Dusty bronchitis

Dust bronchitis is a disease of the bronchi, in which their diffuse damage does not occur due to infection, but due to mechanical or chemical effects on the mucous membranes of the bronchial tree of dust particles that are in the inspired air. This disease belongs to the category of professional and has a chronic form.

Professional dust bronchitis is most often diagnosed in miners in coal mines and ore quarries, in workers in the metallurgical and chemical industries, in the production of building materials, where production processes are associated with the grinding of materials and the ingress of a large amount of solid particles into the atmosphere. Work on textile, flour milling and woodworking enterprises differs from dustiness.

This disease has two etiological varieties: dusty bronchitis and toxic-dust bronchitis (in the presence of various toxic components in the dust).

[1], [2]

Causes of dust bronchitis

So, as can be seen from the very name of the disease, the cause of dust bronchitis is dust, that is, solid microscopic particles of different origin. The pathophysiological mechanism of affecting the bronchi looks as follows. When the air is inhaled, dust particles through the nasopharynx and the larynx enter the tubular airway branch system of the trachea - bronchi. The functional task of the bronchi consists not only in supplying air to the lungs and removing a mixture of gases from the respiratory system, but also in purifying the inhaled air.

The walls of the bronchi are covered with a mucous membrane consisting of ciliated (ciliated) epithelium, and in a deeper layer are glands producing mucus. Particles of dust settle on the cilia and villi epithelium, enveloped in mucus and removed by contracting the bronchial muscle plate - when a person coughs (and coughs up phlegm).

When the dust content in the air exceeds the physiological capabilities of the bronchi, dust settles on the cilia of the epithelium, reducing or completely blocking their contractions. This leads to dystrophy and sluschvaniyu whole sites of ciliated epithelium and functional frustration of the bronchi. In this case, the mucus that accumulates in the lumens of the bronchi becomes thicker and constantly irritates the nerve endings of the reflex zones of the bronchi. As a result, there is a cough.

A significant lesion of the bronchial mucosa prevents the timely removal of mucus, and it begins to cover their lumens. In clinical medicine, this is called obturation or obstruction of the bronchi and is often detected with a disease such as chronic dust bronchitis.

[3], [4], [5], [6], [7], [8]

Symptoms of dusty bronchitis

Clear classification of this pathology is not, but according to the typical signs of varying degrees of bronchial lesions, experts allocate chronic dust bronchitis of three degrees.

Symptoms of dusty bronchitis of the first (easy) degree:

• Overcome attacks of dry cough (sputum is very small, it is difficult to cough up);
• 1-2 times during the year there are exacerbations of prolonged periods of coughing;
• with considerable physical exertion, dyspnea may occur;
• In the course of auscultation of the bronchi with the help of a phonendoscope, more severe breathing is heard, at times - dry wheezes.

Symptoms of dusty bronchitis of the second (middle) degree:

• repeated repeated long coughing spells, accompanied by a slight separation of sputum;
• shortness of breath during normal physical activity;
• possibly a feeling of difficulty breathing and attacks of suffocation;
• listening to breathing fixes its stiffness and weakness, as well as the presence of wheezing in the lower part of the lungs;
• acceleration of exacerbations up to 3-4 times during the year;
• during an exacerbation the volume of a sputum increases (there can be an insignificant quantity of pus presence);
• changes in respiratory function with a reduction in the volume of forced expiration to 70-80%;
• a radiologic examination reveals a moderate change in the pattern of the lower sections of the lungs, a pathological thickening of the bronchial walls, a swelling of their mucous membrane, and a diffuse expansion of the air spaces of the distal bronchioles, which is characteristic of emphysema of the lungs;
• signs of the pulmonary heart (enlargement and expansion of the right heart).

