Diagnosis of occupational bronchial asthma. Symptoms of occupational bronchial asthma

Many researchers in increasing the number of biologically active influences in the environment modern man environment see one of the reasons for the increase in morbidity allergic diseases, including bronchial asthma. In this case, a large role is given to the intensive chemicalization of industry, the use of household chemicals, and the uncontrolled use of medicines, widespread vaccination of the population, etc. Due to the massive and selective contact of the population with industrial allergens in production conditions, the problem of occupational bronchial asthma acquires not only medical and biological, but also social and hygienic significance.

Bronchial asthma is not a specific occupational disease, but often observed in various production conditions and etiologically associated with the influence of certain factors in the production environment, asthma is an independent nosological form of occupational pathology and at the same time one of the types of “general” bronchial asthma. Therefore, many issues of pathogenesis, classification, clinical picture and treatment relate to both general and occupational bronchial asthma.

In the development of the allergic process in occupational bronchial asthma, as well as in general asthma, three stages are distinguished: I - immunological, II - pathochemical, III - pathophysiological.

Taking into account the antigenic structure of the industrial allergen and the clinical and pathogenetic features of the allergic process, it is most appropriate to theoretical aspect, and in terms of practical significance, it seems to highlight the following clinical variants of occupational bronchial asthma that developed as a result. exposure to chemical allergens and allergenic organic dust (fur, cotton, flax, flour, tobacco, grain dust and natural silk allergen):

1) bronchial asthma, similar to the atopic form,

2) bronchial asthma with combined sensitization to occupational and bacterial allergens,

3) asthmatic bronchitis.

Despite the similarities in issues of etiological diagnosis, bronchial asthma, which developed as a result of exposure to chemical allergens: metal sensitizers chromium, nickel, cobalt, manganese, as well as formaldehyde, rosin, epichlorohydrin, ursol, platinum, diisocyanates, polymer compounds, lubricants, etc. has some features.

Occupational bronchial asthma of the atopic type, which developed as a result of exposure to chemical allergens, usually affects workers with extensive work experience (10 years and above) aged 30-56 years, who do not have a history of hereditary-constitutional predisposition to allergic diseases.

Occupational bronchial asthma atopic type quite often preceded by allergic lesions of the skin and upper respiratory tract that arise in the first months and years of working with chemical allergens. The simultaneous development of allergic skin lesions, upper respiratory tract and bronchial asthma is also common. This combination is a mandatory symptom complex when exposed to platinum salts, and also occurs upon contact with formaldehyde-containing polymers, chromium salts and other allergens. You should pay attention to the fairly common combination of bronchial asthma with upper respiratory tract allergies, which precede asthma in approximately 1/3 of cases, and with the same frequency join asthma later.

In the second variant of bronchial asthma, characterized by combined chemical and bacterial allergies, the development of asthma is also often preceded by infectious and inflammatory diseases of the respiratory system in the form of repeated respiratory infections, acute bronchitis or pneumonia. Unlike patients with the first option, bacterial and chemical allergens in these cases have a combined sensitizing effect. In this regard, it is not possible to identify the primary pathogenic factor that caused sensitization of the body.

In the clinical picture of this variant of the disease, there are simultaneously signs of bacterial allergy and allergy to an occupational factor, which greatly complicates the solution of diagnostic and labor examination issues. Characteristic feature The course of this type of bronchial asthma, in contrast to the first option, is the absence of elimination symptoms. Attacks of suffocation in patients in this group are not replaced by complete remission when removed from contact with the industrial allergen. This nature of asthma is due to bacterial allergies and symptoms inflammatory process in the bronchial tree, determining the severity of the process. The clinical course of the disease is dominated by signs of infectious-allergic bronchial asthma. Patients, as a rule, secrete mucopurulent sputum, which can be bacteriologically examined to identify pathogenic flora. In this case, low-grade fever and slight leukocytosis in the blood are quite rare. The level of eosinophilia in peripheral blood in this group of patients is higher than in the previous one. Severe course of the disease, development of severe respiratory failure and lack persistent remissions explains the rather rapid development of emphysema and cor pulmonale in patients with the second variant of occupational bronchial asthma. With this variant of the disease, the same pattern of combination with allergic changes in the upper respiratory tract and skin remains.

Characteristic for patients in this group, and unlike exposure to chemical allergens, is the absence of a history of respiratory infections preceding the development of asmatic bronchitis and asthma. During the period of monovalent allergy, bronchial asthma due to exposure to organic dust, as well as from chemical allergens, proceeds according to the atopic type with a clear symptom of elimination and exposure. With timely employment, patients experience fairly rapid and complete reverse development allergic process even in severe cases of the disease. Complications of microbial allergies are observed, as a rule, in long-term workers after repeated respiratory infections and other inflammatory diseases of the respiratory system. Bronchial asthma in these cases takes a more severe course, with the development of severe attacks of suffocation, not only when performing work, but also when removing contact with the industrial allergen. Rational employment does not bring relief to such patients, and their prognosis is more serious. Quite early development of infectious allergies (bacterial and fungal) and the appearance of foci of infection are especially characteristic of exposure to cotton dust, abundantly contaminated with bacteria and fungal spores, as well as for grenage work due to unfavorable microclimatic conditions. If you have a long history of working in contact with an industrial allergen and the presence of an allergy to it, revealed during examination, the disease in such cases should be regarded as occupational.

Severe forms of bronchial asthma are not typical for patients who worked with tobacco dust. When removed from contact with dust, even with quite severe attacks of suffocation, the disease usually undergoes reverse development.

Dust of plant and animal origin can also lead to the formation of not only bronchial asthma, but also asmatic bronchitis, characterized by the presence bronchospastic syndrome, signs of an allergic process (eosinophilia in the blood and sputum) and the absence of extensive attacks of suffocation.

Depending on the route of entry into the body, some types of organic dust, as well as chemical allergens, can cause not only allergic damage to the respiratory system, but also to the skin. For example, eczema, dermatitis, urticaria, and allergic rhinitis are often observed in winders, steamers, tyers of coco-winding production, workers in tobacco fermentation plants and tobacco growers, in whom the allergen gets on both the skin and through the respiratory tract. In workers of cotton spinning plants, tobacco factories, and grain processing enterprises, when an allergen enters the body only through the respiratory system allergic lesions not observed on the skin. Bronchial asthma in these industries is often combined with atrophic and subatrophic changes in the upper respiratory tract.

Diagnostics . Of great importance in establishing the diagnosis of an occupational disease, including occupational bronchial asthma, is the sanitary and hygienic characteristics of working conditions, which gives an idea of the duration of contact of the worker with production factors, the nature of the allergen, the route of penetration into the body, and the concentration in the air. Further diagnostics to establish the genesis of the disease is aimed at studying allergic history, which helps to clarify the role of heredity, household, pollen and bacterial sensitization and mainly the connection of the disease with exposure to industrial allergens. Primary care provides some assistance in establishing the timing of the development of allergies when performing work and fairly rapid clinical improvement when contact is interrupted. medical documentation in the form of an extract from the medical history, data on the patient’s attendance at medical institutions and periodic materials medical examinations.

