Asbestosis

Asbestosis Pulmonary fibrosis caused by asbestos inhalation is called asbestosis. Pneumonicoza is the general term for diseases of the lungs caused by inhaling mineral powders and storage. Asbestoza is a chronic inflammatory medical condition affecting the parenchymal tissue of the lungs caused by the inhalation and retention of asbestos fibers. Usually occurs during or after exposure to vacuum large quantities of asbestos fibers and is an occupational disease. Patients may experience severe dyspnea and are at increased risk of developing certain cancers including lung cancer and mesothelioma. Signs and symptoms of asbestosis do not manifest until after a waiting period, a few decades. The main symptom is installing a Dyspnoea, especially on exertion. Advanced cases of asbestosis may lead to respiratory failure. Rales are heard on auscultation. There is no cure for this disease. Oxygen therapy at home is often necessary to relieve symptoms and to correct hypoxia. Supportive symptomatic treatment includes respiratory physiotherapy to remove secretions from the lung through postural drainage, chest percussion and vibration application. Medication may be prescribed nebulizers to humidify secretions and chronic obstructive pulmonary disease to treat. Indicate annual immunization for influenza and pneumococcal pneumonia. Patients should be aware that they are at risk of developing cancer, and smoking cessation is recommended. Pathogenesis Asbestos fibers are long and thin, the curved or straight. Curved fibers are called serpentine and amphibole righteous. Scientists recognize five different amphibole: amositul, antofilitul, tremolite, and crocidolite actinolitul. Chrysolite is by far the most common type of asbestos fiber produced in the world. Production and use of asbestos has increased greatly in the years 1877 and 1967. In 1930 and 1940 scientists have recognized a link between exposure to asbestos and asbestosis. In 1950 it was established that asbestos is a predisposing factor for bronchogenic carcinoma and malignant mesothelioma. Cumulative dose of inhaled fibers over a period of time and type, durability and size of fibers influence carcinogenic and fibrogenicitatea. Asbestosis incidence varies with the cumulative dose of inhaled fibers, the higher the dose is increased by both increasing the risk of asbestosis. All types of asbestos fibers in the lungs are fibrogenice. Amfibolele in particular are more carcinogenic to pleura. Fiber diameter less than 3 micrometers are fibrogene because they can penetrate cell membranes. Than 5 micrometer long fibers are incompletely phagocytosed and remain in the lungs, releasing cytokines. Initial bifurcation occurs alveolar inflammation and is characterized by the influx of alveolar macrophages. Asbestos-activated macrophages produce a variety of growth factors including fibroblast proliferation interacting with fibronectin. Oxygen free radicals are then released by macrophages, lezind proteins and lipid membranes and supports the inflammatory process. Individuals may differ in succeptibilitatea to asbestos cleaning fucntie of pulmonary and other factors still unidentified. People who smoke have an increased risk of asbestosis due to alteration mucociliare cleaning of asbestos fibers. Signs and symptoms Due to the development depending on the dose asbestosis symptoms appear only after a latent period of over 20 years. Latent period may be shorter after intense exposures. Dyspnea on effort is the most common symptom and worsens as the disease progresses. Patients may have a nonproductive cough. A productive cough or bronchitis suggests concomitant respiratory infection. Patients may exhibit nonspecific chest discomfort, especially in advanced cases. Physical examination: Rales are the most important signs during patient examination. They are persistent and are described as dry and fine rales cellophane. Are best heard at the lung inferior posterior and lateral areas. Initially finally listen to the inspiration phase. However, in advanced cases rales may be heard during the entire inspiratory phase. Occasionally this rales precedes radiographic lung abnormalities and the respiratory tests. Rales may be absent in one third of patients. Digital clubbing is seen in 42% of cases. It is not associated with disease severity. Excursions advanced cases cost reduction correlates with restrictive respiratory impairment and reduced vital capacity. In advanced cases, patients may experience the following signs associated with pulmonary heart: cyanosis, jugular venous distension, pedal edema and reflux hepatojugular. Diagnosis Laboratory studies: The diagnosis of asbestosis is made in the presence of three characteristics: exposure to asbestos with a latent period, evidnetierea fibrosis by radiographs, physical examination and tests of specific respiratory capacity affected with or without biopsy or bronchoalveolar lavage with evdentierea fibers. Imaging Studies: Chest radiograph shows infiltrates reticulonodulare observed especially in the lungs. The diagnosis of asbestosis requires multiple elements, radiography is positive prodictiva modest value. When combined with abnormal signs (rales) and respiratory fucntiei test abnormal, positive predictive value increases. Bilateral pleural thickening can be observed. A calcified plaque located in the diaphragmatic pleura is an indicator of exposure to asbestos but not diagnostic. Other locations of asbestos tiles 9 ribs bilaterally. Pleural adhesions rarely cause peripheral atelectasis with rounded edges that can simulate a lung tumor. In advanced stages of the disease of honey-combs appear cystic spaces by merging interstitial infiltrates and small lung fields. Computed tomography is useful in defining pleural abnormalities (effusion, thickening, plaques, malignant mesothelioma, rounded atelectasis) and evidence of parenchymal density which is suggestive of bronchogenic carcinoma. Respiratory tests: diffusion capacity reduction may precede changes in lung volume. The first sign is abnormal physiological hypoxemia during exercise. Total lung capacity is reduced as asbestosis and other restrictive diseases. Using spirometry vital capacity seems reduced. Oximetry-oxygenation assessment is important because hypoxemia uncorrected cause pulmonary hypertension and cor pulmonale. It will measure lung gas. Bronchoalveolar lavage in the diagnosis asbestosis has limited applications. Is useful in identifying infections diffuse infiltrates that simulate bronchogenic carcinoma diagnosed asbestosis and. Can provide qualitative information on asbestos fibers. Fibre optic bronchoscopy is performed to facilitate lavage. It is indicated for respiratory examination when radiological studies are suggestive of bronchogenic carcinoma. Transbronhoscopica lung biopsy is not recommended for the diagnosis of asbestosis. Histological examination: diagnosis of asbestosis and asbestos body requires visualization of fibrosis in electron microscopy. Corpus of asbestos fibers asbestos develop-shirt ferritin protein and a characteristic aspect of the boat. These alone are not diagnostic of disease as they are discovered occasionally in healthy individuals. Differential diagnosis is made with the following conditions: silicosis, sarcoidosis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, dermatomyositis, collagen vascular disease. Treatment Expuenrii control asbestos in the workplace is the most effective way to prevent asbestosis. Cessation of exposure once the diagnosis is made is imperative as exposure increases the rate of progression. However the disease can progress and outside exposure. Smokers must stop smoking cigarettes. Treatment includes treating the infection and immunization against influenza and pneumococcal pneumonia. Will be prompt antibiotic treatment when lung infections. It will assess the status of oxygenation in resting and exercising. If the test detects hypoxemia at rest or additional effort will prescribe oxygen. Drugs are not effective in treating asbestosis. Corticosteroids and immunosuppressants do not change course. Prognosis: Asbestosis can cause pulmonary hypertension, cor pulmonale, right heart failure. Progressive respiratory failure cumulative risk factors depending on the amount of asbestos inhaled, degree of dyspnea, smoking cigarettes, impaired lung and pleura, honey combs visible on X-rays and the large number of cells in bronchoalveolar lavage imflamatorii. Risk of lung cancer is high in these patients, and mesothelioma, a cancer of the esophagus, biliary system and kidneys.