, later disturbs constantly, including at rest. At any time it is possible to listen to a lot of the dry whistling and buzzing rattles.
Specific forms of manifestation of a pneumoconiosis from vegetable microparticles are described. One authors consider them sharp byssinosis, others recognize as independent nozologiya. Cotton factory fever is shown by a fever, an indisposition, cold in the first days of working week. Recovery occurs within several days. At cough of weavers the bronkhospastichesky syndrome in total with a hyperthermia develops. The workers contacting to low-grade cotton wool have mattress fever. Symptoms of the general intoxication and gastrointestinal frustration prevail. Similar feverish states unite in the general syndrome of toxic organic dust.
At a timely exception of influence of the harmful agent of an aggravation stop, complications do not manage to develop. The patient completely recovers. Late revealed byssinosis leads to formation of chronic pulmonary heart. Except the constant amplifying from loading of short wind, the patient is disturbed by zagrudinny pains of the aching character, tachycardia. Because of stagnation on a small circle of blood circulation the liver increases, the feeling of discomfort in the right podreberye appears. Hypostases of the lower extremities which are hardly stopped by medicines join. Partial loss of ability to independent movement, self-service is observed.
The accurate interrelation of symptoms with work allows to establish the nature of occupational disease. "the syndrome of Monday" is typical for byssinosis. For the purpose of early identification questioning is carried out. Help to specify the diagnosis and to differentiate byssinosis with other bronchopulmonary pathology additional methods of a research:
- Spirometry. Allows to estimate function of external breath, reversibility of a bronchospasm. In a debut of a disease of changes on a spirogramma is not present. At the second stage indicators decrease, but they are reversible and raise after use of an inhaler with bronchial spasmolytic. In the started cases there are signs of respiratory insufficiency: parameters of external breath steadily low, reaction to bronkhorasshiryayushchy medicine is absent.
- Pikfloumetriya. By means of a portable pikfloumetr monitoring of volume and high-speed indicators of the house and on production is possible. Variability of values is estimated. At byssinosis the dispersion of key parameter during the working day is more, than during week-end, holidays or during the holiday. At further progressing of pathology daily variability disappears.
Methods of radiodiagnosis have auxiliary value. Radiological signs, specific to byssinosis, do not exist. The X-ray analysis and KT of bodies of a thorax help to find existence of bronkhoektaz, emphysema and other pulmonary complications. Definition of the general and specific IGE, prik-tests allow to reveal a sensitization to pollen, food, household and epidermalny allergens and to distinguish byssinosis from bronchial asthma. Extent of defeat of the right departments of heart decides on the help of an echocardiography.
Treatment of byssinosis
Prime value in treatment of any pneumoconiosis has elimination of influence of a harmful factor. An indispensable condition in therapy of byssinosis is the exception of contact with components of vegetable dust. Change of working conditions is enough for recovery at early stages of pathological process. Patients with the started forms are observed at the pulmonologist, receive pathogenetic treatment by inhalation and system corticosteroids, bronchial spasmolytics, metilksantina, a kislorodoterapiya. Local bronkhoektaza are removed in the surgical way. In the absence of contraindications operation is carried out in the low-invasive videotorakoskopichesky way. In a terminal stage transplantation of the heart lungs complex is possible.
Forecast and prevention
Byssinosis of the I-II stage is completely curable. Correctly picked up pathogenetic therapy allows to increase considerably duration and quality of life of patients with the III stage of a disease. Improvement of working conditions helps to prevent developing of byssinosis. Workers need to use individual means of protection. Regular routine inspections by the pathologist help to reveal in due time a pneumoconiosis, to suspend further deterioration in a state.