Stages and clinic of silicosis. Silicotuberculosis

Silicosis is the most common and most severe dust lung disease associated with the inhalation of aggressive silica dust (quartz), which causes the development of nodular fibrosis. MPC dust containing more than 70% crystalline silicon dioxide - 1 mg/m3, from 10 to 70% - 2 mg/m3, from 2 to 10% - 4 mg/m3; for dust containing more than 70% amorphous silicon dioxide - 1 mg/m3, from 10 to 70% -2 mg/m3.

Silicosis is more common among workers in “dusty” occupations in the mining industry (drillers, tunnellers, cutters, blasters), in the machine-building industry among cutters, etc., in the production of refractory materials, when grinding sand, and tunneling.

For the silicotic process in the lungs, along with the formation of nodules, the development of fibrous tissue along the bronchi, vessels, around the lobules and alveoli is also characteristic, which entails the development of diffuse-cellular or reticulate-branched fibrosis. fibrous tissue compresses and pulls the bronchi, resulting in lobular atelectasis in some areas and vicarious bullous emphysema in others. malnutrition lung tissue entails focal necrosis with the formation of small silicotic caverns. The time of development of silicosis varies widely: in miners, silicosis can occur with a work experience of 3-10 years, in cast cutters - 1-4 years, in porcelain makers - 10-30 years. The frequency of occurrence, the speed of development of the disease and the degree of lung damage depend on working conditions, dispersion and concentration of quartz dust and individual reactivity of the organism.

The diagnosis of the disease should be based on data from the general and professional history, hygienic characteristics of working conditions (especially on information about the concentration and composition of dust) and the results of X-ray examination. Despite the value of x-ray data, taken in isolation, they are insufficient for the diagnosis of silicosis.

Symptoms

Complaints of patients: early onset shortness of breath, tingling in the shoulder blades, chest pain, cough. Often general weakness, fatigue, headaches, heartburn, etc. Chronic diseases of the upper respiratory tract are very common, mainly atrophic rhinitis, rhinopharyngitis, rarely laryngitis, diseases of the paranasal cavities.

The clinic of pulmonary pathology is nonspecific. Moderate emphysema is determined, mainly in the basal (lower lateral) sections; less often - mild bronchitis, sometimes the phenomena of bronchospasm. Bronchitis may precede silicosis. With the progression of silicosis, indicators of function worsen external respiration. However, they may also be early symptom due to violation neurohumoral regulation breathing. The discrepancy between the scarcity of clinical and the severity of radiological changes is characteristic: emphysema inherent in silicosis contributes to radiological recognition lung seals and, conversely, interferes with their clinical detection by percussion and auscultation.

I stage

Clinical symptoms very scarce. Shortness of breath with significant muscle tension, intermittent, mostly stitching, chest pains, little dry cough. Box sound over the lower lateral parts of the chest wall, harsh, somewhat weakened breathing, intermittent dry rales. The vital capacity of the lungs at this stage does not decrease and may even be increased. Slight shortening of breath holding time, occasionally slight increase ESR.

X-ray: the gates of the lungs are expanded, the shadows of compacted and enlarged lymph nodes. The altered pulmonary pattern consists of fine mesh formations of irregular shape and nodular shadows (up to 1-2 mm in diameter). The pleura is symmetrically thickened, mainly in the region of the apex. The lungs are somewhat swollen, transparent, the diaphragm is low, pleural sinuses opened, intercostal space expanded, the ribs are located horizontally.

II stage

The increase in shortness of breath, the inability to perform work associated with a large physical stress. Cough, often with scanty sputum, chest pains of a constricting nature. More common emphysema with limited mobility of the lung margins. Severely weakened breathing, dry rales, often small bubbling wet rales and pleural friction rub in lower sections. A noticeable increase in pulmonary insufficiency, the phenomenon of a developing cor pulmonale. ESR increase.

X-ray: the picture gives the impression of being splattered with a stroke of the brush (the so-called "shot lung" or "blizzard"). Nodules are counted in many tens and even hundreds, their size is from 1 to 5 mm in diameter, the shape is irregularly rounded, the intensity is average, the contours are clear. The nodules are scattered throughout the lungs and alternate with cellular formations, replacing the normal pattern. The roots of the lungs have, as it were, a “chopped off” appearance; possible shell-like calcification of the lymph nodes; pleural adhesions are frequent in the region of the apexes, in the interlobar fissures and in the region of the costophrenic sinuses. The diaphragm is low, the pleural sinuses are open. Breathing movements the diaphragms are normal or reduced, the exhalation is lengthened, the range of motion of the ribs is increased.

