Pneumokoniosis

In the second half of the 17th century, the Italian physician Ramazzini produced an internationally recognised standard work on the occupational diseases that were important at the time, which was translated into 5 languages.

In 1775 in England, Pott was the first to prove a connection between occupational activity and cancer in chimney sweeps (Buchter 1986).

In 1860 Greenhow pointed out the so-called Monday symptoms in flax workers (Ulmer 1976).

The term "pneumoconioses" was first used by Zenker in 1867 (Hoffmeyer2007).

In Germany, Baader founded the first clinical department for industrial diseases in Berlin in 1914 (Buchter 1986).

Pneumoconioses are diseases of the lungs caused by inhalation of inorganic dusts. Diseases of the lung caused by organic dusts are - according to the original definition - not included (Herold 2018).

Pneumoconioses are divided into:

• Active pneumoconioses: these include inhalations of quartz dust (silicosis), of asbestos dust (asbestosis), of berylium dust or fume (berylliosis), and of aluminum dust (aluminosis), among others.
• Inert pneumoconioses have no significant disease value; these include, for example, dust inhalation of iron

Pneumoconiosis is still one of the most common occupational diseases leading to disability (Herold 2018).

As early as 1928, Ickert showed that the incidence of pneumoconiosis depends on the age of the patient. He found an incidence of pneumoconiosis ranging from 40.3% (occupational age 0 - 5 years) to 100% (occupational age 30 - 35 years) (Ickert 1928).

Pneumoconiosis results from inhalation of dusts that are less than 5/1000 mm in size or from vapors:

Fibrinogenicdusts such as.

• Asbestos
• Quartz
• Beryllium
• Talcum
• Hard metal
• Kaolin
• Aluminum
• Mixed dusts (dental laboratory)

Toxic dusts such as:

• Aluminum
• Beryllium
• Cadmium
• Zinc
• Chromium IV compounds
• Cadmium
• Manganese
• Arsenic
• Nickel
• Thomas slag
• Vanadium pentoxide
• Dust from cotton, flax and hemp
• Dust from various exotic woods

Allergenic dust (so-called mold-containing dust); this can lead to illnesses that often go under the collective term "extrinsic allergic alveolitis" (Thomas 1996):

• Grain
• Hay
• Mushroom compost
• Cheese
• Sugar beet residue
• Fungal spores from humidifiers
• Bird dung
• Tea and coffee dust
• Cork dust (cork dust lung)

The following factors must be present for pneumoconiosis to develop.

Physical conditions are:

• Sedimentation
• Diffusion

Chemical prerequisites are:

• Substances such as quartz have a very pronounced fibrinogenic effect; with other substances such as coal, iron deposit without reaction (so-called inert substances)

Reaction of the host:

• Clearancerate
• Immunological factors

Symptoms of pneumoconiosis usually only develop at an advanced stage. The difference between the relatively minor subjective symptoms and the considerable X-ray findings is then striking.

Complaints can occur:

• chesty cough
• Dyspnea at rest
• Exercise dyspnea

In the late stage, a cor pulmonale - with the corresponding symptoms - can occur. In addition, there is a significantly increased risk of developing carcinomas (especially with asbestos exposure) and tuberculosis (especially with silicosis) (Thomas 1996).

X-ray findings

Multiple, variably sized shadows (usually between 1- 10 mm in size) are found on the radiograph of the thorax. These shadows show a uniform density.

The radiological changes are divided into (Thomas 1996):

• Grade 1: fine reticular lung pattern.
• Grade 2: dense foci (so called snow flurries)
• grade 3: conglomerate nodules with perifocal emphysema

Lung function

Initially, a predominantly restrictive or predominantly obstructive dysfunction is found in the lung function.

In the later stages, a chronic nonspecific respiratory syndrome (CURS) is seen (Thomas 1996).

The manufacture and use of asbestos was banned at the beginning of 1994 when the Ordinance on Hazardous Substances of 26.10.1993 came into force (Büttner 2004).

Occupational health and safety conditions are the most important precaution when dealing with inorganic and/or organic dusts. This includes the use of technical aids such as filtering the room air by using dust extractors or humidifying the room air etc.

Only if these measures do not lead to the desired success should personal dust protection with the aid of masks and the use of respiratory protection equipment be used as the ultima ratio, since these measures are sometimes not used or changed due to certain stresses on the wearer (e.g. high respiratory resistance, weight, skin irritation, impaired vision, poor communication possibilities, etc.) (Ulmer 1976).

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2. Büttner J U (2004) Asbestos in pre-modern times - from myth to science. Waxmann Publishing House S 262
3. Gerok W et al (2007) Internal medicine - reference work for the medical specialist. Schattauer publishing house S 434-
4. Herold G et al (2018) Internal Medicine. Herold Publisher S 395
5. Hoffmeyer F et al (2007) Pneumoconioses. Pneumology (61) Georg Thieme Publisher S 774-797
6. Ickert F (1928) Staublung and Staublung tuberculosis Springer Verlag 32
7. Müller-Quernheim J et al (2003) Interstitial lung diseases - standards in clinic, diagnostics and therapy. Thieme Publishing House SS 141-148
8. Thomas C et al (1996) Special pathology. Schattauer Publisher 109
9. Ulmer W T et al (1976) Pneumoconioses. Springer Publishing House SS 57-67