In general, the results of studying the professional, allergic history and development of the disease determine the feasibility of conducting a special allergological examination and allow us to presumably navigate the selection of diagnostic allergens necessary for carrying out targeted specific diagnostics. That variant of bronchial asthma, which is similar to the atopic non-occupational form, is characterized by the presence of a positive elimination symptom ( significant improvement state or cessation of attacks upon separation from an industrial allergen) and exposure (development of attacks of suffocation upon contact with an industrial allergen), without presenting significant difficulties in diagnosis. In order to clarify the role of the professional factor, as the last stage of the examination, patients undergo specific allergological testing.

There is no need to examine the patient during periods of prolonged and frequent exacerbations of bronchial asthma and severe general condition, when a provocative inhalation test is contraindicated, laboratory-specific methods should also be used immunological diagnostics that do not require the direct participation of the patient.

All methods of specific in vitro immunological diagnostics are based on identifying the antigen-antibody reaction or on the interaction of the antigen with lymphocytes that realize delayed-type hypersensitivity.

In conclusion, it should be noted that only an integrated approach, including the collection of an occupational and allergological history, relevant documentation, on the basis of which one can get an idea of working conditions and the dynamics of the disease, the results of special allergological and immunological examinations, makes it possible to establish the occupational genesis and etiology of bronchial asthma and decide questions medical labor examination.

Evidence supports the occupational etiology of bronchial asthma the following facts: 1) presence of contact with an industrial allergen; 2) possible combination asthma with other clinical manifestations occupational allergies: damage to the skin, upper respiratory tract; 3.) the presence of elimination and exposure symptoms in the clinical course; 4) positive reaction of patients to skin tests, and, if necessary, to a provocative inhalation test with an industrial allergen; 5) positive results of immunological reactions (mandatory research when exposed to chemical allergens).

Treatment . In patients with occupational bronchial asthma of the atopic type, an essential point in complex therapy is timely employment away from contact with industrial allergens, dust, irritants. Considering the lack of such patients obvious signs inflammatory process in the respiratory organs, during treatment, bronchodilator mixtures should be prescribed in powders (aminophylline 0.15 g, platiphylline 0.003 g, papaverine 0.03 g, ephedrine 0.025 g), in the form of mixtures (marshmallow root infusion 6 g per 200 ml of water, aminophylline 1.2 g, diphenhydramine 0.5 g), by injection (into a vein 5-10 ml of a 2.4% solution of aminophylline along with 10-20 ml of 20 or 40% glucose solution, into a muscle - 1-1.5 ml 24 % solution of aminophylline in combination with 0.2% solution of platyphylline 1 ml, 2% solution of papaverine - 2 ml and 5% solution of ephedrine - 0.5-1 ml). Along with bronchodilators, antihistamines (tavegil, diazolin, suprastin, diphenhydramine) and expectorants (thermopsis, marshmallow, ipecac, potassium iodide) are prescribed.

Patients with bronchial asthma in combination with chemical and bacterial allergies, along with bronchodilators in the form of complex compositions in powders and injections for persistent attacks of breathlessness, are prescribed intravenous drip infusion of aminophylline, corglycone, heparin, suprastin and 0.85% sodium chloride solution. With the current infectious-inflammatory process in the bronchial tree, it is recommended to prescribe antibacterial drugs, taking into account the patient’s tolerance and the results of microbiological examination of sputum.

Having achieved the cessation of asthma attacks, in the future it is advisable to use the disodium salt of chromoglycate (intal) in a dose of 4 to 6 drops per day, which is most effective for bronchial asthma of the systolic type. In some cases, during the period of remission of the disease, treatment with histaglobulin, which gives fairly long-lasting remissions, can be recommended. Treatment begins with a dose of 0.5 ml subcutaneously once a day. If the drug is well tolerated, after 2-3 days (under monitoring the patient’s well-being), histaglobulin injections are repeated, gradually increasing the dose. There are 10-12 injections per course.

If there is no effect from the conducted therapeutic activities You can prescribe steroid hormones in the form of inhalations (becotide 2 puffs 5-6 times a day), orally or by injection (prednisolone, urbazone, polcortolone, triamsinolone, dexazone, etc.). The dose of the drug is selected depending on the patient’s condition and his tolerability. Along with these medications, it is necessary to pay attention to the use cardiovascular drugs, potassium supplements, diuretics.

Among the methods of specific pathogenetic therapy A special place is occupied by hyposensitization, which is successfully used in the general clinic for atopic bronchial asthma. For occupational allergies, this method has not found wide application.

When resolving issues of medical and labor examination, a patient with occupational bronchial asthma must first of all be removed from contact with an industrial allergen and transferred to work that is not associated with exposure to substances with sensitizing and irritating effects. A clinical expert opinion requires an individual approach and depends on the severity of the process, the clinical course of the disease, the patient’s age, profession and concomitant pathology.

With occupational bronchial asthma of the atopic type, patients should be recommended rational employment and timely retraining. If transfer to another job is associated with a loss of qualifications and a decrease in the amount of work, then the patient is referred to the VTEK to determine the degree of disability. In case of more severe occupational bronchial asthma with the presence of bacterial allergies and an infectious-inflammatory process in the bronchial tree, when there is a need to limit work ability, the VTEC authorities can use, along with establishing the percentage of loss of ability to work, to determine the disability group for an occupational disease, the duration of which is determined by the further course of the disease. diseases.

Obstructive processes in the respiratory system associated with exposure to occupational irritants are called occupational bronchial asthma. The disease develops after several years of addiction to the allergic agent. Provoking factors are substances of organic and inorganic origin. Since people's contact with industrial irritants is becoming widespread, the problem has great value not only from a medical, but also from a hygienic and social point of view.

Etiology

During the studies, more than several hundred substances that could provoke the disease were recorded. Occupational bronchial asthma belongs to the category of pathologies that are diagnosed by allergen determination. This plays a role not only in treatment, but is also important from the legal side when it is necessary to transfer the patient to another job or register a disability.

The release of a large number of agents into the air environment is explained by imperfect technological processes in production, which includes poor sealing, ventilation, cleaning, and disposal. According to the latest data, it is customary to divide all factors related to pathology into trigger and inducer factors. The first agents are not capable of causing inflammation of the respiratory system, unlike the second, but lead to obstruction against the background of existing diseases. Traditionally, occupational bronchial asthma is diagnosed according to the following etiological list:

Protein substances of animal origin: agricultural workers, veterinarians, research staff
Dyes: fabric and fur production, hairdressing, cosmetics and perfumes
Protein elements of plant origin: food industry, farming, grain growing, bakeries, textile workshops
Wood dust: carpentry, furniture and woodworking industries.
Colophon resin: electricians, radio electronics engineers
Enzymes, enzymes: pharmaceuticals, production of cosmetics, detergents, active additives
Sensitizing metals and halogens: builders, welders, metallurgists, thermal power engineers
Polymers: production of glue, plastics, varnish, polyurethane
Antioxidants and latex elastomers: workers in the engineering industry
Rubber: rubber production
Isocyanate substances: roofers, construction workers, repair crews
Active substances of drugs: doctors, veterinarians, pharmacists.

In addition to professional etiological factors, there is an indicator of predisposing causes. Genetic predisposition, climatic conditions, bad habits, and low standard of living increase the risk of development and complications. Often there is a combination of several provoking agents at once, which aggravates the course of the disease and is more difficult to diagnose and treat.