III stage

Severe shortness of breath, not only during work, but also at rest. Rapid fatigue, weakness. Cough, sometimes painful, in attacks, with much sputum. Often cyanosis of the lips, face, coccyx fingers. Severe diffuse emphysema. Alternating areas of hard and weak breathing. Scattered dry and moist rales, pleural rub. Severe pulmonary heart disease ("cor pulmonale").

X-ray: characteristic are the merging of nodular and cellular formations into massive homogeneous intense shadows that have uneven and fuzzy contours, oval or irregular in size from 1-2 cm to extensive conglomerates with a diameter of 7-10 cm. The latter are usually located asymmetrically: either in the lateral sections of the middle belt, or in the subclavian or supraphrenic belts. On hard images or tomographic examination, it is sometimes possible to identify a silicotic cavity located centrally among massive seals.

With silicosis, there are often a number of abnormalities in other organs and systems, in addition to the respiratory one: arterial hypotension, myocardial dystrophy, digestive disorders, chronic gastritis, violations of the antitoxic function of the liver, cholecystoangiocholitis. Kidney damage is possible - albuminuria, erythrocytes in the urine, significant impairment of renal filtration, even in the initial stages of silicosis. Functional disorders central nervous system- asthenic or asthenovegetative syndrome. Some endocrine and metabolic disorders, in particular protein metabolism disorders; FROM - vitamin deficiency; decrease in immunobiological reactivity. Blood: compensatory hyperglobulia and hyperhemoglobinemia, reticulocytosis. In severe stages - a tendency to hypochromic anemia, leukopenia, stab shift, inhibition of lymphocytosis, increase in ESR. There is a significant excretion of silicon in the urine (2-3 times more than normal).

Most often, silicosis is complicated by pulmonary tuberculosis. Pneumonia is also a common complication of silicosis. Their sharply worsening influence on the course of the silicotic process is noted. At the same time, pneumonia itself, developing against the background of a silicotic lung, acquires an atypical protracted course. In advanced cases - the development of bronchiectasis, bronchogenic cancer is possible.

Distinguish as special forms of rapidly progressive silicosis, when the process develops in the first 3-5 years of work with quartz dust or, having appeared not so early, quickly, in 2-3 years, passes from I to II, as well as late silicosis - a process that occurs 5-10 years or more after cessation of contact with quartz dust.

Late silicosis is considered as special shape with an atypical severe course, rapid progression and poor prognosis. Joining and acute course tuberculosis. The occurrence of late silicosis is explained by the deposition of quartz dust in the lungs, which, continuing to have a fibroplastic effect, is direct cause illness. Great importance is given to a change in the reactivity of the body under the influence various reasons- rheumatism, pneumonia, chronic alcoholism, cooling, heavy physical labor and etc.

Working capacity examination

Silicosis even in stage I is a contraindication to the continuation of work in dusty conditions. It is necessary to transfer to another job without exposure to dust, irritating gases and adverse meteorological factors. Heavy physical activity is also contraindicated.

In stage II of silicosis, the patient always has the right to disability (for the most part of group III, in case of tuberculosis, respiratory and heart failure - group II).

AT Stage III diseases, the presence of severe respiratory and heart failure almost always leads to disability, and sometimes to the need for outside care (disability II or even I group).

Due to the weak signs of silicosis of the lungs, this disease is ignored, not noticed by patients on early stages. And in vain: the disease is dangerous, it can extensively destroy lung tissue, lead to death, and often there is a need for donor transplantation.

It is a type of pneumoconiosis that develops with frequent, regular inhalation of silicon dioxide, quartz, mineral elements that contain silicone dioxide. The presence of silica in the mountain layers of granite or sandstone sometimes reaches 95-100%. In this case, the lung matter is damaged, sometimes entire sections of the lung are replaced by fibrous formations.

Since silicon dioxide is not absorbed into the blood, does not dissolve in water, it slowly accumulates in the alveoli and parenchyma of the respiratory organs, gradually exerting a destructive effect. At first, the symptoms are not noticeable, but after long years the formation of fibrosis develops shortness of breath, lack of oxygen and respiration.

Prevalence and occurrence

Silicosis is an occupational disease. AT dangerous group includes professions where people are forced to constantly inhale very fine sandy dust.

These include:

Miners;
Grinders;
Road construction specialties;
Sandblasting workers;
Sand pit developers and others.

