Professional bronchial asthma
Occupational Diseases / / August 12, 2017
Bronchial asthma - the most typical and severe allergic disease of the respiratory system.Pathological and pathophysiological basis of bronchial asthma - bronchial obstruction caused by allergic inflammation (swelling of the bronchial mucosa and bronchioles, reflex bronchoconstriction, increased secretion of glands).
main direct cause of the disease is a specific allergen sensitizer.However, the resolution can be different factors exogenous and endogenous effects, and other allergens.A significant role in asthma development of the nervous system plays.Great importance is attached to the infection.
Distinguish primary (atonic) asthma that occurs under the influence of certain external allergen, and a secondary (non-atopic, infectious-allergic), which is a consequence or complication of a chronic, often infectious, diseases of bronchopulmonary apparatus.
During asthma distinguish two steps: I stage monoallergii when the patient is sensitized to only one specific agent and stage II, when the strict spec
Professional asthma allocated on etiological principle, when the disease develops under the influence of a particular occupational hazard, which has sensitizing capacity - the production of allergen.These factors, with which the person is in contact in their professional activities, are extremely numerous and varied: chemical compounds (pesticides, Ursol, beryllium, chromium), a number of pharmaceutical preparations (the root of ipecac, Tifen, vitamins), some cereals and industrial crops (cotton,flax et al.), yeast and mold fungi, antibiotics and many others.Therefore, occupational asthma is found in representatives of various professions.Allergens enter the body by inhalation in the form of fumes, dust and vapors.In rare cases, it may be received through the mouth (for example, tea tasters) or through intact skin (from the workers cosmetic surgeries).
«Home» allergens can also play the role of occupational factors, such as pollen from the flower girls.If the allergen has a pronounced sensitizing effect, bronchial asthma under adverse working conditions can be massive (eg, in contact with Ursol).If the sensitizing effect is less pronounced, clearly advocates the role of the original individual reactivity and bronchial asthma in the profession are sporadic.
Primary occupational asthma arises under the influence of a specific allergen production at the experience from a few to several years beadle, mostly between 2.5 and 4 years.Characterized paroxysmally developing suffocation.The first attack of asthma is often preceded by allergic rhinitis and other allergic manifestations, but the attack may develop on the background of full health.
For the first occurrence of asthma attacks characterized by an attack on the job, or shortly thereafter.There have been acute lung swelling, difficult breath, wheezing, dry high tone, decreased lung capacity and a violation of their ventilation function (maximum ventilation, index Tiffno, pneumotachometry indicators).In the blood - slowing down blood coagulation, thrombocytopenia, leukopenia, eosinophilia, etc. Changes in protein composition of blood:. Albumin decreases and y-globulins - increases.The attack can last several hours.After an attack occurs sputum.In sputum - eosinophils, allergic inflammation elements (crystals Charcot - Leyden, Kurshmana spiral).Seizures may be exacerbated in the premenstrual and menstrual period, triggered by cooling, physical activity, or in any other internal or external stressor.
flow is very variable.In some patients the appearance of typical asthmatic attacks preceded the current long-term bronchitis.Asthma can start much later, sometimes after years.In the future, with continued exposure to the allergen attacks are repeated, become heavier, lighter shorter intervals.In the long process is complicated by severe obstructive bronchitis or pneumonia, emphysema, pneumosclerosis, pulmonary and cardiopulmonary failure.Gradually lost the original is a clear link with the work of suffocation.
secondary occupational asthma develops at greater length of service, as a consequence or complication of any preceding the occupational disease bronchopulmonary apparatus, and usually takes place on the background of the disease (or toxic dust bronchitis, pneumoconiosis, chronic pulmonary fibrosis, etc.).In the secondary development of asthma sensitizing role airways infection.Attacks often occur at night, deterioration is seasonal.
Many industrial allergens, along with a sensitizer, and have irritating (Ursol, chromium, ammonium persulfate, etc.) And can cause both primary and secondary asthma.The establishment of a professional nature of asthma presents certain difficulties, especially during parallergii when a clear link with professional allergen lost.
Diagnostic criteria of occupational asthma are:
1. Availability of contact with the allergen in a production environment.
2. The development of the disease during this contact, a clear chronological relationship of the first attacks of breathlessness work.
3. The presence of the latent period, the length of which depends on the degree of exposure to the allergen and the individual reactivity.
4. Significant improvement in the condition of patients, and even complete cessation of attacks during breaks in work (at the beginning of the disease), the resumption of attacks of breathlessness when returning pas work in the same conditions.
5. The combination of bronchial asthma with extrapulmonary allergies (dermatitis, rinopatiya, et al.).
6. Clinical recovery in full and constant contact with the termination of a professional allergen.
7. The presence of similar diseases in other working of production.
8. Positive results provocative diagnostic tests (skin tests and nasal, inhalation test).
9. These specific Allergic diagnostics.
should be emphasized that the tests confirm the positive professional etiology of asthma, but negative test results themselves do not allow to reject it.
diagnostic criterion of secondary vocational asthma is the recognition of the professional nature of the prior chronic bronchopulmonary disease (chronic bronchitis, dust or toxic etiology, etc.).
professional treatment of asthma based on the same principles as the treatment of asthma of other etiologies (bronchodilators, expectorants, desensitizing and anti-inflammatory drugs, including corticosteroids, physiotherapy, antibiotics, cardiac, cytostatics, and oksigeno-aeroionotherapy, physiotherapy, spa treatment and so forth.).
disability When primary bronchial asthma for a full recovery is sufficient to eliminate contact with the allergen (the rational employment - are counter-contact sensitizing, irritating and toxic substances, adverse weather conditions).If necessary - disability group III for a period of retraining.With frequent attacks, poorly amenable to therapy, as well as secondary asthma, when after the termination of seizures can subside in frequency and intensity, but the underlying disease remains, usually holds persistent limitation or disability (disability group III or II).The nature of professional disability.
Compliance with sanitary requirements for working conditions as regards the possible admission of the allergen into the air, and to other factors of production (fumes, dust, weather conditions).
Avoid pas work in contact with allergens persons suffering from any allergic disease, having in the anamnesis of such diseases or a family history of allergies.Identifying people with latent allergy and dynamic observation.