Pathogenesis

The impact of allergic substances on the respiratory system leads to a multi-stage complex of body responses. Research has revealed that occupational bronchial asthma is characterized by various immunological disorders. Depending on the type of contact with the antigen, primary and secondary reactions are distinguished. Occupational pathologies refer to the type that develops after repeated exposure to the same agent.

The body's gene memory stores information about long-existing lymphocyte clones that are in the semi-active phase and are responsible for collecting data. Because of this, antibody synthesis occurs three days after the shock. In a dependent response, recognition receptors bind to the antigen, which is then taken up and digested by phagosomal lymphocytes. As a result, the resulting peptides return to the surface, which leads to stimulation of helper cells, proliferation and transformation into producing plasma cells.

When allergic agents and reagents interact, degranulation occurs with the release of sirotonin and histamine. These substances affect the manifestation of shortness of breath, spasm, and insufficiency. The mediator between all reactions is the adenyl cyclase enzyme associated with cell membranes, which promotes the transition of adenosine triphosphoric acid into the cyclic form. The inferiority of this mechanism can also influence the development of the disease as a trigger factor.

The classification involves division into three types: allergic, non-allergic and mixed occupational bronchial asthma. The first type is characterized by a latent period, implying prolonged exposure leading to the body’s addiction. The second form is characterized by the absence of immune mechanisms. Here the leading role is played by the direct influence of irritant irritants on the bronchi, which releases histamines. The third type is the participation of a combination of factors.

Atmosphere working area contains allergens and irritants: solvents, gaseous, alkaline, acidic, toxic elements. Each of the mediators leads to inflammation of the mucous membrane, atrophic and destructive processes, and the production of metabolites associated with the synthesis of antibodies.

Clinical picture

The symptoms inherent in occupational pathology do not differ from the signs of a disease of other pathogenesis. Before an attack, preliminary symptoms occur: sore throat, sneezing, nasopharyngitis, shortness of breath. Allergic skin reactions are also possible: itching, rash, redness, inflammatory contact dermatitis, up to swelling.

Further symptoms are expressed in acute attacks during interaction with provoking agents:

Dyspnea obstructive
Sitting position, leaning on your hands, with your torso tilted forward
Accessory muscle tension
Tachycardia
Pale or bluish skin
Breathing whistling
Sputum is viscous, has no impurities, transparent
Conjunctivitis.

The course of each type of pathology has a certain development:

The periodic form of occupational bronchial asthma is characterized by short-term exacerbations that occur no more than once a week. Symptoms are moderate, the difference between spirometry data at 8.00 and 20.00 does not exceed 20%.
The persistent form of the disease is mild, with manifestations two to three times every seven days. The spread of values at the beginning and end of the day is 30%.
Moderate course – daily attacks with sleep disturbance and inability to carry out even minimal physical activity. The spread of spirometry parameters is from 40%.
The severe form is characterized by almost continuous symptoms. The attacks are mainly nocturnal. The difference in indicators exceeds 40%

The specific disease occupational bronchial asthma is distinguished by its modeling manifestations. Initial attacks of suffocation are observed an hour and a half after the patient starts working. They are preceded by characteristic industrial reactions: rhinitis, lacrimation, sneezing, frequent dry cough. Later symptoms begin after 8 hours and can last up to two days. Symptoms of occupational pathology may appear several years before the characteristic signs of bronchial asthma.

When combined with bacterial allergens, the cough has strains of staphylococcus, streptococcus, pneumococcus. In such patients, attacks of obstruction are not followed by periods of remission upon cessation of contact or change of job. Unlike other types, it develops both in the first moments of interaction with the pathogen, but can also be detected after 10 years.

Diagnostics

A patient with a suspected occupational type of asthma requiring treatment should contact a general practitioner, phthisiatrician, pulmonologist, allergist and oncologist. The examination takes into account subjective factors, including human complaints. Objective information implies the following analyzes and tests:

Data on sanitary and hygienic working conditions
The nature of production activities with verification of agents and their activity
Skin scarification with a standard set of allergens
Inhalation provocative tests (during remission)
Enzyme immunoassay test systems
Monitoring expiratory flow and volume
General biochemical examinations
X-ray of the chest cavity
Examination of sputum for bacteria, atypical viruses, microflora status
Computed and magnetic resonance imaging.

An accurate diagnosis of occupational type bronchial asthma and determination of treatment is based on the following criteria:

Confirmation of airway hypersensitivity
Presence of asthmatic precursors
Relationship between symptoms and place of work
Onset of manifestations within 24 hours of exposure to the agent and continuation for at least 3 months
Detection of signs of obstruction
Data from biochemical and instrumental examinations.

Principles of treatment

Therapy for occupational pathology is based on the same principles as general techniques for asthma. A prerequisite is to stop contacting a place whose air is filled with toxic and allergic substances. Main goal treatment consists of controlling clinical manifestations: stopping exacerbations, reducing the risk of complications and adverse reactions.

Complex schemes involve the use of medications, physiotherapy, special gymnastics. The list of medicines includes the following names:

Salbutamol

A bronchodilator drug from the group of beta-two adrenergic receptor ligands. It relieves asthmatic attacks and is suitable for short-term use, so it is not used to prevent symptoms. Inhibits the release of histamines and lipid active elements. Suppresses reactivity and relieves spasm, increases pulmonary capacity during treatment. The product affects the production of secretions and helps with the discharge of sputum. Prevents the activity of inflammatory mediators and improves the functioning of ciliated epithelial tissue of the bronchi.

The effect after administration begins within 5 minutes and lasts for 6 hours. Available in aluminum cylinders for inhalation, in the form of tablets and syrup. The dosage is 2 doses every 4 hours, but not more than 5 times a day. Tablets are taken one unit 4 times a day. Contraindicated in case of problematic pregnancy and pathology of fetal development. Analogs are Fenoterol, Salmeterol, Terbutaline.

Aldecin

Glucocorticoid with anti-inflammatory and antiallergic effect. It is able to suppress the activity of arachidic acid metabolites. Helps transport macrophages and neutrophils into cells, which reduces mucosal swelling and bronchial hyperfunction. When taken, susceptibility to dilators increases and their effect improves. The drug has antitoxic and antishock properties. Suitable for treatment in case of ineffectiveness of xanthines.

Used to suppress an asthma attack in aerosol form. For mild to moderate disease, two doses of inhalation are prescribed three times a day. The severe stage requires double the amount. Contraindicated in cases of infection with strains of tuberculosis and fungi. The drug is prescribed for prolonged attacks and status asthmaticus. Analogues are Beklazon, Rinoklenil, Nasobek.

Montelukast

A new generation bronchodilator with the ability to counteract leukotriene receptors. It inhibits the cysteinyl activity of epithelial cells of the respiratory system, which makes it possible to relieve spasm. Complements the functions of beta-adrenomimetics, retains a dilating effect during treatment for 2 hours. Effective in preventing both nighttime and daytime symptoms. When using, one should take into account the decrease in the properties of drugs of the theophylline group and coagulants.

The dosage is 0.01 g once a day, it is better to take the tablets in the evening. Possible side effects headache, dyspeptic disorders. Contraindication – increased sensitivity to the components.