If there is a trade union committee in the workplace, which is obliged to monitor working conditions, the incidence of workers is much less common.

What is silicosis and how does it occur? Silica dust is deposited in the respiratory tract, accumulates in the lungs slowly and gradually. Usually the first manifestations of the disease begin 15-20 years after the start of contact.. When dust particles are chemically active or their entry into the respiratory canal is too significant, the first signs develop earlier.

In the lungs, silicon chips fall under the scope of macrophages. The cells responsible for the immune barrier fight against foreign dust particles by secreting special enzymes that injure the lung alveoli and cause fibrosis. The connective tissue grows, small rounded nodular formations are formed.

If you do not start treating the disease in a timely manner, do not eliminate the cause, the nodules become larger. In the fibrous focus, blood circulation and oxygen metabolism are disturbed. The lung tissue loses elasticity, and when breathing, a person begins to experience tremendous difficulties.

Signs of silicosis lung damage by type

Patients with chronic pulmonary silicosis have mild or no symptoms. Over the years, shortness of breath progresses, sometimes it is attributed to aging. At first, signs of shortness of breath appear with exertion, over time it appears at rest. Chronic form silicosis is characterized productive cough, which can be caused by occupational bronchitis or smoking. Cough syndrome causes pain in the chest area, sometimes soreness appears not only during coughing.

Ultimately, in 15-20 years, pulmonary hypertension, respiratory failure, lung tissue compaction develops due to the filling of the alveoli with pathological exudate, fluid, and blood. Severe advanced cases lead to right ventricular failure of the heart, regardless of whether contact with the dioxide crumb continues or not.

A rapidly progressive form of silicosis

It develops with a shorter inhalation of silicon particles, approximately 10-12-15 years, but the impact is quite intense. Symptoms and radiography of the respiratory organs are the same as in chronic silicosis.

Pathology is characterized by silicate formations, similar to nodules, that surround the connective tissue. Sometimes bacterial or fungal infection. Often this form reveals autoimmune diseases, which approximates the signs of the underlying disease.

Acute course

In acute silicosis, shortness of breath and cough progress rapidly. Patients lose weight, general weakness, fatigue appear. In the lungs, bilateral rales are heard, characterized by a crackling sound. Respiratory failure is often formed in 2 years. Often, pulmonary hypoxemia develops when blood flow to the lungs is disturbed.

Complicated form

With this form, fibrosis affects the lung tissue massively. Upper lobes are affected much more frequently. respiratory symptoms and respiratory failure are pronounced. FROM amim frequent complication is a silicotic conglomerate and a pulmonary conglomeration.

There are other complications, such as:

Spontaneous pneumothorax;
Chronic obstruction of the upper respiratory canals;
Broncholithiasis.

Sometimes massive fibrous growths lead to emphysema. Lung matter pathologically changes, this is facilitated by the expansion alveolar tissue, destruction of the walls of the alveoli is observed.

How is the diagnosis made?

The main method of diagnosis is the study of anamnesis in combination with x-ray examination. A biopsy confirms the diagnosis when dubious data appear on Rg-images.

Additional methods are used to differentiate silicosis from other diseases of the bronchopulmonary system:

High-resolution CT and MRI - the lung pattern has a cellular structure, the pleura thickens;
Spirography - reveals violations of ventilation of a mixed type;
The study of blood gases - controls the dynamics of development;
Pulse oximetry - control over the saturation of hemoglobin in the blood;
Blood test for C-reactive protein, rheumatoid factor, antinuclear antibodies.

It is necessary to distinguish silicosis from sarcoidosis, anthracosis, asbestosis, miliary tuberculosis, granulomatosis, mycosis of the lungs. For additional examination, bronchoscopy is prescribed, tuberculin tests, sputum analysis.

Video

Video - dangerous situations causing silicosis of the lungs

How to treat the disease?

When the disease is detected early stage, the treatment of silicosis of the lungs includes only physiotherapy. When pain occurs, medications are prescribed to alleviate the condition. After taking the drugs, the cough becomes less deep, sputum discharge improves.

Medicines for treatment

Many are prescribed for treatment. different drugs. Bronchodilators are used in tablet form or as syrups, they irritate sputum, improve discharge. Sometimes drugs containing hormones are prescribed. Most often they are used in the form of inhalations, expanding the bronchopulmonary canals, facilitating respiratory movements.