Symptoms of dusty bronchitis of the third (severe) degree

• cough becomes permanent and productive (with phlegm);
• Shortness of breath is not only with minimal physical stress, but also at rest;
• a significant change in the pattern of the basal and lower parts of the lungs;
• there is an asthmatic syndrome and signs of perifocal pneumonia (focal non-inflammatory lung injury);
• diffuse pulmonary emphysema syndrome with obstruction (constriction or complete obstruction of certain areas of the bronchial tree);
• periods of exacerbation are frequent and last for a long time;
• respiratory function is significantly impaired (the volume of forced expiration is reduced to 50% or less), a decrease in oxygen in the blood (hypoxemia) to 85%;
• manifest signs of decompensated pulmonary heart (rapid fatigue, increased drowsiness, hyperhidrosis, pulsation at the top of the abdomen, pressing sensations in the chest, swelling of the cervical veins).

Symptoms of toxic-dust bronchitis

Toxic-dust bronchitis - as a kind of professional dust bronchitis - is complicated by the fact that in the inhaled air, besides dust, there are toxic substances such as formaldehyde, sulfur compounds, chlorinated hydrocarbons, ethylene glycol, nitrites, metal oxides, etc. Getting them on the mucous membrane of the bronchi leads to its irritation and inflammation.

Symptoms of toxic-dust bronchitis are expressed not only in coughing attacks, but also in the form of an increase in body temperature, pus in sputum, changes in the biochemical composition of the blood. In the process of inflammation of the bronchial mucosa their walls are deformed, the lumens narrow, and there may be scars that break the air passages into the lungs.

Diagnosis of dust bronchitis

Diagnosis of chronic dust bronchitis is based on a full history, taking into account all patient complaints and the nature of their professional activities. The following survey methods are used:

• general analysis of blood and urine;
• biochemical and bacteriological analysis of sputum;
• X-ray of the chest (bronchus and lungs in two projections, on exhalation and inspiration);
• spirography (the vital capacity of the lungs is established and recorded graphically);
• spirometry (the volume of the forced exhalation is determined);
• oxigemometry (the level of oxygen saturation of the blood is determined);
• Capnography (the pressure of carbon dioxide in the air filling the alveoli of the lungs is determined);
• pneumotachography (the degree of bronchial resistance and elasticity of lung tissue is determined);
• electromyography (bioelectrical activity of the respiratory muscles is determined);
• bronchography (with contrast medium);
• CT and MRI of the lungs.

In the process of diagnosis of dust bronchitis, it is necessary to exclude other pathologies of the respiratory system, in particular, the chronic form of pneumonia, pulmonary tuberculosis, malignant neoplasm (sarcoidosis, lymphogranulomatosis), diffuse fibrosing alveolitis, bronchiectatic disease, etc. Therefore, a differential diagnosis of dust bronchitis is very important. For this purpose, bronchoscopy is performed with simultaneous transbronchial biopsy of lung tissue and their histological examination, as well as puncture of the lymph nodes located at the roots of the lungs.

[9], [10], [11], [12]

Treatment of dust bronchitis

It should be noted that the treatment of dusty bronchitis is long and, first of all, is aimed at restoring the patency of the bronchi and removing their spasms.

Drug therapy of this disease involves taking medications to facilitate the allocation of sputum, that is, expectorants based on the herb of thermopsis, leaves of mother-and-stepmother, althea root or licorice - in the form of ready-made syrups, potions or homemade broths.

To improve sputum discharge in chronic dusty bronchitis, doctors prescribe alkaline inhalations: 100 ml of distilled or boiled water - 3 g of sodium bicarbonate and 1 g of sodium tetraborate and sodium chloride. Inhalation should be done several times a day (15-20 ml per procedure).

Acetylcysteine, Bisolvon, Ambroxol (Lazolvan), etc. Are used for the same purpose. Acetylcysteine (synonyms - ATSTS, Bronholizin, Mukobene, Tussicom, Fluimutsil, etc.) is prescribed to 0.2 g three times a day (or 0.6 g one time). Possible side effects in the form of nausea and vomiting, noise in the ears and urticaria. Contraindicated in severe bronchospasm, liver disease, kidney, adrenal dysfunction, gastric ulcer and duodenal ulcer in the stage of exacerbation, during pregnancy.