Ambroxol

A drug that stimulates mucociliary functions and has an expectorant effect. Necessary for violation of the drainage activity of the bronchi. The mucolytic helps the cilia move freely, thereby restoring the formation of secretion with reduced viscosity. By accelerating the production of surfactants, it prevents pathogenic bacteria from entering the respiratory tract. In addition, it can have anti-inflammatory and antioxidant effects. A noticeable clinical effect develops 5 days after the start of treatment.

The dosage is 10 mg/kg body weight in doses divided into 4 doses for respiratory failure. The drug is well tolerated; it is not prescribed only in case of intolerance to the components. Synonyms are Lazolvan, Lindoxil, Mucozan.

Physiotherapy

Treatment in the periods between attacks is based on the prevention of exacerbation and complications of the pathology using the following procedures:

Barotherapy is an effect in the zone of corrected pressure. It is carried out in a sealed chamber with attached pumps. At low values, microcirculation in the vessels improves, at high values, toxins are removed from the lungs faster.
Phonophoresis is intended to stimulate the drainage functions of the bronchi. During the procedure, drugs containing hydrocartisone, calcium ions, and analgesics are used to reduce pain.
Magnetotherapy can improve bronchial patency, increase the body's immune resistance, and normalize respiratory activity.
Climatic treatment is indicated for all patients with a diagnosed occupational form of asthma. A long stay in a coastal or mountainous region ensures sustainable rehabilitation and recovery.
Breathing exercises can improve gas exchange and eliminate oxygen starvation, remove spasm and ensure normalization of secretion production. There are several methods, but they all require prior consultation with a doctor.

Prevention and prognosis

At primary manifestations pathology, it is enough to eliminate the possibility of contact with the allergen for the person to fully recover. A more severe course requires rational employment, outside the zone of action of sensitizing, toxic substances and irritants. In particular difficult cases the patient is assigned a third disability group for the period of retraining.

The main condition for preventing illness is compliance with hygienic and sanitary safety measures in the workplace. It is important to remember about personal protection methods and use all recommended means in a timely manner. The prognosis is poor if a person with symptoms of asthma returns to being in an environment with triggering agents after a course of treatment. Complications of the disease include atelectasis, acidosis, pneumothorax, and dyscirculatory encephalopathy.

People suffering from allergic pathologies or having a predisposition to them are strictly prohibited from working in potentially hazardous enterprises. For this purpose, there must be special methods of professional selection. In addition, all personnel are required to undergo a medical examination twice a year.

Occupational bronchial asthma may result from harmful effects production factor. The disease is characterized by reversible disorders that are closely related to obstructions in the airways and is expressed by specific symptoms.

Most often, occupational asthma occurs under the influence of allergens that promote the production of immunoglobulins E (IgE). Statistics state that this diagnosis occurs in 2-15% of cases of all asthmatic diseases among adult patients.

Causes of the disease

As a rule, the most common is the occurrence of asthmatic syndrome as a result of the following factors:

Elements of chemical origin

nickel, ursols, chromium;
platinum, manganese, cobalt;
formalin, diisocyanate, epichlorohydrins;
preparations for washing dishes, dye;
polymer, pesticides.

Allergens of biological origin

animal waste products;
synthetic materials;
bee products;
helminths, flies.

Vegetable

pollen of flowering plants;
flavored oils;
wood ash, etc.

Medication

hormonal and fermented agents, vaccine;
vitamin concentrates;
antibiotics wide range actions;
sulfonamides, analgesics, etc.

The influence of such elements is quite often interrelated with the effects of toxins, irritating drugs, unfavorable ecological environment, nervous overload and physical stress. These manifestations contribute to an increase in the symptoms of bronchial asthma.

Pathogenesis

The basis of asthmatic diseases is the reagin type of hypersensitivity.

Occupational bronchial asthma, which develops in an atopic form, differs from other forms of autoallergic components in the constant circulation of antigens in lung tissues. In addition, due to cytotoxic processes, anti-tissue antibodies are formed.

IN environment The workplace, in addition to allergens, contains substances that can cause irritation. These chemical components can provoke inflammatory diseases in the bronchial mucosa. This provokes the development of atrophy occurring in the bronchi and increased penetration of metabolites into bloodstream. With such symptoms it is necessary specific treatment.

At the heart of the occurrence bronchial diseases, which resemble asthmatic bronchitis, a compliment-dependent reaction is of no small importance. At this time, there are no typical signs of suffocation, and there is no obvious reagin development of allergies.

Occupations that cause the development of the disease

Most often, occupational disease occurs among the following professions:

paint shop workers spraying isocyanates;
working specialties related to the production of plastics, porous materials and epoxy resins. In these industries there is direct contact with isocyanates, acid anhydrites, and azodicarbonamides;

people baking bread in contact with amylase and flour;
vivarium workers and people associated with laboratory animal research. In this case, there is direct contact with animal proteins and insects. In addition, asthma can occur when animals are treated;
physicians in close contact with latex, glutaraldehydes and methyl methacrylates;
food industry (contacts with allergenic food products);
dishwashers, house cleaners (enzymes);
electronics industry (rosin);
pharmaceutical industry (medicines);

metallurgy, gold mining;

hairdressing salons (chemicals);
printing and laboratory workers, photographers, etc.

These professions involve contact between humans and harmful substances that cause direct irritation. respiratory function as a result of irritation bronchial tree, resulting in the need for specific treatment of the disease.

An attack of the disease can occur instantly with a sharp increase in symptoms, or it can proceed latently, when a person does not even suspect the development of bronchial asthma.

Classification of the disease

It is impossible to unambiguously classify occupational bronchial asthma. However, it can manifest itself in several forms of this disease:

atopic - most often determined in people with a predisposition to allergies;
occupational bronchial asthma is similar to the atopic form, which occurs under the influence of various allergic factors;
chronic types of asthmatic bronchitis;
symptoms resulting from exposure to various fungi.

Diagnosis, manifestations and frequency of repetitions bronchial attacks and complication of diseases are conditionally divided into 3 degrees:

1. Light

Diagnosis of this form is not difficult, although in the intervals between the onset of an attack, symptoms of the disease may not be observed. Mild degree asthmatic disease in the interval between attacks is characterized by hard breathing, the appearance of rare dry wheezing, audible on exhalation.

2. Medium

This stage of the disease is accompanied by moderate shortness of breath and more difficulty breathing, especially during physical exertion. In addition, severe coughing and phlegm may occur. minimum quantity bronchial mucus.

3. Heavy

With a prolonged course of an asthmatic attack, its duration is prolonged and obstruction (blockage) of bronchioles with sputum is observed, which can lead to the impossibility of breathing and death.

Clinical picture

The primary symptoms of the development of occupational bronchial asthma, in which it is necessary compulsory treatment, are:

severe itching;
increased lacrimation and burning in the eye area;

rhinitis;
heavy wheezing;
paroxysmal cough;
interaction with allergens associated with production can lead to the development of angioedema, the appearance of which requires mandatory drug treatment.

This type of disease is characterized by acute attacks of suffocation against the background general health patient. At this stage, the attack is easily controlled by bronchodilators and limiting contact with the industrial allergen.

Diagnostics

To identify an occupational disease, a detailed history and high-quality diagnosis are important. The time when the first symptoms of bronchial asthma appear is of no small importance. When clarifying the cause of a disease related to a person’s work, it is recommended to conduct a number of additional examinations.