List of drugs:

Eufillin is an effective remedy for relaxing bronchial muscles, lungs, and for improving vascular patency. The drug is prescribed in combination with other drugs. After using the remedy, the sputum becomes liquid, it is better to leave;
Pulmicort - dilates blood vessels, relieves inflammation, contains hormones. The tool helps to relieve an attack of coughing, relax the bronchial muscles. Available as a solution for inhalation using a nebulizer;
Salbutamol is a bronchodilator drug that reduces the viscosity of mucus and activates its discharge. Pharmacies sell this drug in capsules and solutions for inhalation. The device turns the solution into fine dust that settles on the bronchi, alveoli when inhaled;
ACC is a powder agent with a mucolytic effect. The patient takes the medicine at the beginning and end of the day, one sachet, as a result of which the sputum liquefies, its withdrawal is stimulated;
Chymopsin - enzyme preparation is made from the glands of large horned animals. It is used as inhalation, while necrotic areas are separated, sputum reduces viscosity. As a result, the cough becomes more moist, part of the sputum is better expectorated;
Ambrobene - 2 ml of the drug is poured into the mouthpiece of the nebulizer. After inhalation of the vapors of the medicine, mucus and sputum are better expectorated;
Ventolin - affects the viscosity of sputum, improves its expectoration. The drug is inhaled through a nebulizer. For manipulation, mix 2 ml of the drug with 2 ml physiological saline. Inhalation is done for 8-10 minutes, until all the liquid has evaporated from the device chamber;
Berodual - improves function respiratory system, relieves bronchospasm, expands the respiratory ducts, improves mucus discharge. In the nebulizer chamber, the medicine is poured in half with saline.

Attention ! This list medications are provided for informational purposes only. Self-treatment of silicosis is unacceptable, so as not to appear undesirable consequences and there were no complications.

When a person has a profession associated with the inhalation of fine dust, he should be more attentive to his health. If the first symptoms of silicosis occur, you should contact the district clinic to a local therapist or a bronchopulmonologist.

Traditional methods for the treatment of silicosis

Funds from folk pharmacy widely used with traditional preparations. Best Departure sputum, cough reduction can be achieved by applying herbal decoctions and infusions.

A mixture of chicory and motherwort - in a thermos, mix a tablespoon of each herb, then the raw material is poured into 0.5 l hot water, left overnight. In the morning, the solution is filtered, divided into three doses, drunk after meals;
Infusion of horsetail and comfrey - herbs are taken in equal proportions. Two tablespoons of the mixture should be poured with boiling water, insist in a thermos. Take 100 g 4 times a day;

Well removes the viscosity of cocoa mucus and aloe juice. To do this, grind three leaves of the agave with a blender, add three tablespoons of cocoa powder, pour in a little badger fat. The remedy should be taken every morning before breakfast, washed down with a glass of warm water.

Physiotherapeutic methods

Physical procedures improve the patient's condition, are used together with drugs and inhalations. With the help of the method, a stable remission is achieved, it is possible to prevent or stop fibrotic changes in the organs.

Electrophoresis with drugs;
Ultrasound on the chest;
Inhalations with O2;
massage manipulations.

Sometimes such an unusual procedure as Charcot's douche is used. Pressurized water jets are applied to the chest and back of the patient. The flow of liquid is quite strong, the person can hardly keep his balance. These actions activate the waste of mucus and sputum.

What is the forecast?

After treatment, the prognosis depends on the type and course of the disease. The chronic type proceeds for a long time, if detected at an early stage, it is possible to cure the disease, provided that the provoking factor is eliminated. Further, the disease stops progressing, the person lives a full life.

Not everyone is able to opt out. harmful work. If there is a need to work in harmful conditions, safety rules should be observed, as well as the observance of working conditions from the management. When the boss does not solve problems, it is better to leave the enterprise and find another job.

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Diseases resulting from exposure to harmful production conditions are called occupational diseases. They are divided into 5 groups depending on the nature of the influencing factors. Group II includes diseases associated with exposure to dust. This group also includes silicosis, which is the most severe form pneumoconiosis.

Causes that provoke the onset of the disease

Silicosis begins to develop as a result of the introduction into the lungs of the smallest solid particles containing silicon dioxide (dioxide) or quartz glass. Another reason why this serious illness lungs, inhalation of dust of heavy metals for a long time.

This is the first time Occupational Illness found among miners. In terms of the number of diseases, the prevalence of silicosis among miners was one of the first places.

In the future, the risk group for silicosis was replenished with representatives of the following professions:

masons;
grinders;
foundry workers;
quarry and mine workers;
construction workers;
porcelain workers and potters;
stone cutters;
cement plant workers.

