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

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