Bisolvon tablets (synonyms - Bromhexin, Solvin, Flegamine) for 0.008 g prescribed 8 mg 2 times a day for liquefaction of sputum. The drug can cause nausea and vomiting, as well as dyspeptic phenomena and exacerbation of peptic ulcer. A drug Ambroxol (synonyms - Lazolvan, Bronchoprot, Fluixol, Mukovent, Secretile, Viscocil, etc.) is taken to reduce the viscosity of sputum and its better removal from the bronchi - one tablet (30 mg) no more than three times a day (during food intake). Among its undesirable, but possible effects are nausea and vomiting.

To remove bronchial spasms with professional dust bronchitis, bronchodilators such as Teopec and Terbutaline are used.

The drug Teopheline (analogues - Theophylline, Theostat, Theotard, Retafil, Asmolept, Spofillin, Eufilong) not only broadens the lumens of the bronchi and reduces the tension of the respiratory muscles, but also activates the function of the ciliary epithelium of the bronchi. Dosage is determined by the doctor strictly individually, and the standard dose is: the first 1-2 days - half a tablet (0.15 g) 1-2 times a day (after meals, with an interval of 12 hours between meals); then 0.2-0.3 g twice a day. The course of treatment can last up to three months. Teopec is not prescribed for hyperthyroidism, myocardial infarction, heart rhythm disturbance, epilepsy. Among its side effects: dizziness, headache, nausea, vomiting, abdominal pain, tachycardia, anxiety, sleep and appetite disorders.

To the group of selective beta2-adrenostimulyatorov refers Terbutalin (synonyms - Brikanil, Arubendol, Spiralil, Terbasmin, Terbutol, Tergil, etc.), available in tablets of 2.5 mg. His doctors prescribe a pill twice a day. Contraindications to the use of this drug are dysfunction of the thyroid gland, tachycardia, infectious diseases of the uterus, chronic pyelitis. And possible side effects manifest in the form of palpitations and tremors.

Expand the clearance of bronchial blockers of M-holinoretseptorov. For example, Ipratropium bromide (synonyms - Atrovent, Vagos, Itrop, Arutropid, Normosecretol) is recommended by doctors for the treatment and prevention of respiratory failure in chronic dust bronchitis - 1-2 doses (1 dose - 0.02 mg ) three times a day. However, this drug causes dry mouth and increases the viscosity of phlegm. It should be used with caution for increased intraocular pressure (glaucoma) and impaired patency of the urinary tract in prostate cancer.

Treatment of dust bronchitis is carried out with the help of special respiratory gymnastics, increased oxygen pressure in the pressure chambers (by the method of hyperbaric oxygenation). A positive effect is provided by such physiotherapeutic procedures as electrophoresis with a solution of calcium chloride (on the chest), UHF currents and decimeter waves (per zone of the roots of the lungs), as well as short-wave diathermy on the area between the scapulae.

Prevention of dust bronchitis

The main prevention of dust bronchitis is the use of individual protective equipment (dust masks, petal masks, etc.) in dusty production. And the obligatory presence in the industrial premises of supply and exhaust ventilation and other means of collective protection of workers.

It is necessary to undergo preventive medical examinations on time, provided for the personnel of similar enterprises and industries.

Forecast for dust bronchitis

It should be borne in mind that dust bronchitis is a very serious disease, which is fraught with irreversible negative consequences. As it develops from stage to stage, the threat of the pulmonary heart makes the prediction of dust bronchitis very pessimistic. After all, as the size of the right ventricle of the heart increases and changes in large vessels of the small circle of blood circulation, dystrophic and even necrotic processes occur in the tissues of the heart muscle. Dust bronchitis of the third degree threatens with disability and disability.

[13], [14], [15], [16]