The list includes the main working occupations that are directly affected by the harmful effects of dust, and it could be continued. Lack of well-organized protection against the harmful effects of dust in the workplace is the main cause of silicosis in these professions.

The reaction of lung tissues to mineral dust, the degree of its severity and nature, depend on:

concentration and duration of contact;
individual sensitivity;
sizes and aerodynamic characteristics of dust.

Silicosis develops slowly, gradually destroying lung function. The disease is considered chronic and constantly progressive. But its greatest danger lies in the fact that for a long time it can develop without symptoms.

Varieties of the disease

According to the ability to progress under the influence of factors, several types of silicosis are distinguished.

Classic or chronic – for a long time can remind of itself with slight shortness of breath and rare cough. With such implicit symptoms, only an X-ray of the lungs will show the presence of the disease. The main signs of silicosis on x-rays are rounded areas of blackout. Over time, classic silicosis can become progressive even with the elimination of pathogenic factors.

progressive view characterized by increased dyspnoea. The obscurations in the lungs increase in size, as shown by x-ray of the lungs. As the disease progresses, airway obstruction occurs, leading to sensations of suffocation.

accelerated silicosis develops very quickly against the background of intense exposure to dust with silicon dioxide.

Finally, acute silicosis develops due to the powerful effect of silicon dioxide in just a few months. The main symptom of acute silicosis is severe respiratory hypoxemia.

In addition to difficulty breathing, symptoms of acute pulmonary silicosis include:

temperature;
weakness;
weight loss;
sweating.

stages

Doctors distinguish three stages of silicosis, each of which has its own characteristics. The symptoms of lung silicosis also vary from stage to stage.

The first signs of the disease are characteristic of the first stage of the disease:

shortness of breath with increased physical activity;
dry rare cough;
chest pain periodically appears;
a slight protrusion of the chest in the lower part, which can only be detected by a specialist upon examination.

Already at this stage, the diagnosis of silicosis will show the presence of existing deviations in the health of the person being examined. The presence of deformations of the pulmonary pattern and the presence of a small number of nodules up to 1 mm in size (shadows) will be visible on the x-ray. These will be the first signs of the disease.

Based on x-ray data and the presence of characteristic symptoms silicosis of the first stage is diagnosed.

In the second stage, the deviations become more serious. Gradually accumulating changes:

shortness of breath occurs already with minor physical exertion;
the cough gets worse;
chest pains become regular;
breathing becomes frequent even at rest.

In the third stage, a tough picture of the final stage of the disease unfolds:

shortness of breath becomes a constant companion of the patient's life;
frequent painful bouts of coughing with phlegm, and even with blood;
frequent asthma attacks;
nodular shadows merge into large spots;
tachycardia and heart failure.

The logical conclusion of the third stage of silicosis can be emphysema or pulmonary pneumosclerosis.

Ultimately, silicosis provokes:

decreased immunity;
violation of lymph circulation;
pneumothorax;
bronchiectasis.

Diagnostics

If you are working in production with large quantity dust, naturally the question arises of where you can check the body for the presence of a disease.

Main diagnostic procedure- X-rays of light.

In the future, the diagnosis of silicosis is carried out by a number of specialists: a pulmonologist; cardiologist, phthisiatrician; neurologist. Each of medical professionals will give his opinion, which will help to recreate the picture of the disease in general.

According to the conclusion of the commission, a person has the right to disability. The disability group is assigned depending on the objective condition of the patient.

Treatment

Treatment of pulmonary silicosis should begin immediately after the diagnosis is clarified. The duration and nature of treatment depend on the stage of the disease.

How and how to treat this lung disease, doctors decide, based on the current state of the patient.

After diagnosing and making a diagnosis, it is necessary to exclude the patient from contact with dust containing silicon dioxide.

In the initial stages, physiotherapy, koumiss therapy, sea or mountain resorts help to treat this disease.

Physiotherapy treatments:

oxygen inhalation;
respiratory and medical gymnastics;
UFO UHF and ultraviolet radiation, slowing down the fibrous process in the lungs with silicosis;
alkaline and hydrochloric alkaline inhalation that activate the vital activity of the tissues of the respiratory tract.

For the first and second stages of the disease, Spa treatment, thus providing partial compensation harm received at work.

If acute silicosis is diagnosed, then with the help of a medical solution, mucus is removed from the respiratory tract, testing the patient's condition.

In the treatment of silicosis of the second stage, when the patient suffers from shortness of breath and a strong cough, he is prescribed expectorants and drugs that relieve bronchial spasms.

