Особенности обострений профессиональной хронической обструктивной болезни легких в условиях воздействия аэрозолей, содержащих наночастицы

Abstract

Abstract. Phenotypes of exacerbations of occupational chronic obstructive pulmonary disease (COPD) due to aerosols containing nanoparticles is not studied enough. The objective was to establish rate, severity, cellular type of inflammation, clinical features of acute exacerbations of occupational COPD due to industrial aerosols containing nanoparticles exposure. Materials and methods. A prospective observational study of 50 subjects with occupational COPD (of which 26 due to aerosols, containing metal nanoparticles and 24 due to aerosols containing silica nanoparticles) and of 50 subjects with COPD due to tobacco smoke performed. Follow up period was 26 (24; 30) months. Groups were matched by age, gender, COPD duration. Groups of occupational COPD has the same smoking status. Nanoparticles and dust concentrations at workplaces air were measured by inductively coupled plasma atomic emission spectrometry and by scanning electron microscopy. COPD exacerbations rate and severity, cellular type of inflammation during exacerbations were investigated. Relationships were assessed by Cox proportional-hazards regression. Results. Occupational COPD due to aerosols containing metal nanoparticles exposure was characterized by high exacerbation rate. In comparison to occupational COPD due to aerosols containing silica nanoparticles exposure the hazard ratio (HR) was 4,59, 95% CI 1,35–15,63, in relation to COPD in tobacco smokers HR was 3,35, 95% CI1,22 – 9,21. The risk of exacerbations requiring hospitalization also was higher in this group, HR 4,35, 95% CI 1,10-12,3 and HR 3,90, 95% CI 1,33–11,42, respectively. In occupational COPD due to aerosols containing silica nanoparticles the exacerbation rate was the least. Metal nanoparticles mass concentration at the workplace air was associated with COPD exacerbations HR 1,031, 95% CI 1,012–1,11, exacerbations requiring hospitalization HR 1,028, 95% CI 1,010–1,092 and with eosinophilic inflammation during COPD exacerbation ОР 0,015, 95% CI 0,002 – 0,036. Silica nanoparticles mass concentration was associated with COPD exacerbations HR 0,025, 95% CI 0,003–0,094, exacerbations requiring hospitalization HR 0,021, 95% CI 0,009–0,105 and with neutrophilic inflammation during COPD exacerbation HR 1,019, 95% CI 1,008–1,057. Exacerbations of occupational COPD due to aerosols containing nanoparticles exposure had higher rate of respiratory support and excess length of hospital stay. Conclusion. Occupational COPD exacerbations are associated with chemical composition and mass concentration of nanoparticles in industrial aerosols