Bài giảng Bệnh phổi nghề nghiệp - PGS.TS.BS. Lê Hoàng Ninh

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Bài giảng Bệnh phổi nghề nghiệp do PGS.TS.BS. Lê Hoàng Ninh biên soạn bao gồm những nội dung về lịch sử Y học nghề nghiệp; những nguyên lý trong bệnh phổi nghề nghiệp; hơi chất độc; suyễn/hen nghề nghiệp; viêm phế quản xí nghiệp. Mời các bạn tham khảo.

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Nội dung Text: Bài giảng Bệnh phổi nghề nghiệp - PGS.TS.BS. Lê Hoàng Ninh

BỆNH PHỔI NGHỀ NGHIỆP GS TS BS Lê Hoàng Ninh
Tóm tắt lịch sử y học nghề nghiệp • Thời Cổ đại • Thời trung cổ ( Middle Ages) • Thời Ramazzini (1633-1714) • Thời cách mạng công nghệ ( Industrial Revolution ) • Thời đại mới ( hiện nay)
Thời cổ đại • Major economic activities included agriculture, mining for metals, and quarrying. • Pliny the Elder (AD 23-79) recorded the danger to miners from inhalation of fumes and vapors • Because mining was so dangerous, it was considered suitable only for slaves and as punishment for criminals.
Thời trung cổ • The Erz Mountains in Bohemia was an important area for the mining and refining of useful and precious metals. A physician named Agricola became the town physician of Joachimsthal. • He recognized that mining activities could lead to conditions that caused chronic shortness of breath. • Agricola was probably observing silicosis and tuberculosis
Thời Ramazzini • He published De Morbis Artificum Diatriba in 1700 (Treatise on the Diseases of Workers). He describes: • Dyspnea and metal poisoning in miners • Bronchitis from irritant fumes • Lung fibrosis in potters • Asthma from exposure to corn &flour • Silicosis in stonemasons
Ramazzini • “When a doctor visits a working class home he should be content to sit on a three-legged stool, if there isn’t a guilded chair, and he should take time for his examination; and to the questions recommended by Hippocrates, he should add one more – what is your occupation?”
Ramazzini • “Medicine, like jurisprudence, should make a contribution to the well-being of workers, and see to it that, so far as possible, they should exercise their callings without harm. So I for my part have done what I could and have not thought it unbecoming to make my way into the lowliest workshops and study the mysteries of the mechanic arts.”
Thời Cách Mạng Công Nghệ • Production of steel on an industrial scale. • Increased coal mining to make coke • Fabrics are made in factories from cotton and wool thanks to new machinery. • Charles Turner Thackrah, a town doctor, reported his observations on lung disease in miners and metal grinders and described a new method of measuring lung volume.
The Industrial Revolution Continued • Britain institutes Workmen’s Compensation Acts. • As of 1897, injured workers had rights to compensation from compensation from contributions paid by employers. • Silicosis (1919) and Asbestosis (1931) were later recognized and covered.
Thời Công Nghệ Mới • E.R.A. Merewether (1892-1970) established the danger of asbestos and promoted the first legislation to control it. • Late 19th century, occupational lung cancers are described in miners. • Allergic alveolitis is described in 1932 • Berylliosis is described in Germany in 1933 • 1970, Congress passes OSHA legislation.
Những nguyên lý trong bệnh phổi nghề nghiệp • Industrial processes change and become increasingly complex. • We should anticipate the appearance of a wider range of potentially toxic substances in the air. • It is unlikely that the lung will develop many new ways to react to inhaled substances. • We’ll see old lung diseases with new causes
Induction Periods • Ngắn: – Asthma – Infections – Allergic alveolitis – Toxic poisonings • Dài: – Pneumoconioses – Neoplasms
Lich sử nghề nghiệp • All jobs held in their lifetime and the duration. • Do symptoms improve with weekends and vacations? • The longer they have had symptoms from occupational asthma, the less clear the connection between symptoms and work • What they did, not their title: – “brusher” drills into hard rock – “caulker” uses electric arc equipment to gouge and fuse metal plates
Lịch sử nghề nghiệp • Toxic exposures can produce airway symptoms or an alveolitis. • If everyone in the workplace is affected in a dose-dependent manner, the etiology is likely to be toxic rather than immunologic. • Toxic reactions can occur on the first exposure. Immunologically-mediated diseases require re-exposure
Hơi Chất độc • Asphyxiating gases displace oxygen in the alveolus, on the hemoglobin molecule, or prevent oxygen utilization by the cytochrome • Irritants are noticed quickly by the patients and create symptoms proximally to distally. (chlorine and ammonia) • Toxins that attack the alveolar membrane (phosgene and nitrogen dioxide)
Suyển/ Hen Nghề Nghiệp • Symptoms usually begin several weeks after exposure begins. • Early in the syndrome, the patient may just notice a dry cough. • Patient may not be continuously exposed to provoking antigen. • A portable peak-flow meter and a diary is very helpful in determining if a work-place antigen is responsible
Viêm Phế Quản Xí nghiệp (Industrial Bronchitis ) • Identical symptoms to chronic bronchitis seen with cigarette smoking • Coal workers • Grain Workers • Most non-smokers do not have a decrement in FEV 1.0
Hypersensitivity Pneumonitis • An inflammatory, immunologically mediated response at the alveolar and bronchiolar level to organic particles or gases. • Acute, persistent, and subacute-recurrent forms of the disease.
Acute HP • Fever, muscular aches, and malaise 4-8 hours after exposure to the antigen. • May be associated with dry cough or chest tightness. • Shortness of breath is a feature of a severe attack. • Symptoms peak 8-12 hours after exposure and improve over the next 12-24 hours.
Persistent HP (acute) • An atypical pneumonia picture with bilateral infiltrates on CXR, hypoxemia, and rales. • May return to hospital within days after “improving” on antibiotics.