In the treatment of the third stage of the disease, complicated by the development of massive fibrosis, surgical intervention may be necessary.

In the treatment of silicosis, folk remedies use plants that promote active cleansing and regeneration of bronchial and lung tissues: white pomegranate flowers, blackhead, plantain, coltsfoot, soybeans, barley, aloe. Such means can effectively support the body for a long time.

What causes complications?

Complications of the underlying disease are caused by a number of diseases:

bronchial asthma;
pulmonary heart failure;
pneumonia;
obstructive bronchitis.

An important role in shaping the negative development scenario is played by bad habits: smoking, alcohol abuse, drugs, and harmful production factors or poisoning. They can significantly shorten life.

Silicosis - (silicium - silicon from lat.) is a type of pneumoconiosis, the most common and rather difficult flowing. Silicosis is characterized by diffuse proliferation of fibrous connective tissue and the formation of nodules in the lungs. As a result, the connective tissue impairs the ability of the lungs to carry out oxygen exchange.

Silicosis also increases the risk of other lung diseases such as tuberculosis, bronchitis, and emphysema.

This is an occupational disease, most often it occurs in people of working specialties whose activities are related to metallurgy, mining, engineering and porcelain-faience industry.

The cause of the development of the disease is prolonged inhalation of dust containing silicon dioxide. Silicon dust can be found in many industrial productions, even ordinary sand contains about 60% silicon. But here the most important point is the particle size of silicon. Sand particles are too large to get into the lungs when inhaled, but if the silicon particles are finely dispersed, 2-3 nm in size, they easily enter the bronchioles and alveoli when inhaled, causing their damage and the development of fibrous tissue.

An important role in the development of silicosis is played by the duration of contact with silicon dust and the quantitative contamination of inhaled air with it. If air dusting is moderate, then silicosis develops after about 10-15 years of work in production. But if the concentration of dust is significant, then literally in 1-2 years an acute form of silicosis can develop. Sometimes the disease develops several years after contact with silicon in the workplace. This is the so-called late silicosis.

This disease was discovered in 1705 by the Italian physician Bernardino Ramazzini, who noticed the presence of sand in the lungs of stonecutters.

Symptoms of the disease

Silicosis may not bother the patient for a long period.

The first symptoms of the disease will appear as:

Dry, infrequent cough.
Pain in the chest area.
Shortness of breath (especially after exercise)
Periodic sputum production.

When the pathological process begins to progress, the symptoms of the disease become brighter and more pronounced.

Are getting stronger pain and shortness of breath. Shortness of breath begins to manifest itself even at rest. Coughing becomes more frequent, sputum separation continues. Can join accompanying illnesses, for example, bronchial asthma or chronic bronchitis.

In advanced forms of the disease, cough becomes a constant companion of the patient, sputum is abundantly separated, the intensity of pain in chest increases, a feeling of squeezing joins, cyanosis and hemoptysis may occur.

Pathogenesis

The development of silicosis is associated with physical, chemical and immune processes that are triggered by the impact of silicon dust particles on the tissues of the human body.

There are several theories explaining the pathogenesis of silicosis.

Toxico-chemical theory, otherwise it is called "solubility theory". According to this theory, crystalline silicon dioxide, dissolving in tissue fluid, forms a colloidal solution consisting of silicic acid. This acid has a damaging effect, and the process of fibrosis development starts.
Physical and chemical theory. According to it, the destructive effect of silicon particles is due to the structural features of the crystal lattice; as a result, an interaction occurs, active chemical reaction between tissues and silicon particles, silicic acid is formed, which, as is already known, starts the process of fibrosis development and takes part in the construction of collagen fibers.
The immunological theory, according to which, when cells and tissues are exposed to silicon dioxide, the formation of autoantigens and, accordingly, autoantibodies occurs. The resulting immune complexes have an effect on the growth of connective tissue.

The pathogenesis itself in the modern view includes several important stages:

Inhalation of a fine particle of silicon, its penetration into the final sections of the respiratory airways (alveoli, bronchioles).
The stage of absorption of silicon particles by alveolar macrophages (the process of phagocytosis).
There is a death of macrophages with release from contents, including silicon particles.
Repeated phagocytosis and repeated death of macrophages.
The formation of fibrous connective tissue in places of damage.
development of fibrosis.
substitution connective tissue healthy lung tissue.
Violation of oxygenation processes and the development of the pathological process.

Peculiarities clinical course, complications.