Conduct assessments effectively maximum speed expiratory air (EMA) with a special drug. After instructions, the patient can do this independently. The results are recorded after waking up every 2 hours for 4 weeks, indicating the time spent at the workplace in close contact with harmful substances. In a special notebook for recording the results, it is recommended to note the medications that the patient was taking at that time.

After this, the doctor draws up a daily chart with the lowest and highest values.

When deciphering the result, 3 components play the main role:

Maximum increase in minimum and maximum values during operation.
Decrease in average value during operation.
Maximum boost positive result during rest.

Appropriate diagnosis and history of these three characteristics indicate the occurrence of occupational asthma. In addition, to clarify the diagnosis, an intradermal test for a possible allergen can be performed. If the reaction is positive, the final conclusion is that the disease is of an allergic nature.

The presence of IgE in the blood is confirmed by the results of the radioallergosorbent test. However, it should be borne in mind that no diagnosis guarantees a 100% result. Each person is individual, and a positive reaction to an allergy test can occur to another substance. In such cases it is required additional diagnostics provocative test for bronchial response.

All diagnostic measures are carried out in a hospital setting, under the supervision of the attending physician, who, if necessary, is able to provide emergency assistance, because in some cases the introduction of a provoking substance can cause an acute attack of asthma.

Treatment tactics

Main direction therapeutic therapy is to control the symptoms of the disease and achieve a positive result. Treatment is determined by the following tasks:

1. Relief of an asthmatic attack

Most often, an attack is stopped at an early stage inhaled drugs for bronchial opening (Salbutamol, Atrovent, Berotec, etc.).

2. Adequate treatment on a basic basis

In case of acute development of a bronchial-asthmatic condition, emergency treatment using systemic (Prednisolone) as well as inhaled (Clenil, Pulmicort) glucocorticosteroids is recommended. Good effectiveness is shown by the use of combination drugs (Seretide and Symbicort), as well as long-acting antagonists (Salmeterol, Formoterol, etc.).

Antileukotrienes (Singulair, Acolat, etc.), leukotriene blockers (Zileuton) and tableted methylxanthines (Teopek, Theophylline) can be prescribed.

In order for the treatment to be as effective as possible, it is provided individual approach to every patient suffering from bronchial asthma. The choice of medication and the required dosage directly depend on the severity of symptoms and the level of control of bronchial asthma. In case of complicated course of the disease, urgent hospitalization may be required.

Preventive measures

Occupational bronchial asthma in some cases, with early diagnosis and timely treatment can be expressed by minimal symptoms. To do this, it is necessary to adhere to preventive measures aimed at improving the patient’s working and rest conditions.
If you have a hereditary predisposition to allergic diseases, it is recommended to avoid activities associated with increased risk development of an asthmatic attack. If necessary, it is recommended to take medications according to the regimen prescribed by the attending physician and undergo regular preventive examinations.
The use of nebulizers has a positive effect during an acute attack of bronchial asthma. They use liquid solutions medicines, which, under the influence of vapors, enter the respiratory tract, improving the functionality of the bronchi. Thereby neutralizing the acute symptoms of the disease.

At the first signs of bronchial syndrome, it is mandatory to contact a medical institution for necessary examination And further treatment diseases.

Adjuvant therapy

Additional treatment may include antibiotics and expectorants, as well as:

homeopathy;
herbal treatment;
use of acupuncture methods;
speleotherapy;
physiotherapeutic measures;
breathing exercises according to Buteyko and Papworth.

It is important to remember that when confirming an occupational disease of bronchial asthma, it is necessary to exclude all negative factors that provoked the disease (change of profession, retraining, etc.). If it is impossible to fulfill these conditions, an MSE (medical and social examination) can be carried out and in the future it is possible to establish the degree of disability. After which the main condition is timely observation by the attending physician.

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Branch of NOU VPO Medical Institute"REAVIZ" in Saratov

Faculty of Postgraduate and Additional Education

ABSTRACT

Topic: Profoccupational bronchial asthma

Completed: Yurasova Lyudmila Andreevna

Checked: Borisenkova Alla Valerievna

Saratov 2014

Introduction

1. Main part

1.1 Clinic. Diagnostic criteria

1.2 Treatment

1.3 Examination of work capacity

Conclusion

List of used literature

Introduction

Occupational pathology is a clinical discipline that studies the etiology, pathogenesis, clinical picture, diagnosis, treatment and prevention of occupational diseases. Occupational diseases also include diseases that are caused by exposure to unfavorable factors in the working environment. Labor is one of the forms of human activity that provides beneficial influence on his health and ensuring the well-being of society. At the same time, certain types of work under certain conditions can cause occupational diseases, and this is usually facilitated by insufficient technical equipment of production and non-compliance with the necessary sanitary and hygienic standards.

To date, due to the introduction of new technology in various industries and agriculture, the adverse effects of production factors have been largely eliminated. This, in particular, was facilitated by the use of modern powerful mechanisms for work requiring great physical stress; comprehensive automation of many production processes; complete sealing of equipment at chemical plants; application of remote control and monitoring. Of great importance in improving working conditions is the special service created in our country at sanitary-epidemiological stations, and now - “Rospotrebnadzor” for preventive and routine sanitary supervision at industrial enterprises, transport and agricultural facilities. An important role in preventing the development of occupational diseases belongs to a rational regime of work and rest, as well as medical and sanitary care for workers and medical examination. The specified complex of technical, sanitary, hygienic and medical measures contributed to a decrease in the rates of occupational diseases and a change in its structure. Many forms of occupational diseases have completely disappeared. Currently, mostly light and erased forms are found. According to the etiological principle, they distinguish the following groups occupational diseases:

1. caused by exposure to industrial dust (dust bronchitis, etc.);

2. caused by exposure physical factors production environment ( vibration disease, lesions caused by exposure to intense noise, various types of radiation, high and low temperatures external environment etc.);

3. caused by exposure to chemical factors in the working environment (various acute and chronic intoxications);

5. occupational diseases from overexertion individual organs and systems (diseases of the musculoskeletal system, peripheral nerves and muscles).

Bronchial asthma, which occurs at work and is associated in its origin with the specific working conditions of workers, is one of the occupational diseases.

Occupational asthma is an allergic disease of the respiratory tract due to single or constant contact in the workplace with harmful chemicals, as well as substances of animal origin. Meaning occupational hazards in the development of bronchial asthma was noted by Ramazzini in 1700, since the middle of the last century, have been described frequent cases the occurrence of asthma among people in a number of professions: furriers (Ursol), pharmacists (ipecac, iodifylline), flour millers, metalworkers, etc. At present, there is no doubt that occupational factors play a significant role in the occurrence of allergic diseases, including bronchial asthma . The group of industrial allergens consists of the most diverse chemical structure and composition of the substance: metals (nickel, chromium, platinum, cobalt, etc.) and their compounds; some nitro paints, ursol, rosin, formaldehyde, epichlorohydrin, bitumen, synthetic polymers, etc. These substances are used in many industries, and therefore occupational asthma can occur in representatives of a number of professions:

Painters - spraying dyes - isocyanates;

Workers in the production of plastics, porous materials, epoxy resins, etc.;

Workers using and producing adhesives - isocyanates, acid anhydrides, cyanoacrylates;

Bakers - flour and amylase;

Vivarium staff, scientists working with laboratory animals - animal proteins, insects;

Healthcare workers - latex, etc.;

Food Processing Workers - Shrimp, Crab, Green Beans, Oats, Wheat, Soybeans, etc.;

Detergent production workers - enzymes;

Electronics industry workers - rosin;

Workers pharmaceutical industry- penicillins, cimetidine, ipecac, etc.;

Workers refining precious metals - complex platinum salts;

Metallurgists - smoke from welding stainless steel;

Hairdressers - henna, persulfate salts;

Printers - gum arabic, reactive inks;

Sawmill workers - wood dust or bark particles;

Laboratory workers, merchant mariners, felt manufacturers - castor bean dust;

Photographers - ethylenediamine.

