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The purpose of development of this clinical practice guidelines was to provide evidence-based protocols that help the practitioner and the patient make the right decision for the health assessment, treatment and prevention of pneumoconiosis. Pneumoconiosis is the interstitial lung disease of occupational origin caused by prolonged inhalation of inorganic dust, characterized by chronic diffuse aseptic inflammation in lung tissue with the development of pulmonary fibrosis. Currently, thereare no treatment that provide a cure pulmonary fibrosis and changes in the dynamics of decline in lung function. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and some clinical symptoms of pneumoconiosis, as well as the prevention of complications. To enhance the effect of pharmacotherapy is recommended to use non-drug therapies that enhance the functionality of the respiratory system.

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The analysis of the applied in Russia classifications of pneumoconiosis and occupational hypersensitivity pneumonitis in relation to the international classifications of occupational lung diseases and the classification of interstitial lung diseases (ILD) was performed. The necessity of a new approach to the classification of occupational ILD was proved and solutions of the problem were offered.

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Results of operative conference of North-West Russia pulmonologists and occupational therapists were summarized and covered improvement of current list of occupational diseases. Resolution of the operative conference on the problem is presented.

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Nineteen patients with chronic obstructive disease of the lungs and 15 patients with chronic non-obstructive bronchitis of the dust etiology were examined for the purpose of investigating the rheological blood properties and of their interrelation with pulmonary hypertension. The hemorheological properties were evaluated by spontaneous aggregation of erythrocytes and thrombocytes. The control group comprised 8 healthy subjects. The results denoted that the rheological blood properties are to a great extent impaired in patients with dust bronchitis. The rheological blood properties worsened as hypertension of the small blood-circulation circle was increasing; it preceded the development of pulmonary hypertension in patients with chronic obstructive disease of the lungs. The aggregation changes appear to be primarily related with the functional state of thrombocytes in patients with chronic non-obstructive bronchitis; a concurrently higher aggregation of thrombocytes and erythrocytes was observed in patients with chronic obstructive disease of the lungs. The obtained data can be useful for designing a medicamental correction scheme of rheological impairments as a trend within the treatment of affected hemodynamics in the small blood-circulation circle in patients with duct bronchitis.

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The activity of neutrophilic elastase and the level of its major inhibitor--an alpha 1-inhibitor of proteinases were studied to evaluate the protease-antiprotease system in the bronchoalveolar lavage fluid (BALF) of patients with chronic dust-induced bronchitis (CDB) and pneumoconiosis (PC). It was found that CDB, as compared with PC, was characterized by a higher elastase activity in the BALF (70%) and that there were a larger number of patients with elastase activity (40%), which correlated with the detection rate of emphysema. Free elastase activity and relative proteinase alpha 1-inhibitor deficiency suggest that the BALF protease-antiprotease system is impaired in patients with CDB and PC, which is more pronounced in patients with CDB.

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X-ray examination of 36 patients with exogenic toxic alveolitis (ETA) has proved that ETA may run both in x-ray positive and x-ray negative forms which run with similar clinical manifestations. It is important in ETA diagnosis to measure pressure in the pulmonary artery and to examine pulmonary perfusion. In complicated cases it is recommended to conduct histological verification of the diagnosis in bronchial or open lung biopsy.

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The article represents data characterizing course of chronic bronchitis in 78 machinery workers subjected to toxic irritative and sensibilizing aerosols. Findings are early bronchial obstruction and pulmonary emphysema, frequent disorders of microcirculation and lesser circle perfusion, propensity to interstitial pulmonary fibrosis and lung hypertension. The results could serve as a base for pathogenetic therapy and necessitate to include COLD into Occupational Diseases Register.

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The study was undertaken to obtain additional data on the role of neutrophils in the pathogenesis of idiopathic pulmonary fibrosis (IPF). Various functional parameters of neutrophilic functional activity, i.e. phagocytosis, chemotaxis, random migration, oxidative metabolism (3 types of chemiluminescence: spontaneous formylmethionyl peptide-stimulated, and prodigiosan-stimulated), and the level of circulating immune complexes of different size were determined in patients with IPF and healthy individuals. The patients showed a decrease in phagocytosis and an increase in neutrophilic chemotaxis and oxidative metabolism, which was related to the output of toxic oxygen forms. The changes revealed were found to be associated with the activity of an pathological process. The findings suggest that neutrophils can be involved both in the development of and in the occurrence of a pathological process in IPF.

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Cytological and immunological investigations of bronchoalveolar lavage fluid (BLF) have been performed in 87, 27, 32 and 94 patients with fibrosing alveolitis (FA), exogenous allergic alveolitis (EAA), histiocytosis and pulmonary sarcoidosis (PS), respectively. The diseases appeared to demonstrate significant differences in BLF cell composition and relations between T-lymphocyte theophyllin-resistent and theophyllin-sensitive subpopulations. The findings can be applied in differential diagnosis of disseminated processes in the lungs. The number of neutrophils and the subpopulations correlation in FA and EAA may serve criteria of the disease activity and adequacy of the treatment administered.

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The results of mathematical treatment of the clinical and immunological parameters are analysed in 17 patients with sarcoidosis and in 17 with pulmonary histiocytosis X. Function of separation and clinical and immunological parameters which are most essential for differential diagnosis have been determined by the separation plane method. This work allows one to improve differential diagnosis and establish correct diagnosis of these diseases without resorting to invasive methods of examination.

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