Depending on the clinical and radiological features, there are three forms of the course of silicosis:

The interstitial form is the most favorable, it is distinguished by a relatively benign course.
The nodular form is the most common course of silicosis and occurs most often.
Tumor-like form - may develop as a result of the interstitial fibrous process, but most often acts as the third stage of the nodular form.

Silicosis can cause a large number of complications, the most common of which is the addition of concomitant lung diseases: emphysema, tuberculosis, bronchiectasis, chronic bronchitis, bronchial asthma.

Conditions such as respiratory failure may also develop, pulmonary hypertension, pneumothorax.

Some patients may experience a decrease functional activity liver (in the neutralization of toxins or the formation of prothrombin). On the late stages diseases, manifestations of neurological disorders are observed, it can be headache, inhibition of vegetative reactions, dizziness.

Treatment, prognosis, prevention

First of all, those with silicosis should stop contact with silicon dust. Patients are shown breathing exercises and oxygen inhalation.

If the course of the disease is complicated by the addition of tuberculosis, then the patient is prescribed at least three anti-tuberculosis chemotherapy drugs.

The patient's nutrition should be complete, with high content protein products. Regular visits to resorts would be appropriate. Expectorants and bronchodilators can help manage cough and shortness of breath. In case of infection, antibiotics and sulfonamides are used.

The prognosis for the disease depends on its stage and nature. Of great importance are the individual characteristics of the patient's body. Chronic silicosis always has a more favorable prognosis. Acute silicosis often leads to serious complications, even if contact with silica is completely stopped.

Prevention of silicosis disease includes:

required, regular medical examinations persons in contact with silicon dioxide.
Reduction of dust content in working areas.
Use of personal protective equipment (respirators).

Pulmonary silicosis is considered one of the most common and most severe forms of pneumoconiosis. The occurrence of this disease is due to prolonged inhalation of dust containing silicon oxide. Moreover, the debut of this pathology can develop not only during contact with dust, but also some time after its termination.

The most common silicosis among workers in the mining industry, mechanical engineering, metalworking and ceramic industries.

Causes and mechanisms of development

Silicosis occurs as a result of long-term human contact with dust containing silicon oxide, in particular, when working in the mining industry.

The mechanism of action of dust on the body has long been tried to be explained taking into account the type of dust, its chemical and physical properties. Numerous theories about the origin of silicosis have been discussed in the past, but none of them has been fully established. scientific justification. According to modern ideas immune mechanisms play a major role in the development of the disease.

accumulate in the alveoli
penetrate lymphatic vessels and nodes.

This is perceived by the body as penetration foreign body from the outside, which causes certain defensive reactions.

At the first stage, macrophages are activated and dust particles are phagocytosed.
As a result, silicon dioxide interacts with proteins and lipoproteins of the cell, which leads to damage to its organelles and death.
Dust particles, once again free, are phagocytosed by new macrophages.

So lactic acid and other decay products accumulate in the lung tissue. This starts the process of collagen synthesis, which further leads to the development of fibrosis.

In addition, constant irritation of the receptor apparatus of the mucous membrane of the respiratory tract by dust particles leads to its atrophy, the development of bronchitis and emphysema.

Clinical manifestations

The clinical picture of silicosis is characterized by some scarcity of subjective and objective signs. It is due to the presence of emphysema and inflammatory process in the bronchi. Quite often complaints come to light only at active questioning and are not specific.

Early manifestations of silicosis are symptoms that may accompany any chronic illness lungs:

pain in the chest.

The latter may take the form of tingling, discomfort or tightness under the shoulder blades, which is due to the involvement of the pleura in the pathological process and the formation of adhesions.

In the initial stages of the disease, shortness of breath is more associated with bronchitis and, therefore, in their absence, it appears only with significant physical exertion. As the pathological process progresses, fibrosis of the lung tissue worsens, while shortness of breath can disturb a person even at rest.

Cough in patients with silicosis is associated with irritation of the respiratory tract by dust. It may be intermittent dry or with scanty sputum. Some patients cough up purulent sputum. This indicates the development or.