Many types of industrial dust, aerosols and vapors have not only allergic properties, but also the ability to mechanically injure the mucous membranes of the respiratory tract, as well as cause irritation. Therefore, according to the nature of the effects on the respiratory organs, they are divided into the following groups:

1. Substances that have a pronounced sensitizing effect: for example, antibiotics, sulfonamides, vitamins, chlorpromazine, rosin, some types of wood dust, bitumen, etc.

2. Substances are sensitizers, which at the same time have a local irritant effect, and some of them cause the development of pneumofibrosis. These include chromium, nickel chloride, chloramine, ursol, formaldehyde, some types of dust (flour, cotton, tobacco, wool, cement), electric welding aerosol, etc.

3. Substances that have an irritating effect and cause the development of pulmonary fibrosis: chlorine, fluorine, iodine and their compounds, nitrogen oxides, vapors of acids and alkalis, many types of dust (dust of silicon dioxide, various silicates, coal, graphite, iron, aluminum, etc. ).

Substances of the first group cause the development of primary occupational bronchial asthma.

When exposed to a substance of the second group, the development of bronchial asthma is preceded by a nonspecific lesion of the bronchial tree (occupational bronchitis), against which secondary bronchial asthma develops.

Substances of the third group are characterized by the development of chronic toxic or dust bronchitis, toxic pneumosclerosis or pneumoconiosis. Therefore, bronchial asthma in patients in such cases should be considered as a complication of the underlying occupational lung disease.

professional bronchial asthma treatment

1. Main part

1.1 Clinic. Diagnostic criteria

The clinical course of primary and secondary occupational bronchial asthma has a number of features. Primary occupational bronchial asthma can develop at different times from the start of work in contact with an industrial allergen, from a year to 11-15 years or more. Primary asthma is usually accompanied by severe allergic manifestations (eczema, dermatitis, Quincke's edema, allergic rhinitis). Attacks of bronchial asthma occur in different times. In some patients, during a short stay in the workshop, in others, 1-2 years after starting work or at the end of a shift, in others - only at night while sleeping. At the onset of the disease, asthma attacks are provoked by occupational factors - inhalation of a specific allergen. With continued contact with the allergen, the condition of patients worsens, attacks become more intense and prolonged. During this period, sensitivity to other substances also occurs; asthma attacks occur not only to a specific antigen, but also to other influences. The formation of a conditioned reflex mechanism for bronchial asthma attacks is possible. In such cases, asthmatic attacks occur from a variety of influences: emotions, physical activity, pungent odors, hot and cold air, etc.

Secondary bronchial asthma usually develops after a longer period of time from the start of work in contact with the product than primary asthma. Asthmatic phenomena in secondary asthma develop gradually against the background of previous chronic bronchitis or chronic diseases of the nasopharynx (chronic nasopharyngitis, turbinate polyposis, sinusitis, deviated nasal septum, etc.). with secondary bronchial asthma externally allergic nature the disease is less pronounced than with the primary one.

There is nothing specific in the clinical picture of occupational bronchial asthma. The clinical picture of bronchial asthma includes symptoms of suffocation and the interictal period. All variants of bronchial asthma have a mandatory common feature- attacks of expiratory suffocation. Typical attack suffocation includes three periods:

I - harbingers;

II - height;

III - reverse development.

The period of precursors begins several minutes, hours, sometimes days before the attack and manifests itself various symptoms: vasomotor reactions from the nasal mucosa (profuse watery secretions, sneezing, itching), paroxysmal cough, sputum retention, shortness of breath, agitation, pallor, cold sweat, increased urination, skin itching in the upper chest and neck, in the back area.

The height of the period begins with expiratory suffocation with a feeling of compression behind the sternum. The inhalation is short, the exhalation is slow, convulsive, three to four times longer than the inhalation, accompanied by loud whistling wheezing. The patient's condition is grave, the position is forced, with the body tilted forward, the face is pale, puffy, with a cyanotic tint, and an expression of fear. Accessory muscles take part in breathing. There is tachycardia, an accent of the second tone above pulmonary artery. Lower limits lungs are lowered, percussion tone above the lungs with a tympanic tint. When auscultating the lungs, a large number of dry wheezing sounds are heard, various shades, mainly during exhalation. With prolonged attacks, signs of right ventricular failure may be observed. The ECG reveals an increase in the T wave, and there may be ST segment depression. At X-ray examination increased transparency of the pulmonary fields, low standing and low mobility of the diaphragm, increased pulmonary pattern, increased shadows of the roots are noted. When defining a function external respiration, daily fluctuations in PSV and FEV1 are noted, which indicates the severity of bronchial obstruction.

In the peripheral blood - eosinophilia, in the sputum analysis - eosinophils, Kurshman spirals and Charcot-Leyden crystals in the blood, dysproteinemia, an increase in the content of b and g globulins, histamine and histamine-like compounds are noted.

According to the severity of the disease, they are distinguished:

1. Intermittent bronchial asthma:

Asthma symptoms less than once a week;

Short exacerbations from several hours to several days;

Night symptoms 2 times a month or less often;

No symptoms and normal function lungs between exacerbations;

FEV1 or PEF >80% predicted;

Daily fluctuations in PEF or FEV1 are less than 20%.

2. Mild persistent bronchial asthma:

Symptoms once a week or more often, but less than once a day;

Exacerbations of the disease may interfere with activity and sleep;

Nighttime symptoms occur more often than 2 times a month;

FEV1 or PEF more than 80% predicted;

Daily fluctuations in PSV or FEV1 are 20-30%.

3. Persistent bronchial asthma of moderate severity:

Daily symptoms;

Exacerbations may affect physical activity and sleep;

Nighttime symptoms occur more than once a week;

Daily intake of short-acting 12-agonists;

FEV1 or PEF 60-80% of predicted;

Daily fluctuations in PSV or FEV1 are more than 30%.

4. Heavy persistent bronchial asthma:

Daily symptoms;

Frequent exacerbations;

Physical activity is limited by asthma symptoms;

FEV1 or PEF less than 60% predicted;

Daily fluctuations in PEF or FEV1 are more than 30% of predicted.

An acute attack can develop into an asthmatic state or result in severe death of the patient.

Asthmatic status.

Istage:

1. Frequent occurrence During the day of prolonged uncontrollable attacks of suffocation, breathing is completely restored in the inter-attack period.

2. Paroxysmal, painful, dry cough with labored sputum.

3. Forced orthoptic position, rapid breathing up to 40° with the participation of auxiliary respiratory muscles.

4. Breathing sounds and dry wheezing can be heard from a distance.

5. Severe cyanosis and pallor of the skin and visible mucous membranes.

6. CVS - tachycardia, heart rate 120 per minute.

ONS - irritability, agitation, sometimes delirium, hallucinations.

