Diagnostic markers of exacerbation of chronic obstructive pulmonary disease in workers exposed to industrial aerosols and tobacco

Abstract

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the most common occupational diseases registered in workers exposed to dust for a long time. This disease significantly worsens the quality of life, requires constant monitoring in the centers of occupational pathology and regular preventive measures. The proportion of COPD in the structure of occupational diseases has not changed significantly for decades, high rates of disability and premature mortality characterized this disease. The study aims to research the diagnostic parameters of COPD exacerbation under the influence of industrial aerosols and tobacco in the clinic of occupational diseases. Materials and methods. Researchers examined 153 patients with occupational COPD (toxic gases and inorganic dust). The comparison group consisted of 103 patients with smoking COPD. We established the diagnosis of COPD in accordance with the criteria of GOLD 2011. The duration of the study was 5 years. The authors conducted a complex of clinical and laboratory studies in all patients with an emphasis on the diagnostic parameters of COPD exacerbation and lung function. The critical significance level is p=0.05. Results. The development of occupational COPD under the influence of industrial aerosols and tobacco affects the frequency and predominant phenotype of exacerbations. Rare but severe exacerbations, mainly with eosinophilic type of inflammation, are present in COPD from the action of toxic gases. They respond well to therapy with systemic GCS. With COPD from the action of dust, hospitalization is not necessary for short-term exacerbations with neutrophilic type of inflammation, since such exacerbations respond to therapy with bronchodilators, and a significant proportion of exacerbations require the use of antibacterial therapy. Also, in COPD from the action of toxic gases, the experience of exposure to aerosols and gases of the production environment is an independent predictor of any exacerbations. But we do not have data on the significance of the length of service and the intensity of dust exposure. Conclusion. The risks of exacerbations of occupational COPD and the predicted features of their course depend on the etiological production factor, its intensity and duration of exposure. Clinical features determine different tactics of treatment and prevention of health deterioration. With the severity of COPD exacerbation from the action of toxic gases, symptoms of emphysema and hypoxemia are characteristic, with COPD from the action of dust, symptoms of bronchial obstruction, emphysema and hypoxemia are characteristic. Obtained results can use to construct risk meters of exacerbations and the scale of effectiveness of rehabilitation measures, to revise the standards of treatment and prevention of patients with COPD of professional genesis, as well as for the differential diagnosis of occupational obstructive pulmonary disease. Limitations. The study was conducted on the basis of Novosibirsk State Medical University and on the basis of the City Clinical Hospital No. 2. The limitations of the study may be the unidirectionality of the study performed and the small sample of patients participating in the research. Ethics. All patients have signed an informed consent form. The study program, the content of the informed consent, and the materials of the article were approved by the local ethics committee of Novosibirsk State Medical University and City Clinical Hospital No. 2.