It should be noted that clinical manifestations silicosis do not always correspond to changes in the lungs, which reveals x-ray examination.

stages of silicosis

According to radiological and clinical data, 3 stages of the disease are distinguished:

In the first stage of the disease general well-being patients satisfactory, rarely worried slight cough, tingling in the chest, shortness of breath is not pronounced or minimal. The examination may reveal a boxed percussion sound over the lower lateral parts of the lungs, weakened or hard breathing with single dry rales. During this period, there are already signs of fibrosis and emphysema in the lower lateral parts of the chest.
The second stage is characterized by severe symptoms. Shortness of breath is increasing, which now occurs with slight physical exertion, pain in the chest increases, viscous sputum can be separated when coughing. Objectively, the patient has signs of emphysema with limited mobility of the lower edges of the lungs and areas of weakened breathing, which alternates with hard. In such patients, the restrictive type is revealed according to the results.
In the third stage, pronounced fibrosis is detected in the lungs, severe respiratory failure develops with shortness of breath at rest and cor pulmonale. Such patients are concerned about intense chest pain, cough with sputum, asthma attacks. During auscultation in the lungs, weakened, sometimes hard breathing with dry and wet rales, as well as a pleural rub are heard.

Complications of silicosis

Silicosis often occurs with chronic bronchitis.

The course of silicosis can be aggravated by the following pathological conditions:

(accompanies both lungs and severe forms silicosis).
Tuberculosis (frequent and severe complication, difficult to treat).
Spontaneous.
Pulmonary heart.
Rheumatoid arthritis.
Systemic connective tissue diseases.

Features of the course of the disease

Silicosis is a disease that can have different course depending on the working conditions, the aggressiveness of the dust factor, the duration of its influence on the body, as well as the form of fibrosis and the presence of complications. Special meaning has an individual predisposition and condition of the upper respiratory tract at the time of contact with dust.

AT clinical practice It is customary to distinguish slowly progressive, rapidly progressive and late silicosis.

In the first variant of the disease, the transition from stage to stage takes decades (usually interstitial fibrosis).
The second option develops much faster - the pathological process lingers in one stage for about 5 years (nodular fibrosis).
A late variant of silicosis can manifest itself after 10-20 years of relatively short (about 5 years) contact with quartz dust after exposure to provoking factors (severe, tuberculosis).

Principles of treatment

The main directions in the treatment of silicosis are:

termination of contact with the irritant;
reduction in the amount of dust deposits in the lungs;
removal of dust from the body;
inhibition of fibrosis;
improvement of pulmonary ventilation and local blood circulation.

The treatment must have A complex approach and at the same time take into account the severity of the condition of patients, the severity of the manifestations of the disease and the presence of complications. In the latter case, the tactics of managing the patient is due to the condition that complicated the course of silicosis:

for tuberculosis, anti-tuberculosis drugs are prescribed;
at infectious complications- antibiotics;
with the development of rheumatoid arthritis - cytostatics, etc.

There is no specific treatment that can stop fibrosis in silicosis. However, a certain effect can be achieved using:

physiotherapy techniques (alkaline inhalations, UHF, UFO);
sanatorium treatment (at the initial stages of the disease);
physiotherapy exercises.

To increase overall resistance in such patients, it is recommended good nutrition and taking vitamins.

Disability examination

Solving the issue of the working capacity of patients with silicosis is a rather difficult issue. This takes into account the stage of the disease, the form of fibrosis, the features of its course, the presence and severity of functional disorders and complications.

Patients with stage 1 silicosis can continue to work same place if the disease developed 15 or more years after the start of exposure to dust. And at the same time, they had an interstitial form of silicosis without signs of respiratory and heart failure.
Individuals with stage 1 interstitial disease that developed with little dust experience (less than 15 years) and nodular silicosis should be transferred to non-dust related work.
If the fibrous process in stage 1 silicosis has severe complications, such patients may be recognized as disabled.
All patients with stage 2 silicosis, regardless of the form and course, work in harmful conditions is contraindicated.
When the disease progresses to stage 3, patients are usually disabled and need constant outside care.

Prevention

Personal protective equipment will reduce the risk of developing silicosis.

The basis for the prevention of silicosis is the maximum dedusting air environment production facilities and protection of personnel from harmful effects quartz dust. For this, developed whole complex technological measures:

mechanization of the production process;
use of remote control;
the use of various wetting solutions for dust precipitation;
effective ventilation system;
the presence of dust collectors;
usage individual means protection (special suits with clean air supply, respirators).

For timely detection initial stages silicosis at such enterprises, medical examinations are carried out with a frequency of 1 time per year.

Conclusion

Silicosis is one of those diseases that reduce the duration and reduce the quality of life of patients. However, not all of them proceed in the same way. Its course and tendency to progression is determined by many factors, including the presence of complications. To alleviate the condition of such patients can only be an early termination of contact with dust and the timely implementation of therapeutic and preventive measures.