Stage II(“mute lung” or stage of decompensation):

The condition is extremely serious, pronounced shortness of breath, shallow breathing, forced position, swollen neck veins, skin pale gray, moist, there is excitement, followed by indifference. On auscultation, the breath sounds are “mute lung.” The pulse is frequent up to 140º with weak filling, arrhythmia, hypotension, muffled heart sounds, possibly a gallop rhythm.

Stage III (hypercapnic coma):

The patient is unconscious, convulsions are possible, diffuse diffuse “red” cyanosis, cold sweat, shallow, rare, arrhythmic breathing, Cheyne-Stokes breathing, on auscultation of the lungs: absence of respiratory sounds, cardiovascular system - threadlike, arrhythmic pulse, blood pressure sharply reduced , collapse, gallop rhythm, ventricular fibrillation is possible.

Diagnostic criteria

The diagnosis of occupational asthma is somewhat difficult. It is known that many chemical compounds cause asthma when present in the environment. To make a diagnosis, a precisely established history of the disease and identification of contact with industrial allergens before the first attack of suffocation are of great importance. The first attack of suffocation often appears during work; the patient’s further condition worsens, especially after vacation or weekends. The diagnosis of occupational bronchial asthma can be successfully confirmed by studying indicators of external respiratory function: changes in PEF at work and outside the workplace, and conducting specific provocative tests.

1.2 Treatment

The effectiveness of treatment depends on the possible identification of the sensitizing agent and its elimination. Treatment of occupational bronchial asthma depends on the severity of the disease.

1. Bronchial asthma of mild intermittent (episodic) course - does not require daily preventive therapy.

2. Persistent bronchial asthma mild course- taking low doses of inhaled corticosteroids, or long-release theophylline, or cromon, or an antileukotriene drug.

3. Persistent bronchial asthma medium degree severity - taking low and medium doses of inhaled GCS in combination with 2 long-acting agonists, or medium doses of inhaled GCS in combination with long-acting theophylline, or medium doses of inhaled GCS in combination with 2 oral long-acting agonists, or high doses of inhaled GCS , or medium doses of inhaled corticosteroids in combination with antileukotriene drugs.

4. Severe persistent bronchial asthma - taking high doses of inhaled corticosteroids in combination with long-acting inhaled agonists, plus one or more of the following drugs (as needed): extended-release theophylline; leukotriene antagonist; oral 2 long-acting agonist, oral corticosteroids.

The prescription of antibacterial agents is justified in cases where chronic infection precedes or complicates the course of bronchial asthma. In the treatment of bronchial asthma, exercise therapy, massage, acupuncture, phototherapy (magnetic therapy, quartz, electrophoresis with aminophylline with potassium iodide, etc.) are used.

Treatment of status asthmaticus is carried out in the department intensive care and resuscitation.

1. Treatment with glucocorticoids.

Administration of prednisolone 250 mg every 4 hours until a relief effect is achieved, followed by a dose reduction by 20-50% every day.

2. Treatment with aminophylline - intravenously up to 15 ml per day of a 2.4% solution, then intravenously by drip.

3. Infusion therapy - intravenous drip of 5% glucose, rheopolyglucin, Lasix, etc.

4. Combating hypoxemia - inhalation of humidified oxygen.

5. Measures to improve sputum discharge.

Intravenous administration of 10% sodium iodide solution 10-30 ml per day, intravenously or intramuscular injection ambroxol (lasolvan), chest massage.

6. Correction of acidosis - 150-200 ml of 4% sodium bicarbonate solution intravenously.

7. The use of proteolytic enzyme inhibitors - intravenous drip administration of Contrical.

8. Treatment with heparin - subcutaneous administration of 20,000 units per day.

9. Fluorothane anesthesia.

10. Treatment with glucocorticoids - 90 mg intravenously every 1.5 hours, followed by dose reduction.

If there is no effect from conservative treatment endotracheal intubation and artificial ventilation with sanitation of the bronchial tree are performed.

1.3 Examination of work capacity

When deciding on the ability to work and employment of patients with bronchial asthma, it is necessary to keep in mind that, regardless of the severity of the disease, contact with substances with sensitizing and irritating properties, exposure to unfavorable meteorological conditions and great physical stress are contraindicated. Working capacity of patients with occupational bronchial disease mild asthma degree is usually maintained. However, such patients need rational employment. Patients with moderate occupational bronchial asthma may partially lose professional and general ability to work and need constant rational employment. When employed with a reduction in qualifications and wages, the patient is sent to the medical examination to determine the percentage (degree) of loss of general and professional ability to work and disability group III for an occupational disease during the period of retraining (approximately 1 year).

At severe course occupational bronchial asthma may result in permanent complete loss of ability to work. The patient is recognized as having completely lost his general and professional ability to work, incapacitated outside his profession, and needs to be referred to the ITU to determine II or less often I group of disability for an occupational disease and the percentage of general and professional loss of ability to work.

ITU identifies the need for rehabilitation activities(rehabilitation sanatoriums spa treatment, provision of medicines for the treatment of occupational bronchial asthma and its complications, provision of means of delivery (nebulizer) and monitoring the effectiveness of medicines (peak flow meter), if necessary, provision of oxygen concentrate. In this case, all relevant expenses are covered by the social insurance fund.

Conclusion

Occupational bronchial asthma is a disease that can be prevented by timely and properly planned measures:

1. Conducting preliminary (upon employment) and periodic medical examinations. By order of the Ministry of Health and Social Development of the Russian Federation No. 302N dated April 12, 2011. Medical contraindications to work in combination with occupational allergens are allergic diseases: total dystrophic diseases upper respiratory tract, chronic diseases bronchopulmonary apparatus, deviated nasal septum, congenital anomalies respiratory organs, chronic foci of infection, chronic skin diseases and allergic dermatoses.

2. Early detection of initial signs of the disease and rational employment away from contact with industrial allergens. Patients with occupational bronchial asthma are monitored at a medical facility (at their place of residence) throughout their lives. Take a course every year inpatient treatment in occupational pathology centers in order to prevent the progression of the disease and the development of complications.

3. Further improvement of technological processes that reduce air pollution in the working area by industrial allergens, the presence of direction and regular use collective means of protection ( efficient work flow-through exhaust ventilation), regular use of personal protective equipment (masks, petals, respirators).

List of used literature

1. Respiratory diseases: a guide for doctors in 4 volumes, Paleev N. R., ed. M. Medicine 1990;

2. Bronchial asthma in 2 volumes, Chuchalin A.G., editor. M Agar 1997;

3. Occupational diseases: a guide for doctors in 2 volumes. Izmerov N.F., ed. M. Medicine 1996;

4. Occupational diseases Artamonova V.G. Mukhin N.A. ed. M. Medicine, 2004;

5. Occupational diseases Kosarev V.V. Babanov S.A. ed. M: Geotarmedia, 2010;

6. Clinical and immunological features of occupational bronchial asthma Petrovskaya V.E. M. Medicine 2009;

7. Clinical immunology allergology. Translation from English M. Praktika 2000;

8. Occupational diseases Shustov V.Ya., Korolev V.V., Olkhovskaya A.G., ed. 4, Saratov 1991;

9. Emergency pulmonology: clinical picture, diagnosis, treatment: part. - corr. RAMS, professor P.V. Glybochko; Candidate of Medical Sciences, Professor T.V. Golovacheva; Candidate of Medical Sciences, Associate Professor T.M. Ushakova; Ph.D., assistant O.F. Fedorov; Ph.D., assistant N.A. Glukhova, Saratov, 2010;

10. Occupational bronchial asthma, Saakadze V.P., Stepanov S.A., Saratov, 1989;

11. Ministry of Health and Social Protection of the Russian Federation order dated 04/12/2011 No. 302 N

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Professions at risk

Many people neglect protective equipment at their workplace, which increases the risk of contracting an occupational disease. But long-term contact with harmful substances in any case cannot but affect human health. Most often, asthmatic bronchitis occurs in people of these professions:

paint shop workers spraying isocyanates;
people who produce plastics, various polymers, epoxy resin;
bakers who constantly inhale flour, amylase;
laboratory assistants scientific institutes in contact with animals, insects and protein;
veterinarians and livestock breeders;
medical workers using latex, methyl methacrylates, glutaraldehydes;
representatives of the food industry who come into contact with allergens contained in various products;
employees of cleaning companies, technical workers, kitchen workers who use household chemicals;
electronics industry specialists working with rosin;
employees of pharmaceutical companies;
specialists in cosmetology production;
metallurgists, workers of gold processing enterprises;
hairdressers who come into daily contact with varnishes, enamels and other chemicals;
workers of printing houses, photo studios, and various laboratories that use chemical reagents.

All these professions involve direct contact with allergens, which causes the development of asthma. The disease may be asymptomatic, but then a person may become aware of the pathology in a severe form. For some, the attack occurs suddenly with intensely increasing signs of suffocation.

Classification of occupational asthma

The disease is difficult to classify, but some forms can be distinguished:

The atopic form develops in people with a hereditary predisposition to allergic reactions, and professional factor in this case it serves as a catalyst.
Purely occupational asthma caused by allergens in the workplace is reversible and can disappear after a change of workplace.
A chronic form of asthmatic bronchitis, which develops against the background of a secondary infection and is aggravated under the influence of allergens of occupational origin.
Asthma symptoms provoked by various types of mushrooms (speleological studies).

Depending on the form of the disease, drug therapy is carried out.

Symptoms

For a long time, occupational bronchial asthma may not manifest itself in any way. Sometimes the first signs simply go unnoticed:

hard breathing;
wheezing in the chest, especially when exhaling;
moderate shortness of breath;
difficulty breathing with increased physical activity;
intense cough with a small amount of sputum.

When the stage of the disease reaches severe form, an asthmatic attack lasts much longer and obstruction of the bronchi develops, which can lead to blockage of the airways and death.

It is important to respond promptly to allergic symptoms that precede the development of asthma:

itching in the eye area, nose;
sore throat;
the eyes begin to water and burn;
allergic rhinitis may occur;
difficulty breathing with whistling and wheezing;
periodically appearing cough with attacks of suffocation, which occur only in the workplace;
low ability to work, fatigue;
Quincke's edema.

Occupational asthma is characterized by the fact that the attack begins suddenly, against the background of the general normal state of health of the patient. At this stage of the disease, the attack can be easily stopped with bronchodilators, provided that the industrial allergen is immediately eliminated from the patient’s life.

It should be noted that the occupational form of asthma is reversible; while on vacation, a person feels better, and when changing jobs, the signs of the disease may disappear completely.

Diagnostics

Occupational asthma requires a comprehensive diagnosis, the purpose of which is to accurately establish the etiology of the disease and relate it to the patient’s professional activities. For this there are separate medical centers or hospital departments where diagnostics are carried out by specialists in occupational diseases.

The doctor’s task includes a set of activities:

study of the patient’s workplace and working conditions;
identification of allergens by testing;
study clinical picture pathology and duration of the allergic reaction;
prove the occupational nature of asthma and relate the symptoms to the patient’s profession.

To make a diagnosis of an occupational disease, bronchial asthma, all diseases with similar symptoms should be excluded; for this, a series of laboratory tests of blood and sputum are performed and a chest x-ray is taken.

There are a number of general measures to identify occupational asthma that apply to all patients:

monitor the dynamics of external respiration parameters during and after work;
carry out tests to identify occupational allergens;
a laboratory blood test is prescribed to determine immunoglobulin groups G, E;
tests are used - provocateurs with a potential allergen.

After all the data has been collected, the doctor establishes or denies a direct connection between the symptoms and the patient’s professional activity and establishes the correct diagnosis.

Occupational bronchial asthma: examination of work capacity

Conclusion about professional nature asthma is issued by a special commission, headed by a doctor - an expert in occupational diseases. If the doctor’s task is to prove a patient’s disability or complete loss of ability to work, he must take into account the following factors:

sanitary characteristics of the patient’s place of work, which is compiled by the organization’s sanitary doctor;
work experience at this place;
identification of allergens at this particular place of work;
the effect of the allergen on the employee;
differentiating the symptoms of asthma and other diseases caused by viruses and bacteria.

If the commission detects an occupational factor in the disease, a diagnosis is made and the possibility or impossibility of the patient working in the same place is considered. The examination of work capacity becomes a decisive moment in professional activity person, as a result the employee may be advised to change jobs or transfer to light work.

Treatment of occupational bronchial asthma

Occupational asthma is treated comprehensively, depending on the symptoms and severity of the disease. During exacerbations, a person is removed from work and prescribed antihistamines and hormonal drugs. Typically, treatment takes place in several stages, and medications are selected taking into account age and other individual characteristics.

Treatment of occupational bronchial asthma includes:

taking glucocorticosteroids (in the form of inhalations or orally);
therapy with short- and long-acting bronchodilators (beta blockers);
taking cromones;
taking leukotriene blockers;
bronchodilators;
combination drug therapy.

In cases where the course of the disease is complicated, the patient may be hospitalized. If the disease is at an early stage, antiallergic treatment may be prescribed several times a year. If the enterprise cannot provide another place of work for the sick person, the commission raises the question of the person’s incapacity for work.

Preventive measures

Prevention of the development of diseases associated with allergic reactions of the body should begin from the moment of choosing a profession. It is necessary to take into account the hazardous nature of production and follow a number of recommendations in the workplace:

use special protective clothing, masks, respirators, if required by safety precautions;
strengthen immunity, lead healthy image life, monitor your diet;
Maintain personal hygiene after working with hazardous substances;
comply with sanitary standards in the workplace;
undergo medical examinations in a timely manner.

Occupational asthma is difficult to treat, but if you diagnose the pathology in a timely manner or change jobs, you can stop the progression of the disease or control attacks.

Diagnosis of occupational bronchial asthma. Symptoms of occupational bronchial asthma

Etiology

Pathogenesis

Clinical picture

Diagnostics

Principles of treatment

Salbutamol

Aldecin

Montelukast

Ambroxol

Physiotherapy

Prevention and prognosis

Causes of the disease

Pathogenesis

Occupations that cause the development of the disease

Classification of the disease

1. Light

2. Medium

3. Heavy

Clinical picture

Diagnostics

Treatment tactics

1. Relief of an asthmatic attack

2. Adequate treatment on a basic basis

Preventive measures

Adjuvant therapy

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